- Email: [email protected]
Avoidable waste in the production and reporting of evidence
Correspondence
2 For the HINARI initiative see http://www.who.int/hinari/en
3
Hopkins D, Richards F, Katabarwa M. Whither onchocerciasis control in Africa? Am J Trop Med Hyg 2005; 72: 1–2. Amazigo U, Boatin B. The future of onchocerciasis control in Africa. Lancet 2006; 368: 1946–47.
Avoidable waste in the production and reporting of evidence Iain Chalmers and Paul Glasziou (July 4, p 86)1 indicate that the causes and degree of research waste occur in four sequential stages. But from our point of view, another very important factor we should consider is the affordability of access to published research articles. How much research is wasted because those who might benefit from it cannot afford to see its results? In recent years, journal prices have increased far faster than the underlying rate of inflation,2 and the number of free medical research papers is very small. Only 25% of systematic reviews and 18% of metaanalyses are thought to be free in
See Articles page 796
Medline, and about 75% of all medical journals are not free in any way.3 The HINARI programme, set up by WHO jointly with major publishers, enables developing countries to gain access to one of the world’s largest collections of biomedical and health literature, but it misses out Brazil, China, India, and Indonesia, the total population of which accounts for 40% of the world. In China, the largest obstacle for doctors and researchers trying to keep up with scientific advances in medicine is the lack of access to the latest full-text articles.4 The best available evidence, a treasury of medical research, is privately owned and sold only to those who can afford it. This could be the greatest prodigality of all. If we want to achieve the objective that “all cost effective treatments should be free”, as advocated by Archie Cochrane 70 years ago,5 we should first achieve the objective that all best evidence should be free.
Evidence-based Medicine Center of Lanzhou University, School of Basic Medical Science of Lanzhou University, Lanzhou 730000, China 1
2 3
4
5
Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet 2009; 374: 86–89. Delamoth T, Smith R. Open access publishing takes off. BMJ 2004; 328: 1–3. Chen Y, Du L, Ai C, Li Y. Open access for best evidence in the era of globalization. 16th Cochrane Colloquium, Freiburg, Oct 3–7, 2008: 39–40. Du L, Chen YL, Wang MS, et al. Cognitive attitude of medical paper writers toward open access of medical journals—a survey based on authors of Chinese Journal of Evidence-based Medicine. Chin J Sci Tech Periodical 2009; 20: 252–55. Cochrane AL. Effectiveness and efficiency: random reflections on health services. London: The Nuffield Provincial Hospitals Trust, 1971.
We declare that we have no conflicts of interest.
Yao-long Chen, *Ke-hu Yang [email protected]
Department of Error Lennox JL, DeJesus E, Lazzarin A, et al, for the STARTMRK investigators. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatmentnaive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet 2009; 374: 796–806—In this Article, the first sentence of the seventh paragraph in the “Results” section (p 802) should have read: “Fewer laboratory-associated adverse events were recorded in patients on raltegravir than on efavirenz, but the difference was not significant (table 3)”. The final sentence of the footnote to table 4 (p 802) should have read: “Consequently, the 19 patients who developed rashes (generalised, macular, papular, maculopapular, or otherwise unspecified rash) were not recorded”. The concentration of fasting triglycerides for toxic effect in table 5 (p 802) should have been >8·48 mmol/L. Finally, there were some errors in table 6 (p 803). A revised version is shown below with changes underlined. Mean concentration at baseline (mmol/L)
Mean concentration at week 48 (mmol/L)
Change in mean concentration (mmol/L)
Raltegravir group Efavirenz group
Raltegravir group
Raltegravir group Efavirenz group
Total cholesterol
4·13 (0·91)
4·03 (0·99)
4·39 (0·89)
4·89 (1·20)
0·26 (0·75)
0·85 (0·87)
<0·0001
HDL-cholesterol
0·99 (0·33)
0·98 (0·29)
1·10 (0·28)
1·24 (0·36)
0·11 (0·22)
0·26 (0·28)
<0·0001
LDL-cholesterol
2·51 (0·82)
2·39 (0·79)
2·66 (0·78)
2·83 (0·98)
0·15 (0·64)
0·42 (0·75)
0·0002
Total cholesterol/ HDL-cholesterol ratio
4·45 (1·39)
4·38 (1·43)
4·18 (1·20)
4·25 (1·67)
–0·27 (1·14)
–0·14 (1·39)
0·2924
Triglycerides
1·41 (0·83)
1·54 (1·39)
1·38 (0·92)
1·96 (2·17)
–0·03 (0·92)
0·42 (1·46)
<0·0001
Efavirenz group
p value*
Data are mean (SD). *p values are for difference in change from baseline between treatment groups. Tests of significance were done by ANCOVA with terms for baseline lipid concentration and treatment. The last-observation-carried-forward method was used for missing data when the value was absent because of increased lipid concentration (eg, after lipid-lowering drug had started or dose was increased).
Table 6: Changes in lipid concentrations from baseline to week 48
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www.thelancet.com Vol 374 September 5, 2009
2 For the HINARI initiative see http://www.who.int/hinari/en
3
Hopkins D, Richards F, Katabarwa M. Whither onchocerciasis control in Africa? Am J Trop Med Hyg 2005; 72: 1–2. Amazigo U, Boatin B. The future of onchocerciasis control in Africa. Lancet 2006; 368: 1946–47.
Avoidable waste in the production and reporting of evidence Iain Chalmers and Paul Glasziou (July 4, p 86)1 indicate that the causes and degree of research waste occur in four sequential stages. But from our point of view, another very important factor we should consider is the affordability of access to published research articles. How much research is wasted because those who might benefit from it cannot afford to see its results? In recent years, journal prices have increased far faster than the underlying rate of inflation,2 and the number of free medical research papers is very small. Only 25% of systematic reviews and 18% of metaanalyses are thought to be free in
See Articles page 796
Medline, and about 75% of all medical journals are not free in any way.3 The HINARI programme, set up by WHO jointly with major publishers, enables developing countries to gain access to one of the world’s largest collections of biomedical and health literature, but it misses out Brazil, China, India, and Indonesia, the total population of which accounts for 40% of the world. In China, the largest obstacle for doctors and researchers trying to keep up with scientific advances in medicine is the lack of access to the latest full-text articles.4 The best available evidence, a treasury of medical research, is privately owned and sold only to those who can afford it. This could be the greatest prodigality of all. If we want to achieve the objective that “all cost effective treatments should be free”, as advocated by Archie Cochrane 70 years ago,5 we should first achieve the objective that all best evidence should be free.
Evidence-based Medicine Center of Lanzhou University, School of Basic Medical Science of Lanzhou University, Lanzhou 730000, China 1
2 3
4
5
Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet 2009; 374: 86–89. Delamoth T, Smith R. Open access publishing takes off. BMJ 2004; 328: 1–3. Chen Y, Du L, Ai C, Li Y. Open access for best evidence in the era of globalization. 16th Cochrane Colloquium, Freiburg, Oct 3–7, 2008: 39–40. Du L, Chen YL, Wang MS, et al. Cognitive attitude of medical paper writers toward open access of medical journals—a survey based on authors of Chinese Journal of Evidence-based Medicine. Chin J Sci Tech Periodical 2009; 20: 252–55. Cochrane AL. Effectiveness and efficiency: random reflections on health services. London: The Nuffield Provincial Hospitals Trust, 1971.
We declare that we have no conflicts of interest.
Yao-long Chen, *Ke-hu Yang [email protected]
Department of Error Lennox JL, DeJesus E, Lazzarin A, et al, for the STARTMRK investigators. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatmentnaive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet 2009; 374: 796–806—In this Article, the first sentence of the seventh paragraph in the “Results” section (p 802) should have read: “Fewer laboratory-associated adverse events were recorded in patients on raltegravir than on efavirenz, but the difference was not significant (table 3)”. The final sentence of the footnote to table 4 (p 802) should have read: “Consequently, the 19 patients who developed rashes (generalised, macular, papular, maculopapular, or otherwise unspecified rash) were not recorded”. The concentration of fasting triglycerides for toxic effect in table 5 (p 802) should have been >8·48 mmol/L. Finally, there were some errors in table 6 (p 803). A revised version is shown below with changes underlined. Mean concentration at baseline (mmol/L)
Mean concentration at week 48 (mmol/L)
Change in mean concentration (mmol/L)
Raltegravir group Efavirenz group
Raltegravir group
Raltegravir group Efavirenz group
Total cholesterol
4·13 (0·91)
4·03 (0·99)
4·39 (0·89)
4·89 (1·20)
0·26 (0·75)
0·85 (0·87)
<0·0001
HDL-cholesterol
0·99 (0·33)
0·98 (0·29)
1·10 (0·28)
1·24 (0·36)
0·11 (0·22)
0·26 (0·28)
<0·0001
LDL-cholesterol
2·51 (0·82)
2·39 (0·79)
2·66 (0·78)
2·83 (0·98)
0·15 (0·64)
0·42 (0·75)
0·0002
Total cholesterol/ HDL-cholesterol ratio
4·45 (1·39)
4·38 (1·43)
4·18 (1·20)
4·25 (1·67)
–0·27 (1·14)
–0·14 (1·39)
0·2924
Triglycerides
1·41 (0·83)
1·54 (1·39)
1·38 (0·92)
1·96 (2·17)
–0·03 (0·92)
0·42 (1·46)
<0·0001
Efavirenz group
p value*
Data are mean (SD). *p values are for difference in change from baseline between treatment groups. Tests of significance were done by ANCOVA with terms for baseline lipid concentration and treatment. The last-observation-carried-forward method was used for missing data when the value was absent because of increased lipid concentration (eg, after lipid-lowering drug had started or dose was increased).
Table 6: Changes in lipid concentrations from baseline to week 48
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www.thelancet.com Vol 374 September 5, 2009