The editorial by Smith GW and Ebrahim S, though written with seasonal
humour, calls for serious consideration of two issues addressed; validity
and public implications (1). First, data dredging, bias or confounding
grouped together is as old as epidemiology. This is engrained in what my
teacher James Lee at National University of Singapore called the grand
equation of truth. All observations are subject to errors. What we Observe
is equal to the Truth plus or minus errors; random, bias, and confounding,
O=T ± e. In addition, low risks are more difficult to resolve, (do
electric fields cause disease?); what makes epidemiological sense, does
not necessarily make good public policy, (high fertility reduces breast
cancer!), and public health action need not wait break through evidence,
(AIDS prevention preceded the discovery of the HIV) (2). Second,
controversies to the investigators are the engine of growth, leading to
the refining of methods to yield better studies that minimize but do not
eradicate errors. To the general public, they are causes of confusion and
disputes. The mechanisms to address the first issue are available but need
to be practiced, continuously updated and circulated as research methods,
guidelines, CONSORT, and in all learning (3,4). Some journals do well on
this aspect and others should be encouraged.
The second issue has not been adequately examined and overlaps
several areas that include research and public communication ethics (5).
Because, the latter issue can arise without the former, newsworthy
information to the public may be different and undesirable. Newscasters
avoid ambiguities, because the general public loves rationalization, yes
or no clear statements that are easy to understand and apply to self. So,
the mass media broadcasted that older adults tolerate more alcohol and
that breast self-examination is useless. Days are gone when the journals
and scientific advances were a preserve of the profession and so should
the response. What and who should communicate to the general public? The
author and the editor should give a take home message to the general
public. The present set up in BMJ for the caption: what is known and what
the study adds, is a good attempt and should be universally adopted by
authors and journals but should as well include a cautiously crafted
evidence-based message for the general public. Evidence is an appropriate
term both in science and general usage. In both, it has implied
probability.
No conflicting interest declared.
Anthony Lwegaba, Lecturer, UWI School of Clinical Medicine and
Research, QE Hosp., Barbados, W.I. Lwegaba@lycos.com.
1 Smith GW, Ebrahim S. Data dredging, bias or confounding. They can
all get into the BMJ and the Friday Papers. BMJ 2002; 325:1435-8
2.Savitz DP, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Pub Health 1999; 89: 1158-61
3.Moher D, Schulz KF, Altman DG. The CONSORT statement: revised
recommendations for improving the quality of reports of parallel-group
randomised trials. Lancet 2001; 357; 1191-94
4.Moher D, Jones A, Lepage L. Use of the Consort statement and quality of
reports of randomized trials; a comparative before-and-after evaluation. J
Am Med Ass 2001; 285: 2006-7. PMID 11308436 [PubMed].
5.Nelkin D. Scientific journal and public disputes. Lancet 1998; 352 s2: 8
-12
Competing interests:
None declared
Competing interests:
No competing interests
06 January 2003
Anthony Lwegaba
lecturer in Social and preventive Medicine
UWI School of Clinical Medicine and Reseach, QEHosp, Barbados, W.I.
Rapid Response:
Informing the public about controversies
Dear Editor,
Informing the public about controversies
The editorial by Smith GW and Ebrahim S, though written with seasonal
humour, calls for serious consideration of two issues addressed; validity
and public implications (1). First, data dredging, bias or confounding
grouped together is as old as epidemiology. This is engrained in what my
teacher James Lee at National University of Singapore called the grand
equation of truth. All observations are subject to errors. What we Observe
is equal to the Truth plus or minus errors; random, bias, and confounding,
O=T ± e. In addition, low risks are more difficult to resolve, (do
electric fields cause disease?); what makes epidemiological sense, does
not necessarily make good public policy, (high fertility reduces breast
cancer!), and public health action need not wait break through evidence,
(AIDS prevention preceded the discovery of the HIV) (2). Second,
controversies to the investigators are the engine of growth, leading to
the refining of methods to yield better studies that minimize but do not
eradicate errors. To the general public, they are causes of confusion and
disputes. The mechanisms to address the first issue are available but need
to be practiced, continuously updated and circulated as research methods,
guidelines, CONSORT, and in all learning (3,4). Some journals do well on
this aspect and others should be encouraged.
The second issue has not been adequately examined and overlaps
several areas that include research and public communication ethics (5).
Because, the latter issue can arise without the former, newsworthy
information to the public may be different and undesirable. Newscasters
avoid ambiguities, because the general public loves rationalization, yes
or no clear statements that are easy to understand and apply to self. So,
the mass media broadcasted that older adults tolerate more alcohol and
that breast self-examination is useless. Days are gone when the journals
and scientific advances were a preserve of the profession and so should
the response. What and who should communicate to the general public? The
author and the editor should give a take home message to the general
public. The present set up in BMJ for the caption: what is known and what
the study adds, is a good attempt and should be universally adopted by
authors and journals but should as well include a cautiously crafted
evidence-based message for the general public. Evidence is an appropriate
term both in science and general usage. In both, it has implied
probability.
No conflicting interest declared.
Anthony Lwegaba, Lecturer, UWI School of Clinical Medicine and
Research, QE Hosp., Barbados, W.I. Lwegaba@lycos.com.
1 Smith GW, Ebrahim S. Data dredging, bias or confounding. They can
all get into the BMJ and the Friday Papers. BMJ 2002; 325:1435-8
2.Savitz DP, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Pub Health 1999; 89: 1158-61
3.Moher D, Schulz KF, Altman DG. The CONSORT statement: revised
recommendations for improving the quality of reports of parallel-group
randomised trials. Lancet 2001; 357; 1191-94
4.Moher D, Jones A, Lepage L. Use of the Consort statement and quality of
reports of randomized trials; a comparative before-and-after evaluation. J
Am Med Ass 2001; 285: 2006-7. PMID 11308436 [PubMed].
5.Nelkin D. Scientific journal and public disputes. Lancet 1998; 352 s2: 8
-12
Competing interests:
None declared
Competing interests: No competing interests