Needle-Free Test for Premature Babies Means Less Pain. Not So.

Things are not always what they seem. Here’s a lesson for those who follow the medical literature. Read the paper, not the press release.

  

A press release touting the results of a drug monitoring study in premature babies from researchers in Northern Ireland states that the use of heel prick instead of venipuncture is less painful. Two major distributors of press releases, Science Daily and IANS published stories on this with the respective headlines “Needle-Free Test for Premature Babies” and “A painless, needle-free test for premature babies soon.”

Both reports quoted the principal author [obviously, directly from the press release] as follows, “This type of testing will obviously reduce the discomfort of medicine testing in these vulnerable patients.”

However, the objective of the paper as stated by the authors was to “…characterize the population pharmacokinetics…”of the antibiotic, metronidazole, which had apparently not been well-studied in neonates. There was no comparison of heel prick to venipuncture. All samples were drawn via heel prick. Furthermore, nowhere in the paper is there any mention of pain assessment in the babies.

The subject of pain associated with blood testing of babies has been extensively researched. A  1999 review (updated in 2007) by the respected Cochrane Collaboration found that venipuncture was in fact less painful that heel prick for obtaining blood from infants.

Bottom line. The study was about monitoring a drug, not pain. The assertion that heel prick is less painful than venipuncture for babies cannot be a valid conclusion based on the study as published. Press releases can be deceiving.

The lead author of the study did not respond to an email request for comment.

Posters at Medical Meetings: The Real Story

A study presented as a poster at the San Antonio Breast Cancer Symposium received widespread notoriety because it reported that certain subgroups of patients from a much larger study who had undergone hysterectomy and were on estrogen therapy actually had a lower risk of subsequent breast cancer. For some reason the symposium distributed this information in a press release and it was swallowed whole by some media outlets such as Science Daily and MedPage Today. The resulting confusion [most studies show that estrogen use is associated with a higher risk of contracting breast cancer] has caused the symposium’s press conference moderator to regret having featured the poster according to Crystal Phend, a MedPage Today blogger.

Some members of the medical press may be unaware of the manner in which posters are chosen for presentation. In many organizations it works like this. Abstracts are submitted to the organization for oral presentation, which is much more prestigious than simply presenting a poster. An oral presentation requires that the completed paper be submitted to one or more discussants for rigorous peer review prior to the date of the oral presentation. Papers rejected for oral presentation are often accepted as posters without any critical review at all.

For example, the Society of Critical Care Medicine [SCCM] has accepted 1025 posters for its upcoming meeting in January of 2011. The quality of some of the research is quite spotty. One abstract [title available on request] states, “While comparing pre and post [intervention] patients, survival to discharge showed a non-statistical but clinically significant improvement from 29% to 42%. (OR 1.76, 95% CI 0.5-5.9)” This of course is a scientifically inaccurate statement.

Why do organizations accept all submitted abstracts as posters? I believe it is because accepting all submitted abstracts as posters significantly increases meeting attendance. At least one author of the 1025 accepted posters will probably attend the SCCM meeting to be present when the poster is briefly discussed at sessions known as “Professor’s Walk Rounds” or similar names.

There is reward for the authors as well, who can pad their CVs with references to their research as having been “accepted as a poster presentation at SCCM.”

Bottom line. Exercise extreme caution when reporting the results of research presented in a poster.

How Does Science Daily Pick Its Subject Matter?

Ever wonder how Science Daily chooses which research articles to feature on their website? I have. As a total skeptic regarding the applicability of Six Sigma to medicine [see my previous blogs about Six Sigma], a recent post on Science Daily caught my eye. This was a glowing report entitled “Reducing waiting time at an emergency department using design for Six Sigma and discrete event simulation.” It’s about an emergency department in Jordan whose patient waiting times and lengths of stay [LOS] purportedly have been significantly reduced thanks to the miracle that is Six Sigma. The paper appeared in a journal called the International Journal of Six Sigma and Competitive Advantage.

I obtained a copy of the complete paper and have the following observations:

1. The authors already knew the waiting times and LOS were long.
2. They developed a mathematical model based on patient surveys to prove what they already knew.
3. The waiting time data were based on “…a random sample of 96 patients…measured over two random months and shifts.” The LOS data were from “…a random sample of 67 patients…measured over two random months and shifts.” The method of randomization was not stated. The number of patients studied represents 0.075% of all patients seen per year in their ED.
4. There are complex tables and flow charts.
5. Verification that the process was improved was based solely on simulation, not actual performance.
6 The impact factor of the International Journal of Six Sigma and Competitive Advantage is just about zero.
7. Don’t look for this article in PubMed.

So, you might ask, why was this paper featured on Science Daily? This is important because a posting on Science Daily is read by far more people than those who read most journals. Most of the information posted on Science Daily is from press releases generated by the authors of papers or their institutions. When describing how to contribute material, Science Daily states "Please note that we cannot guarantee posting of all the releases we receive, since we try to select those which we think would be of most interest to our readers." Someone from Science Daily is choosing what to post and we don't know how or why.

An email, the only way to contact Science Daily, sent on 8/31/10 asking about this has yet to be answered.