Regular use of common painkillers is associated with hearing loss in middle aged men

Tree earA study has found that regular use of common painkillers – such aspirin, paracetamol, and ibuprofen – increases the risk of hearing loss in men aged 40-74 years.

Using aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or paracetamol twice a week or more over a 20 year period increased the risk of hearing loss by 12%, 21%, and 22%, respectively.

Nearly a quarter (22%) of American men aged 45-64 years use aspirin weekly, largely because it prevents blood clots and is thought to ward off heart attacks in healthy people.  Furthermore, 16% of American middle aged men use paracetamol weekly, whereas 13% use ibuprofen this regularly.

However, just this week the Journal of the American Medical Association published research showing that aspirin doesn’t reduce “vascular events” – such as angina or stroke – in people who don’t have any clinical cardiovascular disease.

As such, the jury is still out on the benefits versus risks of using regular doses of aspirin to avoid cardiovascular disease, and this new research on hearing loss seems to add to the “against” pile.

This study, published in the American Journal of Medicine, assessed 26,917 male healthcare professionals who were aged 40-74 years in 1986.  These men were quizzed every two years on their use of painkillers and whether they had been professionally diagnosed with hearing loss.

Men who used paracetamol at least twice a week were 22% more likely to be diagnosed with hearing loss than people who took it less, whereas regular users of NSAIDs were 21% more likely. On the other hand, the risk was only 12% higher in men who regularly used aspirin.

For NSAIDs and acetaminophen, the risk of hearing loss increased with duration of regular use. Men who used NSAIDs or paracetemol regularly for 4 or more years were 33% more likely to develop hearing loss than those who did not use these drugs as regularly.

The risk of hearing loss varied with age and was greatest in men under 60 years of age. For aspirin, regular users aged less than 50 years and those aged 50-59 years were 33% more likely to have hearing loss than were nonregular users. Interestingly, there was no association between regular aspirin use and hearing loss in men aged 60 years or older.

For NSAIDs, men aged less than 50 years were most strongly affected: regular users aged less than 50 years were 61% more likely develop hearing loss than nonregular users. Those aged 50-59 years were 32% more likely to be diagnosed with hearing loss and those aged 60 years or older were 16% more likely.

There was a similar graded change with age for paracetamol: regular users aged under 50 years were, astoundingly, 99% more likely to have hearing loss than men who used the drug less regularly, whereas those aged 50-59 years were 38% more likely and those aged 60 years and older were 16% more likely.

The authors suggest that the age differential effect might be because hearing loss itself increases with age independently of painkiller use – after the age of 60 hearing thresholds worsen by 1 decibel a year on average. “The relative contribution of regular analgesic use to hearing loss may be greater in younger individuals before the cumulative effects of age and other factors have accrued,” they say.

Curhan S et al. (2010) Analgesic Use and the Risk of Hearing Loss in Men. The American Journal of Medicine 123 (3): 231-237. DOI: 10.1016/j.amjmed.2009.08.006

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Talking therapies for depression are overrated thanks to publication bias

DepressionAn analysis of studies into counseling therapies for depression – such as cognitive-behavioural therapy – has found that the effect of such approaches has been overestimated because studies that show a strong effect of the treatments are getting published over studies with more modest results.

In 117 studies, “talking therapies” had an average effect of 0.67 on symptoms of depression, with zero being “no effect,” whereas once publication bias was taken into account this effect dropped to 0.42.

Publication bias is “the tendency for increased publication rates among studies that show a statistically significant effect of treatment.” Think about it – patients, researchers and editors are going to be more interested in studies showing that a treatment has a considerable effect on a condition than those showing that the treatment has only a negligible effect. As a result, those studies showing a strong effect either way – that a treatment is really good or really useless – are more likely to get published and the effect of a therapy gets overestimated.

Publication bias is known to affect studies on the effects of antidepressant medications: trials showing that a drug works are more likely to get published than those showing that it doesn’t work. This is due in no small part to the pharmaceutical companies that fund drug research wanting to promote the most positive outcome possible for the medications that they sell.

Now a new analysis by Cuijpers et al. has found a similar effect among studies about psychotherapy for depression – only the most dramatic findings are getting out there and as such the effects of “talking therapies” are being “talked up.”

The authors looked at published studies on psychological treatments for depression – either approaches where verbal communication between a therapist and a client was the core element or in which a patient independently worked through a treatment book with some kind of personal support from a therapist.

They found a total of 117 studies that compared 175 treatment conditions with a control condition. When they calculated the effect of treatment in each study and analysed all these numbers together, the mean treatment effect for psychotherapy compared with control was 0.67, with zero being “no effect.”

The authors then undertook several types of statistical tests to determine whether the studies in their analysis were subject to publication bias.

The mean effect dropped to 0.42 once all the data had been adjusted for publication bias, and the various tests all pointed strongly to bias. The authors point out that effect sizes of 0.80 can be assumed to be large, effect sizes of 0.50 are moderate, and effect sizes of 0.20 are small.

Interestingly, no indication of publication bias was found for studies examining interpersonal psychotherapy, which targets how the patient interacts with other people, or for studies examining psychotherapy for women with postpartum depression.

The authors then looked specifically at the much vaunted approach cognitive-behavioural therapy, where therapist focuses on the impact a patient’s present dysfunctional thoughts have on current behaviour and future functioning. The overall effect size of the 89 comparisons between cognitive-behavioural therapy and a control condition was 0.69, but this value was reduced to 0.49 after adjustment for publication bias.

The authors conclude that research on psychotherapy for adult depression does not seem to be any freer from publication bias than research on medication treatment. As they say, “Pharmaceutical companies have clear financial reasons to inflate research findings, and psychological investigators have both personal and professional reasons for doing the same.”

The implications for this analysis are pretty messy – the research suggests that one of the two most important treatments for adult depression is not as effective as assumed, bad news given that “talking therapies” are generally thought to work better than pharmaceutical approaches, the other top therapy.
Cuijpers P at el. (2010) Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. The British Journal of Psychiatry 196 (3): 173-178. DOI: 10.1192/bjp.bp.109.066001

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Keep your eyes on your kids in the laundry room – for the sake of theirs

Liquid detergent tabDon’t leave your young kids unsupervised with your laundry. Not just because they might start mixing with your carefully separated piles of whites and darks, but because they might injure their eyes playing with the brightly coloured liquid detergent capsules.

A letter to the BMJ, ophthalmologists at the Western Eye Hospital in London have highlighted a “wave of paediatric eye injuries” from liquid capsules for fabric detergents. These capsules were responsible for 40% of chemical eye injuries in children under the age of 5 last year at the hospital.

The majority of the 13 children who presented to the hospital with such injuries were girls. In 12 cases the kids were fine after treatment, but one child only had their eyes washed on arrival and sustained permanent burns on both their eyes.

Furthermore, the Poisons Unit at Guy’s and St Thomas’ hospital, also in London, received 192 enquires related to the capsules during 2007-8 and 225 calls during 2006-7, a fifth of which related to ocular exposure.

Liquid detergent capsules, also known as liquitabs, were first introduced in 2001 and are composed of an alkaline solution contained in a water soluble membrane that dissolves when in contact with moist hands or the mouth. Alkali injuries are the most severe form of chemical eye injury and can cause irreversible damage.

The authors advise that concentrated cleaning products like liquitabs should be kept out of the reach of children. If an accident occurs, parents should immediately wash their child’s eyes to reduce the chance that their child will suffer permanent eye damage.

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Hot housed Chinese schoolkids are getting ill from the stress

Chinese schoolchildrenA third of Chinese children experience high levels of school-related stress, and these kids are about five times more likely to have the physical symptoms of stress – that is, headache or abdominal pain – then their less frazzled peers.

Thanks to the combination of China’s recent economic growth – with the increased opportunities for upward mobility – and the vast numbers of people competing for each university place and job, Chinese children are under pressure to do well right from the start of primary school.

A cross-sectional study published in Archives of Disease in Childhood has now shown the negative effects this relentless pressure can have on children’s health.

The study was carried out on more than 2,00 children aged 9-12 years in nine schools in urban and rural areas of Zhejiang, a relatively wealthy coastal province in the east of China.

Nearly a fifth said they rarely enjoyed school, with boys less likely to enjoy school than girls. A total of 81% said they worried “a lot” about exams, and 78% felt under pressure to perform well at school “all the time.”

In particular, the punitive nature of school in China comes across in this study: 44% of children were always afraid of being punished by their teachers. Furthermore, 71% said they were physically punished by their parents at least sometimes. No wonder these kids were so worried about doing well.

When it came to the psychosomatic symptoms of stress, 67% of boys and 66% of girls reported headache at least once a week, whereas 60% of boys and 78% of girls has stomach ache that often.

As a comparison, a study of school stress in Swedish 10-13 year olds reported that 21% of boys and 30% of girls experienced headache and 17% of boys and 28% of girls experienced abdominal pain at least once per week.

Children who were the most stressed on all the measures looked at were 5.6 times more likely to experience headache and 4.9 times more likely to report abdominal pain than kids who were the least stressed. Being bullied was the individual stressor that was most strongly associated with psychosomatic symptoms.

The authors believe that their findings “reflect the high value placed on education in Chinese society, urban and rural, and the widespread belief in the possibility for upward social mobility through education.”

Piling so much stress onto such young children could be storing up problems for the future. Studies have shown that children who have high levels of anxiety and depression are likely to have psychological problems into adolescence and adulthood.

According to the authors, “Much of the stress in Chinese schools is unnecessary and has simply become incorporated into the system.” They recommend reducing the frequency of exams and the sheer volume of homework to make life a little less intense for kids.

Hesketh T et al. (2010) Stress and psychosomatic symptoms in Chinese school children: cross-sectional survey. Archives of Disease in Childhood 95 (2): 136-140. DOI: 10.1136/adc.2009.171660

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Medical school entrance exam favours white public school boys

Exam hallNew research has found that the UK Clinical Aptitude Test (UKCAT), introduced to level the playing field in selection for medical and dental schools, favours male applicants, white people, and students from a higher socioeconomic class or who attended an independent or grammar school.

In the UK, students take advanced level (A level) exams aged 18, and it is the grades they get in these exams that primarily determine whether they can secure a place at university. A levels are affected by socioeconomic bias though – students who are academically able but whose education has been compromised by attending a bad school can end up performing badly and miss out on a place.

The UKCAT, however, doesn’t examine acquired knowledge and candidates can’t be “coached” to pass, so in theory it should provide a more fair assessment of aptitude than A level grades.

In addition, medical school selectors aren’t just interested in academic ability – they want to pick out students who have the personality attributes that will make them a good doctor, like excellent interpersonal skills and professional integrity.

The various components of the UKCAT – verbal reasoning, quantitative reasoning, abstract reasoning, and decision making – are supposed to be best measures to pick out such traits, so the test should also help determine the students who have the personality attributes to make a great doctor.

Unfortunately, the research by James et al, published in the BMJ, suggests that the UKCAT doesn’t really provide a more “equitable assessment of aptitude” than A levels.

The authors looked at data from applicants to 23 UK medical schools who took the UKCAT in 2006, the year it was first introduced. People who sat the test were asked to supply demographic and socioeconomic data such as their parents’ or carers’ occupation. The UKCAT data was then compared with A level results, the current “gold standard” in selection.

From the 18,582 individuals who took the UKCAT in 2006, the authors identified a subgroup of 9884 (53%) students who lived in the UK and for whom they had results data on at least three recent A levels. There was a modest correlation between A level grades and UKCAT scores, which indicates that the test could be used as an alternative to A level grades in the selection process

As far as bias in A level results went, sex didn’t have much of an effect on whether a student scored AAA or AAB – the minimum requirement for medical school admission. However, white students and those whose parents had a managerial or professional job were more likely to get top scores.

Startlingly, applicants who went to an independent or grammar school were more than twice as likely to get top A level grades than those who went to a comprehensive school, sixth form college, or some other sort of higher education institution.

The UKCAT was slightly less subject to socioeconomic bias than A level results. However, male applicants were more likely to get a high score (i.e. a score within the top 30% out of all applicants) than were females. White students were twice as likely to get a high score than students in other ethnic groups, and “professional or managerial background” and “independent or grammar schooling” were likewise independent predictors of a top score.

So although the test is less biased than A levels, the UKCAT still has “an inherent favourable bias to male applicants and those from a higher socioeconomic class or from independent or grammar schools,” conclude the authors.

One major limitation of the study is that about 30% of participants did not provide socioeconomic data when they sat the UKCAT, so a considerable proportion of applicants covered in the A levels calculations were excluded from the UKCAT analyses. Those who withheld socioeconomic status data were more likely to be male, non-white, and from non-selective schools, and were less likely to have top A levels grades and high UKCAT scores. “Arguably, this group contained those candidates who were more likely to benefit from widening participation,” say the authors.

In a rapid response to the research, Rachel Greatrix, chief operating officer of UKCAT, rather unexpectedly welcomes the findings. “It is reassuring that medical and dental schools can use the test as a reasonable proxy for A levels given the on-going debate regarding the speculative nature of predicted grades and discussions regarding post-qualification admissions,” she says. “However, the fact that UKCAT scores are less subject to bias than A level results alone, potentially indicates that if combined with A level achievement, they may offer a fairer tool for selection.”

James D, Yates J, & Nicholson S (2010) Comparison of A level and UKCAT performance in students applying to UK medical and dental schools in 2006: cohort study. BMJ 340 (feb16 1). DOI: 10.1136/bmj.c478

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Music and the Mind: “can’t get it” and “can’t get it out of my head”

MusicWhen I was at the Science Museum Lates event this week, I attended a talk on the perception of music by researchers from the Music, Mind and the Brain group at Goldsmiths, University of London.

The first half of the talk was by Lauren Stewart, a cognitive neuroscientist, who outlined how the brain understands music.

Music is entirely a construct of the mind, she pointed out, because sound waves are simply vibrating air molecules, nothing more.  What is remarkable is not just that the brain understands how to interpret these sequences of molecules, but that we can also understand composites of several different strings of molecules interwoven together; i.e. the different musical elements – for example, guitarist, bass, drums, singer – that make up a song.

Activity of the brain when music is heardBut how did the brain evolve this ability?  One possibility is that music is a super stimulus for pleasure, said Dr Stewart.  The brain, she said, is adapted to recognise patterns. The process of hearing a song and predicting what comes next sets off the neurotransmitter dopamine in areas of the brain associated with other pleasure stimuli, like sex and drugs – suddenly the old adage “sex, drugs and rock’n’roll” makes more sense!  The “musical chills” that you experience when you hear a song you really like is a good example of this process in action.

Dr Stewart studies the disorder amusia, which is a lifelong failure to recognise familiar tunes or tell one tune from another. Sufferers frequently complain that music sounds like a “din” and often avoid social situations in which music plays a crucial role. Such individuals are unable to understand the up and down pitch of music, but have no problems with the pitch changes in speech, like rhythm, stress, and intonation.

Some people develop this problem after significant brain trauma, like a car accident, whereas others are born with it. Dr Stewart describes the genetic component of amusia, “congential amusia,” by highlighting a family of eight siblings from Northern Ireland, four of whom have amusia and four of whom hear music fine. In fact, a study of nine families with some amusic members and ten normal families found that 39% of first-degree relatives of amusic people have the same cognitive disorder, whereas only 3% have it in the control families.

By studying a “broken system,” Dr Stewart hopes to find out more about the “correct” cognitive architecture of music, and its relation to other cognitive skills such as language and spatial awareness. Her present research aims to elucidate exactly which perceptual and cognitive mechanisms are at fault in amusia, whether disordered musical processing has implications for language, and the extent to which such difficulties can impact upon sociocultural functioning.

The second half of the talk was by Daniel Müllensiefen, a computational scientist, who studies involuntary musical imagery, or “earworms.”

Prevalence of earmwormsAn earworm, a direct translation of the German word “ohrwurm,” is a portion of a song or other music that repeats compulsively within one’s mind – “I’ve got a song stuck in my head.” Earworms are related to voluntary musical imagery – earworm activate the same areas of the brain as when you’re listening to music.

Apparently, as many as 90% of people experience an earworm at least once a week, whereas about 50% have one everyday.  The average length an earworm is on repear is 27 minutes, and between 15% and 33% of people find these “cognitively infectious musical agents” unpleasant or disturbing.

Dr Müllensiefen is using computational analysis of music to determine what it is about a song that makes it stick in our heads and become an earworm. He and his team have broken down the melodies over 14,000 pop songs from the 1950s to the present day into sequences of 0s and 1s that computers can deal with.

They have then analysed the statistical distributions and regularities in the data from commercially successful songs to determine what elements make a song a hit. Apparently, what you need is a chorus melody that has a large range and uses only few pitches much more frequently than the majority of its pitches.  Which looks like this:Hit song equation

This talk was a great introduction to how the brain deals with music – both in instances where people can’t get a grip on music and in cases where they can’t get it to go away.

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After hours in the Science Museum

Science Museum DJThis evening my friends and I went to the Science of Music event at the Science Museum in South Kensington. The evening was part of Science Museum Lates, a monthly adults only event where the museum is open until 10pm and special talks and displays are laid on.

The place was pretty packed out with a surprisingly young and trendy crowd. Four of the museum’s seven floors were open, and each handily had several bars and DJs, surely a prerequisite for an event about music. There was even a silent disco, somewhat incongruously located among the satellites and rockets in the Exploring Space gallery.

First off we went to to the Launchpad area, an interactive hands on gallery that is usually packed with kids on a daytime visit to the museum. Instead we had the gallery to ourselves and got to have a proper play with things like electromagnets, generators, and circuit boards.

We then tried to catch the break dance demonstrations in the flight gallery. Alas we only made it for the tail end, but we did find out how angular momentum affects how fast a break dancer can spin on their head: arms out, they slow down; arms flat against their body, they speed up.

Materials man close upMaterials in the bodyWe were unexpectedly quite fascinated by the Plasticity exhibition, which showcases 100 years of plastics. I was particularly interested in the US Olympic ski suit, which had foam pads on areas like the shoulders and forearms that are soft when racing but instantly turn hard impact to absorb shock energy.

While we’re on the subject of materials, another of my favourite exhibits in the that I saw this evening was this “materials man,” who shows the anatomical location and real size of a selection the medical materials and devices that are currently in use.

In the close up, you can see a silicone artificial larynx, a carbon fibre bone plate, a titanium and silicone cardiac pacemaker, and a polytetrafluoroethene methanical aortic valve.  Dentures and a glass eye are in there as well.

All in all, the event was a great chance to have a look around the museum in a laid back atmosphere without hundreds of kids tearing around the place. Oh, and with a beer in my hand, always a bonus!

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Obese children are at high risk of death before middle age

childhood obesityA study published in the New England Journal of Medicine has found that children who were obese were almost twice as likely to die before 55 years of age than those who were not obese. Moreover, children whose weight was in the top 25% out of nearly 5,000 kids were 2.3 times more likely to die from diseases before middle age than those whose weight fell in the bottom 25%.

The authors of this big, long study looked at body mass index (BMI; a measure of weight that takes into account a person’s height) and risk factors for cardiovascular disease in 4,857 children aged 5-19 years who lived on an American Indian reserve in Arizona.

BMI and markers of cardiovascular disease were measured in all children when the study started in 1966 or after. The participants were then followed up until their death, their 55th birthday, or the end of 2003, whichever came first.

A total of 559 (11.5%) participants died before the age of 55, 166 (3.4%) of whom died from a disease or from self inflicted injury such as alcohol or drug abuse – so-called “endogenous causes.”

Children whose BMI fell within the top 25% of all those in the study were 2.3 times more likely to die from endogenous causes before the age of 55 than those whose BMI was in the lowest 25%. In fact, each one unit increase in BMI increased the risk of early death from endogenous causes by 40%.  This relationship persisted but at a slightly lower level once factors like cholesterol level and blood pressure were taken into account.

The authors then looked specifically at the 1394 (28.7%) children who were obese – those whose BMI fell in the top 5% on growth charts from governmental public health body the Centers for Disease Control and Prevention. Compared with non-obese children, these kids were 31% more likely to die before they reached 55.

Children with high blood glucose levels – a sign that diabetes might be on the horizon – were at 73% higher risk of dying early, whereas those with hypertension were at 57% higher risk. This link prompted the authors to say that the link between obesity and premature death “may be partially mediated by the development of glucose intolerance and hypertension in childhood.”

Childhood cholesterol level and blood pressure, however, had no effect on the risk of premature death from endogenous causes.

Speaking to the New York Times, senior author Helen Looker said, “This suggests that obesity in children, even prepubescent children, may have very serious long-term health effects through midlife — that there is something serious being set in motion by obesity at early ages. We all expect to get beyond 55 these days.”

American Indians were studied because childhood obesity has been common for decades in this ethnic group. The prevalence of obesity in young Arizona Pima Indians in the 1960s, when this study was initiated, was similar to that seen in Hispanic and African American children today, so hopefully the results from this long study should be generalisable to kids today.

In a linked editorial, Edward W Gregg of the Centres for Disease Control and Prevention pointed out: “Since the trends with respect to obesity and diabetes among the Pima Indians have been a reliable harbinger for trends in the rest of the U.S. population during recent decades, the present study should intensify the debate about whether interventions that are initiated during childhood and young adulthood can affect our broader diabetes epidemic.”

Furthermore, in a previous study the same authors found that BMI correlated closely with total body fat – adiposity – and that adiposity in turn correlated with cardiovascular risk factors. By extension, the link between BMI and early death in this study suggests that actual body fat is linked with early death.

This is important because BMI is an imperfect measure of weight – for example, some very muscular people might be heavy for their height and thus have a high BMI – thus despite the study results weight might not genuinely be associated with early death. On the other hand, high adiposity – “fatness” – is a more indicative of an unhealthy weight.

“Childhood obesity is becoming increasingly prevalent around the globe. Our observations, combined with those of other investigators, suggest that failure to reverse this trend may have wide-reaching consequences for the quality of life and longevity,” conclude the study authors.

Franks P et al. (2010) Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. New England Journal of Medicine 362 (6): 485-493. DOI: 10.1056/NEJMoa0904130

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Clinical research from the heart

Hot on the heels of Valentine’s day, the British Heart Foundation has announced the winners of their images competition “Reflections of Research,” in which UK scientists funded by the foundation were asked to submit the most striking still and video images of their research.

Winners of the video category are Dr Michael Markl of University of Freiburg, Germany, and Dr Philip Kilner of Imperial College London, and their video of blood flowing through the heart. Concentrate hard and you can see, in red/yellow, blood flowing through the left side of the heart, down the aorta, and into the body as the heart rotates. Blood flowing through the right side of the heart towards the lungs is shown in blue. According to the BBC, in the future doctors may be able to use this type of imaging to help simulate the blood flow in a patient’s heart.

looking-through-the-heartWinners of the picture category were Mathieu-Benoit Voisin and Doris Proebstl from London with their remarkable heart shaped cell stain.

The researchers are studying how white blood cells move from the blood into into damaged tissue to cause inflammation; for example, after a heart attack. They were using using fluorescent pigments to stain two key players in this inflammatory process – pericyte cells from the blood vessel wall (stained red and blue) and collagen (green) – when looking through the microscope they noticed that the cells had arranged themselves into a heart shape.

“Through better understanding of how white blood cells interact with the components of the vessel walls, we hope to identify new avenues to treat conditions that underlie heart and circulatory inflammatory diseases,” said Dr Voisin. “Our research is funded by the British Heart Foundation so we were really delighted to see this heart shaped arrangement of cells appear by chance through the microscope!”

I think my favourite image from the competition is this runner up picture of the muscle fibres in the left ventricle of the heart.

heart stringsThe image, from Dr Patrick Hales at University of Oxford, was generated using diffusion tensor imaging of the heart. This magnetic resonance imaging (MRI) technique tracks the movement of water molecules through the heart muscle, which reveals how the muscle cells are aligned.

“This technology allows us to model the structure of muscles in the heart in a non-invasive way, and how diseases can cause it to change,” said Dr Hales. “In the future, we hope that our research might be able to determine how the structure of the heart is damaged during a heart attack, and how the muscle fibres respond.

“We also hope that our computer models of individual hearts will one day be used as a tool for diagnosis, and could even provide patient-specific assessment of treatment options. Imagine your doctor trying out treatments on a ‘virtual’ version of you, before choosing the right prescription.”

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Half the top US academic medical centers have no policy on ghostwriting

Half of the top 50 academic medical centres in the United States have no policies on their staff ghostwriting research on the behalf of pharmaceutical companies – including UCLA and Mayo Medical School.

Medical ghostwriting is “the practice of pharmaceutical companies secretly authoring journal articles published under the byline of academic researchers.” By getting academics at top universities to put their names to papers, often for financial reward, pharmaceutical companies aim to improve the authority of their research or even sneak dodgy methodology or fabricated findings past journal editors and readers.

Only 10 (20%) of the top 50 US academic medical centres explicitly ban their staff from ghostwriting, according to the survey published in PLoS Medicine, although three of these institutions don’t specifically use the term “ghostwriting” in their policies.

A further three (6%) have authorship policies that prohibit medical ghostwriting in practice by insisting both that staff make a substantive contribution to the paper to qualify for authorship and that all who qualify for authorship be listed.

Although all the top 10 academic research centres in the US have authorship policies, only six ban ghostwriting and the remaining four – including Duke University and Yale – don’t have policies in place.

Ghostwritten articles can be used by pharmaceutical companies to influence the prescribing – and the sales – of their top products. The authors of the study explain this practise by describing how a pharmaceutical sales representative might use such an article to influence the prescribing of a practicing clinician. “When a pharmaceutical salesperson hands a clinician an article reprint, the name of the institution on the front page of the reprint serves as a stamp of approval,” they write. “The article is not viewed as an advertisement, but as scientific research; the reprint is an effective marketing tool because peer-reviewed journal articles generated in academia are perceived to be the result of unbiased scientific inquiry.”

For example, pharmaceutical companies have used ghostwritten articles to promote sertraline – the most prescribed antidepressant in the US in 2007 – methylphenidate – also known as ritalin, the widely used, and abused, ADHD drug – and rofecoxib – otherwise known as Vioxx, the arthritis drug withdrawn in 2004 because it caused heart attacks.

Given how ghostwritten articles can be used to influence drug approval or prescribing, the authors describe the practise as “a serious threat to public health.” To try to combat ghostwriting, they recommend that participating in medical ghostwriting is defined as academic misconduct akin to plagiarism or falsifying data.

Lacasse J & Leo J (2010) Ghostwriting at Elite Academic Medical Centers in the United States. PLoS Medicine 7 (2) DOI: 10.1371/journal.pmed.1000230

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