Tuesday, 27 May 2014

How reliable are medical research checks?

Numbers of publications increasing over
the last 100 years: Note log scale!
A recent report from the BBC highlights a surprising increase in the number of scientific papers that have been peer reviewed but which have subsequently been discovered to contain errors.

Peer review is a time honoured methodology used when a scientist submits a body of work for publication in a scientific journal. Since 1665 when the Royal Society in London published its first journal, peer review has been used to check the accuracy and veracity of scientific work and as such is the bedrock of scientific research. It is used as the minimum standard of acceptance by other scientists when they design their new experiments.

Many experiments give us interesting observations but a subsequent experiment might give us a different result, throwing reasonable doubt over the first result. How do we know what is a good result we can believe? The answer is usually via peer review. Once your work has been (anonymously) picked apart by others working in your field  of research and found to be good, then we can start to believe the result is good.

However peer review isn't a perfect system. There are clear weaknesses - those who review a paper must be your peers, therefore in practice it is possible to deduce who they might be, losing the anonymity of the process. Once there is no anonymity the system is vulnerable to accusations of bias and lack of objectivity. 

There is a steady (very small) trickle of known failures of peer review resulting in the publication of flawed papers - one very recent example of a new, simple method to generate stem cells is an outstanding example, though in this case we are told fraud is the cause rather than just simple error or bias.

There are of course further checks on the quality of research, particularly when results are very far reaching and would be widely used. The first step is often to attempt to repeat the experiment in other laboratories. If results cannot be repeated the doubt is widely circulated in the scientific community and/or formally presented as a 'letter to the editor' of the journal concerned and ultimately the paper can be withdrawn.

The BBC article tells us that the number of paper that have been withdrawn has soared from around 30 to 400 in 2010. We could say that the huge increase is a consequence of a focusing of attention of the whole scientific community on ensuring poor papers do not get through, though that tends to suggest that something is wrong with the system of review rather than we are getting it right!

Having witnessed the writing of many scientific papers, up to and including the point where an author considered whether or not to include a piece of data in the paper that would increase the chances of acceptance of that paper by a 'better journal', I don't think there are major problems. There might be some lingering doubt about some data and it can be a very subjective thought process that leads to that data being included. Every now and then there will be honest mistakes, though it was always a doubt over some additional point rather than the main body of work - after all others would be repeating this and if it didn't work your name would be ruined, no-one would trust your data for a long time!

There is probably a case for including open review for some journals - in this system the paper is available to the whole community to read before publication and for then to openly criticize. It is hard to see this being used for hugely important papers as entire careers are at stake and competition between researchers is fierce. Many would not want to give their competitors access to their data unless it was absolutely necessary - open review would mean they would read your data much earlier than usual (even a year or so earlier).

The system works, frauds are detected. There are many many more papers that need review now than there were even 20-30 years ago, never mind 350 years ago when the peer review system was invented. Reviewers have to limit the amount of time they give each paper - the more senior a reviewer the greater the problem. Perhaps attention needs to be paid to training reviewers, spreading the load a little, providing administrative assistance to reviewers?

Wednesday, 21 May 2014

Mouldy Landscapes

On first looking at the work of Hans J├Ârgen Johansen it is easy to conclude that he specialises in the taking of detailed works on the surface of the moon (but then there are no pools of moisture on the moon)

or perhaps the muddiness left in an estuary when the tide has just receded (but where is the sea?)

or even a forest floor layered in dead leaves - though there don't appear to be any trees.

But in each case something does not quite look right, the image isn't exactly as you might expect if your interpretation is correct.

In fact they are all pictures of various natural materials viewed in unexpected ways: for example moulds growing on different substrates, sometimes for weeks until their appearance is what the artist wants - there is no photo manipulation involved. Johansen arranges different growth substrates (often textiles) and then waits until mould grows over them to form the 'mould landscape'.

Original article

Monday, 19 May 2014

Jayne Fry Climbs Killimanjaro in Aid of the Fungal Infection Trust

The people that know me well will tell you that I am not an natural athlete and the only exercise I used to take was walking back and forth the kitchen (specifically to the fridge).  But, last year I had this mad idea to climb Kilimanjaro so that I could accomplish something spectacular and to celebrate the lives of two much loved women. So, I have been training for the last few months - I go to the gym without complaining too much and I have been up hill and down dale and along beaches thanks to my two bootcamp instructors.

I cannot say that I have been completely enjoying myself but I feel fitter and I am certainly not so fat.
I will be leaving for Tanzania on August 21 which is not too long away.  THAT I am looking forward to :-)

In my mind, I think that if Chris Moyles can do it so can I.

 The charity I am raising money for is the Fungal Infection Trust which you can find more about on the left hand side of my page. Now for the official bit... through Virgin Money Giving, you can sponsor me and donations will be quickly processed and passed to charities. Virgin Money Giving is a not for profit organisation and will claim gift aid on a charity's behalf where the donor is eligible for this.

Comment from the Fungal Infection Trust
Good luck with your fantastic efforts Jayne. You are helping to support the many works carried out by FIT which include the Aspergillus Website, Leading International Fungal Infection (LIFE). Many thanks.

Friday, 16 May 2014

Public views on Medicines Development

In 2013, the European Patients' Academy set out on a massive campaign to measure the attitudes and beliefs of the general public regarding medicines development.

We wanted to explore the public’s knowledge, attitudes and understanding of medicines development; at the same time, we explored the public’s current awareness of and level of involvement in medicines development; finally, we tried to explore the public’s information needs and preferences for different types of information resources vis-a-vis medicines development.

In the following infographics, we show the combined results on a European level as well as for 6 countries - France, Germany, Italy, Poland, Spain, UK. All participants were aged 18 years and over. In total, 7000 members of the public were reached with the survey (2000 in the UK and 1000 in all other countries).

Screenshot France 11.45.17Germany 11.49.16Italy 11.26.32 Poland 11.02.55Spain 11.29.41UK 11.47.15

Original article

Tuesday, 6 May 2014

Why Asthma Still Kills - Review of Deaths From Asthma

Today is World Asthma Day so it is appropriate that we talk about the recent publication 'The National Review of Asthma Deaths' (NRAB): Why Asthma Still Kills.

It has been noted that the number of deaths due to asthma in the UK has been standing at around 1200 for many years, even though the cause of death is usually preventable (in 90% of cases). Why should this be? We can prevent these deaths so why are we not preventing them?

NRAB spent a year (2012) interviewing all those involved in each asthma death (including parents, carers) in an attempt to learn more about the circumstances of each death and to identify commonalities.

NRAB is an extensive report looking at most factors involved in these deaths and its conclusions largely blame lack of awareness/lack of understanding/complacency by many people involved in the care of asthmatics people about the dangers of severe asthma - medical professionals and patients & carers - has a major influence on deaths by asthma. People (all people) are failing to take appropriate action because they don't realise how life threatening an attack can be until it is too late.

Why asthma still kills, the report of the National Review of Asthma Deaths was published on 6 May 2014 to coincide with World Asthma Day. The report and recommendations are available to download here.

Quoting from the Royal College of Physicians:
There are messages for doctors, nurses, patients, parents and carers in the findings and recommendations of the report. Deficiencies were found in routine asthma care and the review outlines recommendations to be taken forward by not only those who treat patients with this chronic condition but also pharmacists, NHS service managers, policy makers, commissioners and patient and professional bodies.
Why asthma still kills calls for an end to the complacency around asthma care in order to save lives and highlights four key messages:

  • Every hospital and GP practice should have designated, named clinician for asthma services. 
  • Better monitoring of asthma control; where loss of control is identified, immediate action is required including escalation of responsibility, treatment change and arrangements for follow-up.
  • Better education is needed for doctors, nurses, patients and carers to make them aware of the risks. They need to be able to recognise the warning signs of poor asthma control and know what to do during an attack.
  • All patients should be provided with a personal asthma action plan (PAAP), which can help them to identify if their asthma is worsening and tell them how and when to seek help.

Let us hope we see those asthma fatalities start to drop over the next few years, 1200 deaths a year is simply far too many.

Moulds & damp homes

Insofar as the influence of moulds and damp homes on asthma is concerned there seemed to be no attempt to analyse either in NRAB other than monitoring mould levels in the outside air. This could well be because there are no clear guidelines yet as to how damp or how mouldy a home must be to cause problems to asthmatics.
What do we know? Severe asthmatics tend to be sensitive to moulds. Around 50% of people with unstable, life threatening asthma react to moulds and we know that asthma tends to happen and get worse in damp homes. We have found that treating severe asthmatics with antifungal medication helps ease symptoms in 70% of those treated.

We believe that these facts make it worth looking at the involvement of damp homes and the direct involvement of fungi in asthma and asthma severity more closely and taking precautions such as advising asthmatic people about reducing damp (and thus microbial growth) in their homes, supporting those who look after asthmatic people, raising awareness of the importance of this amongst housing groups, local councils, groups involved in diagnosing and treating damp in the home (surveyors).

If you feel that your home is damp and your asthma is getting worse you can contact us at admin@aspergillosis.org.uk

Monday, 5 May 2014

Opportunistic Infection Incidence Rises During Treatment for HIV in Japanese Study

Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection. However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased. In the present study, autopsy cases of HIV infection in Japan were retrospectively investigated to reveal the prevalence of opportunistic infections and malignancies.

A total of 225 autopsy cases of HIV infection identified at 4 Japanese hospitals from 1985– 2012 were retrospectively reviewed. Clinical data were collected from patient medical

Results showed that although the incidence of viral infection other than HIV fell after treatment for HIV, teheh incidence of other opportunistic infections - including aspergillosis - rose. The authors conclude that monitoring for such opportunistic infection should be maintained in AIDS patients regardless of whether or not they are being treated with antiviral medication.

Full article can be read here

Contact us at admin@aspergillus.org.uk