Johan Mackenbach Department of Public Health Erasmus MC

Transcription

1 Johan Mackenbach Department of Public Health Erasmus MC

2 Improved population health

3 Improved population health Reliable and relevant information

4 Improved population health Reliable and relevant information Proper scientific practices

5 Enormous advances in population health, but: Little progress in some underfunded areas (e.g., neglected tropical diseases ) Modest progress at high costs in some wellfunded areas (e.g., cancer) Progress sometimes comes with large-scale iatrogenic harm (e.g., drug side effects)

6 Enormous increase of available information, but: There is no evidence for most of what we do in medicine Most published research findings are false (Ioannides 2005) Increased skepticism about the claims of evidence-based medicine

7 Enormous increase of quantity and quality of medical and health research, but: Dissatisfaction with emphasis on publication and citation counts Conflicts of interest are omnipresent financial, personal, ideological, Discovery of breaches of scientific integrity suggests dysfunctioning systems

8 Improved population health Reliable and relevant information Proper scientific practices

9 Improved population health Reliable and relevant information Proper scientific practices

10 Improved population health Reliable and relevant information Proper scientific practices

11 Large-scale iatrogenic harm Suppression of research results Financial interests

12 Modest progress at high costs Overemphasis on positive findings Personal interests

13 Because the prior probability of claims being true is usually low Because many studies are biased and underpowered Because there is selective reporting and publishing of positive effects Ioannides 2005

14 Study publication bias arises when studies are published or not depending on their results - Positive results bias : authors are more likely to submit, and editors accept, positive than null results - Filedrawer effect : authors conduct many more studies than they finally report, and do not submit studies with null results Pipeline bias arises when studies without statistically significant results take longer to get published Within-study selective reporting bias arises when only a subset of the original outcome variables are reported Dwan et al. 2008

15 No progress in population health Publication bias Improper scientific practices

16 Artificial discrepancy between supply of study results and volume of high-impact journals ( winner s curse ) Lack of understanding among scientists of links between their practices and research outcomes Dependence of scientists careers, group grant incomes, and institutions reputations on positive results

17 Remove artificial scarcity of publication outlets by creating new, open journals Change editorial policies, e.g., prioritize papers for quality not relevance Obligatory registration of study protocols, and reporting of protocol-based analyses only Awareness raising, research training, codes of conduct, reporting checklists,. Less emphasis on publication and citation counts, wider range of science evaluation criteria Reduce dependence on industry sponsoring, increase public spending on research

18 Remove artificial scarcity of publication outlets by creating new, open journals Change editorial policies, e.g., prioritize papers for quality not relevance Obligatory registration of study protocols, and reporting of protocol-based analyses only Awareness raising, research training, codes of conduct, reporting checklists,. Less emphasis on publication and citation counts, wider range of science evaluation criteria Reduce dependence on industry sponsoring, increase public spending on research

19 Remove artificial scarcity of publication outlets by creating new, open journals Change editorial policies, e.g., prioritize papers for quality not relevance Obligatory registration of study protocols, and reporting of protocol-based analyses only Awareness raising, research training, codes of conduct, reporting checklists,. Less emphasis on publication and citation counts, wider range of science evaluation criteria Reduce dependence on industry sponsoring, increase public spending on research

20 Medical research has contributed and is still contributing to enormous advances in population health We can probably do even better better priorities, better study quality, better reporting, more integrity, Reducing publication bias is important Erasmus MC can contribute by raising research standards and avoiding perverse incentives Academic institutions should join forces to improve publication practices and reduce conflicts of interest

21 Current publication practices have contributed and are still contributing to enormous advances in population health We can probably do even better better priorities, better study quality, better reporting, more integrity, Erasmus MC can contribute to reducing publication bias by raising research standards and avoiding perverse incentives More importantly, academic institutions should join forces to improve publication practices and reduce conflicts of interest