Download Keynote Address: Two Hundred Years of Communicating the

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Keynote Address: Two Hundred Years
of Communicating the Medical News
Speaker:
Jeffrey M Drazen
New England Journal of Medicine
Winchester, Massachusetts
Reporter:
JM Dormon
Canadian Science Publishing
Ottawa, Ontario, Canada
Jeffrey M Drazen’s fascinating keynote
speech underlined the importance of
accurate, unbiased, scientific data in the
progress of health science, specifically
with respect to the causes and management of diseases.
Over the course of human history, theories concerning the transmission of contagious diseases have ranged, depending
on the prevailing wisdom of the day, from
religious to scientific. However, it has been
the scientific analysis of the causative factors involved in contagion that has led to
successful identification and treatment. For
example, in the case of the highly contagious
and lethal disease tuberculosis, before it was
possible for information regarding common
symptoms (such as coughing and fever) to be
shared among health practitioners and before
new technologies—such as microscopy, staining, and x-rays—had been developed, all that
medical practitioners could do was try to
treat for the symptoms and hope for the best.
Thousands of people died of tuberculosis
every year; a popular cure was to send those
showing blatant signs of the disease to a sanitarium, far away from cities, where they could
find “clean air”. That “treatment” did not
guarantee a cure; however, assembling groups
of patients made it possible for researching
physicians to try their own “cures” on them
(which Drazen referred to as “the early days
of drug trials”). In the 1920s, great claims
were made for the efficacy of of a gold-based
compound, and data were provided to support its use. However, the data were flawed,
and unsound conclusions were based on
selection of patients in a nonrandom manner, which introduced bias. A later, thorough,
randomized investigation of the compound
revealed that it was not a cure at all; in fact,
it increased the likelihood of death! That
revelation focused the scientific community
on the importance of eliminating bias from
such studies and served as a warning about
accepting results at face value.
Much research has since been dedicated
to the development of thorough and unbiased methods for evaluating the efficacy of
drugs and other treatments. Although the
randomized controlled trial itself did not
come of age until the 1960s, its importance
for public-health management and disease
control is widely recognized.
High-quality data are needed to make
informed decisions about health, disease,
and treatment. The desire to perfect statistical test methods and statistical analysis
has resulted in many groups’ dedication
to the cause, and the last 50 years have
seen marked development of techniques
for removing bias. Such reports as the
Greenburg Commission report in 1967 and
such publications as Data Monitoring in
Clinical Trials by DeMets and colleagues
have contributed to the improvement of
research results.
However, there are still numerous examples of how poor study design, changes in
protocols, and misinformation result in faulty
drug evaluations. In 2004, given that study
design and protocol are of such monumental
importance, 13 scientific journals refused to
publish papers for which test protocols had
not been registered in a central National
Institutes of Health database. There was
initially substantial push-back from the pharmaceutical companies, but compliance has
been increasing since 2005.
The future of scientific breakthroughs
depends on the application of sound test
methods, the open discussion and analysis
of results among the community, and the
constant improvement of the technology
that we use to disseminate our data. With
respect to public health, only the most
ethical protocols can be considered, and
careful oversight is required. Accurate and
clear communication of results and discoveries is key, and the community needs to be
dedicated to this goal.
Science Editor • July – September 2013 • Vol 36 • No 3 • 79