Showing papers by "Jocalyn Clark published in 2004"

Relation between randomized controlled trials published in leading general medical journals and the global burden of disease.

Abstract: Background: More than two-thirds of the world9s population live in low-income countries, where health priorities are different from those of people living in more affluent parts of the world. We evaluated the relation between the global burden of disease and conditions or diseases studied in randomized controlled trials (RCTs) published in general medical journals. Methods: A MEDLINE search identified 373 RCTs that had been published in 6 international peer-reviewed general medical journals in 1999. Manual review excluded non-RCTs, brief reports and trials in which the unit of randomization was not the patient; 286 RCTs remained eligible for analysis. We identified the RCTs that studied any of the 40 leading causes of the global burden of disease. Five of these conditions were considered unsuitable for study with an RCT design and were excluded from subsequent analysis. To provide a practical perspective, we asked 12 experts working with international health organizations to rate the relevance to global health of the articles that studied any of the top 10 causes of the global burden of disease, as measured by disability-adjusted life years (DALYs) and mortality, using a 5-point Likert scale. Results: Among the 286 RCTs in our sample, 124 (43.4%) addressed 1 of the 35 leading causes of the global burden of disease. Of these, ischemic heart disease, HIV/AIDS and cerebrovascular disease were the most commonly studied conditions. Ninety articles (31.5%) studied 1 of the top 10 causes of the global burden of disease. The mean rating (and standard deviation) for international health relevance assigned by experts was 2.6 (1.5) out of 5. Only 14 (16%) of the 90 trials received a rating of 4 or greater, indicating high relevance to international health. Almost half of the 40 leading causes of the global burden of disease were not studied by any trial. Interpretation: Many conditions or diseases common internationally are underrepresented in RCTs published in leading general medical journals. Trials published in these journals that studied one of these high-priority conditions were generally rated as being of little relevance to international health.

The Inclusion of Minority Groups in Clinical Trials: Problems of Under Representation and Under Reporting of Data

Abstract: Objective: To evaluate the representation of minority groups in randomized control trials (RCTs), and the frequency with which this information is reported. Study Design: Reviewers collected data on the racial/ethnic composition of study samples from all RCTs published in six leading medical journals in 1999. Results: Of the 280 RCTs, most (204, 71.3%) provided no information on the race/ethnicity of participants. Of the 89 U.S.-based RCTs, 50 (56.1%) reported their minority distribution. Relative to other trials, those funded by the National Institute of Health (NIH) (n = 52) were more likely to report race/ethnicity data (55.8% vs. 23.7%; χ2 = 20.9, p ≤ 0.001) and to include nonwhite participants (13.5% vs. 12.5%; χ2 = 22.7, p ≤ 0.001). Conclusion: Minority groups are currently under-represented in clinical trials. Information on the race and ethnicity of clinical trial participants is currently underreported in six leading medical journals. Reporting of minority group information was significantly bett...

Who cares about academic medicine

Abstract: The reaction to the campaign launched by the BMJ and its partners several months ago1,2 suggests that academic medicine needs resuscitation.3,4 But is it worth saving? The academic medicine campaign aims to develop a vision and set of recommendations for reforming academic medicine in the 21st century. Driven by an international working party, it gives high priority to incorporating the perspectives of the chief customers of academic medicine—patients, policy makers, and practitioners—through a series of stakeholder and regional consultations. The campaign also supplies an opportunity to question the global relevance, responsibilities, and scope of academic medicine: Who is it for? Why does it matter? How best to invest in its future? Articles in this theme issue (including two from the working party (pp 787, 789)) discuss these questions and identify the challenges facing the campaign.5,6

Face transplants technically possible, but “very hazardous”

Abstract: With new technologies in micro-surgery and antirejection drugs, facial transplantation is now technically possible, but British surgeons are being urged to hold off until the ethical issues are debated and more research into immunotherapy and psychological risks is conducted ![Figure][1]

Regulation of natural health products challenged.

Abstract: Opponents to state regulation of natural health products won a major victory when the London High Court gave a coalition of industry and consumer groups the go-ahead to appeal a European Union (EU) directive restricting food and vitamin supplements. The challenge was granted in February and is

Polishing the tarnished image of academic medicine

Abstract: Peter Tugwell , head of the campaign by the BMJ and its partners to promote academic medicine, tells Jocalyn Clark how the discipline has come to be seen as more attuned to self interest than to benefiting society

Dr Foster case notes : A new monthly section will provide data on what is happening in health services

Abstract: A new monthly section will provide data on what is happening in health services Starting this week the BMJ will publish a monthly page highlighting data from Dr Foster, an independent, London based organisation that analyses the availability and quality of health care in the United Kingdom and worldwide (http://www.drfoster.com/).1 We aim to create a page that is rich in data and will allow doctors, managers, and patients to learn from what is happening in the NHS and other healthcare systems. Much of what the BMJ publishes arises from experimental studies, particularly randomised controlled trials. Dr Foster case notes will …

Bush's international health policies “condemn millions of women to die”

Abstract: American policies on international health were condemned last week for being based on ideology rather than science; for rolling back progress achieved in protecting sexual and reproductive health and rights; for increasing the risk of unwanted pregnancies, HIV infection, and unsafe abortions; and for “condemning millions of women to die.” Seven hundred participants from 109 countries gathered in London to review progress on the Cairo Consensus, a programme of action ratified by 179 nation states at the 1994 International Conference on Population and Development (ICPD). The programme, which was designed to achieve sexual and reproductive rights for all by 2015, is now at the halfway point of its 20 year task. It is credited with introducing a human rights …

Slow progress to reproductive rights

Abstract: Religious fundamentalism and a lack of resources are the chief barriers to achieving sexual and reproductive rights for all by 2015, concluded the 2004 International Conference on Population and Development (ICPD) ![Figure][1] Figure. Teen pregnancy: 123 million couples want contraception

Academic medicine: time for reinvention: Summary of responses.

Abstract: Editor—Since we launched our international campaign to promote and revitalise academic medicine, over 60 rapid responses to the cluster of articles published on 1 November 20031-5 have been received. Many were sent from England, several from medical students and trainees, and a notable number came from outside the United Kingdom—reminding us that concern about the fate of academic medicine is very much a “universally relevant” issue. Nearly everyone agreed that academic medicine is suffering, and all offered opinions as to why. Most criticised the lack of adequate government funding of universities and research centres, which was said to foster a dependency on industry. If academic medicine is not valued publicly, argued a general practitioner from Australia, the pursuit of knowledge and truth for its own sake will not be respected. Academic clinicians were said to be poorly remunerated compared with their non-academic peers unless they partner with industry. While many decried the “tainting” of medical research and education by “the profit motive of industry,” at least one commentator felt that a free market within academic medicine should be allowed to flourish. Several commentators drew the distinction between clinician academics and non-academics; we were told not to forget about doctors in the NHS, for example, who do some research or teaching in addition to their clinical duties. Doctors in most countries seem to be struggling to maintain a commitment to research and teaching as well as meeting the ever increasing demands of service delivery. At least two responders emphasised the inextricable link between academic medicine and a functioning healthcare system. They said that without a revival of academic medicine our health systems cannot function as needed. The situation for academic medics may be more dire for those from traditionally marginalised groups (including women) and working in developing countries. Several respondents appealed for our campaign to be as inclusive and global as possible. A retired clinical scientist points out that the same issues vexing academic medicine today were identified a quarter of a century ago, so in terms of a revitalisation strategy, “more of the same” will clearly not do. To continue the dialogue about how best to revitalise academic medicine, we are publishing a theme issue in October 2004. Please send us your submissions by 30 April 2004.

Catering to the customers

Abstract: Sometimes, it is important to state the obvious, even if it is not surprising. In our study[1][1] we document that trials published in the leading general medical journals do not reflect the conditions and diseases that are the most important causes of death and disability internationally. Our study