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All hail the parasites!
There has been a recent scientific kerfuffle regarding some researchers’ reliance on existing data. Is it justifiable only to amalgamate, reanalyse and reinterpret others’ published results—or can one truly add to the field only by contributing original data? This nuanced debate has been politicised by the pejorative phrase ‘research parasites’ to demean those using existing data. Controversially, primary authors do not always do the best job of reporting their data and independent scientists often produce a more genuine report. Ben Goldacre's compare-trials.org advocates ‘new research on all data’, culminating in a BMJ report on efficacy and harms of paroxetine and imipramine in treating major depression in adolescence. An accompanying editorial praised this paper as having ‘the potential to benefit patients, prevent harm, and correct misleading research’. Quite an adulation for the humble research parasite. Perhaps we could think of this as a cover version improving on the original, such as Jimi Hendrix's All Along the Watchtower… but for patient benefit.
N Engl J Med 2016;374:276–7.
A feast of burden
Conceptually the World Bank, via the Disease Control Priorities in Developing Countries group, lumps mental, neurological and substance use (MNS) together as brain disorders. Between 1990 and 2010, MNS have increased by 41%; globally they account for 1 in 10 of each lost year of health. They estimate that epilepsy alone accounts for almost 300 000 excess deaths each year. They promote a solution through greater self-management, such as web-based psychological therapy and an increased scope of community outreach. This, they argue, must be supported with hospital care and specialist services. The World Bank acknowledges that these improvements must be funded; but under the heading ‘How much will it cost? Universal health coverage for MNS disorders’, they do not, ahem, tell us how much this would cost.
Lancet 20158. pii: S0140–6736(15)00390–6.
Multiple sclerosis work
We focus a great deal on making people with chronic neurological conditions better; finally, there is research on how to make people worse. Three hundred and twenty-two Swedish people with relapsing–remitting multiple sclerosis (MS) continued to smoke after diagnosis, out of 728 who were studied. Time to secondary progressive MS was a mean 5% shorter for each year of continuing to smoke. This equated to smokers developing secondary progression on average 8 years earlier. Another sure-fire way to make people with MS worse is to submit them to an assessment for the Employment Support Allowance (ESA, a controversial new stringent test for disability benefits in the UK). Of those studied, 48% felt the scrutiny caused a deterioration or relapse. Sadly, we can't even recommend a cheeky smoke to calm their nerves ahead of the ESA assessment.
JAMA Neurol 2015;72:1117–23.
Looking for the cure
When the Avon Longitudinal Study of Parents and Children was launched with great fanfare in 1991, they may not have predicted a recent Lancet Psychiatry study. The Goth subculture originated in England in the 1980s and is intrinsically wrapped up in postpunk music, literary and film culture, and of course the colour black. Dressed like sullen vampires they eschew all that is frivolous and superficially light-hearted. But is self-identifying as a Goth bad for your mental health? The study looked at 5357 people self-identifying as Goth: they were three times more likely to be depressed (6% vs 18%) and to self harm (10% vs 37%). In fact, there was a dose-like response with the degree of ‘Goth self-identification’. Identifying this population at risk could help to target them, perhaps with a Joy Division?
Lancet Psychiatry 2015;2:793–800.
Pulling my leg?
In this era of information overload, a catchy paper title or abstract can greatly improve an article's reach. As an example, may A Fo Ben recommend ‘Give It a Tug and Feel It Grow’, which starts with, “If a British teenage boy asks you to pull his finger, it is usually an indication that he simultaneously wishes to break wind…” Roger Newport and colleagues studied the illusion of stretching and how this distorted perception of body parts is intrinsic to disorders of body image. Despite this knowledge, they bravely went on to pull the fingers of 600 children and adolescents. A further sign that the authors are not taking themselves too seriously is their prolonged pinky graph (figure 1).
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