Chronic diseases: what are they? How are they inherited?

BACKGROUND

Chronic diseases (CD), miasms or reactional modes, remain one of the darkest concepts of homeopathy. They are supposed to be heritable and originate after suppression of other diseases. Besides this nothing is known about how they might produce the large number of diseases mentioned in homeopathic books. They have been described in a variety of terms, ranging from Kent and Gathak's spiritual or metaphysic conception; the biological-allergic by Paschero, and, Robert's materialist-nutritional point of view. Flores-Bejar et al have outlined an approach to CD from a cellular and bioenergetic point of view.

RESULTS

Cellular pathology has led to an understanding of the basic repair mechanisms of every cell and tissue. These mechanisms exist in order to avoid necrosis or cell death. The main mechanisms are molecular repair, apoptosis and cell proliferation. Failure of these mechanisms leads to 'dysrepair'. Consequences of these 'dysrepair' mechanisms resemble the homeopathic reactional modes or miasms. These abnormal or 'dysrepair' mechanisms are probably the basis of miasms or reactional modes. A new interpretation of miasms is proposed: Psora corresponds to the dysmolecular reactional mode. Syphilis corresponds to dysapoptotic reactional mode. Sycosis corresponds to dysproliferative reactional mode.

Psychometric theory is an obstacle to the progress of clinical research

Psychometric theory is the basis for the development of assessment instruments in psychiatric research. However, the psychometric model appears to be largely inadequate in the clinical setting because of its lack of sensitivity to change and its quest for homogeneous components. Clinimetrics offers a viable alternative to psychometrics, both from a conceptual and a methodological viewpoint. Current diagnostic entities (DSM) are based on clinimetric principles, but their use is still influenced by psychometric models. Suggestions for switching gears in assessment research are offered.

Redundant publications in scientific ophthalmologic journals

OBJECTIVE

The number of scientific publications is often used to measure scientific achievement. This practice can motivate unethical conduct, such as redundant or duplicate publications, defined as publication of the same scientific contents in more than 1 journal. The aim of this study was to estimate the amount of redundant publications in ophthalmologic journals.

DESIGN

Retrospective analysis of published literature.

METHODS

We developed an electronic search engine for redundancies to estimate the amount of duplicate publications in scientific journals. When redundancies reached a given degree (matching score), the articles were screened manually based on authors, titles, and abstracts. We applied this method to the 22 433 articles that were published between 1997 and 2000 in 70 ophthalmologic journals indexed by MEDLINE.

MAIN OUTCOME MEASURES

The number of duplicate publications with a matching score of 0.6 or more, the number of involved journals, and the number of authors.

RESULTS

Redundancies reached a matching score of 0.6 or more in 13 967 pairs of articles. Out of them, a sample of 2210 was reviewed manually. We found 60 redundant articles and estimated that 1.39% of the publications were redundant. Thirty-two journals and an estimate of 1092 authors were involved. In 5% of cases, the scientific conclusions were modified.

CONCLUSIONS

Because of the restrictive selection process, the impracticability of detecting all redundant publications, and the estimated amount of duplicates increases with lower matching scores, we regard our estimate to be the tip of the iceberg. Duplicate publications have several negative impacts, but neither peer reviewers nor editors can protect their journal from them completely. Several deterrents for duplicate publications are possible, but as long as publications remain the central requirement for academic advancement, a solution seems unlikely. Nevertheless, it is the responsibility of all those who care about objective research and evidence-based medicine to address this problem-not only in ophthalmology.

Accountability, trust and informed consent in medical practice and research

During the last 25 years public policy in the UK has aimed to replace 'club' cultures and their supposedly suspect reliance on trust between professionals and public with a new public culture based on accountability and 'transparency'. These transformations have changed both clinical practice and public health policy in deep ways. Are the new conceptions of accountability adequate? Are obligations to be 'transparent' any more than requirements to disclose information which overlook the need for genuine communication? Can demands for ever fuller informed consent improve accountability to individual patients and research subjects? Could we devise more intelligent conceptions of accountability that support more intelligent placing and refusal of trust? What might intelligent conceptions of accountability suggest about proper clinical practice, public health medicine and professional responsibilities?

[Longitudinal studies: concepts and particularities]

In this review the definition of "longitudinal study" is analysed. Most current textbooks on epidemiology do not define a longitudinal study, whereas statistical textbooks do. It is more common to talk about longitudinal data than about longitudinal studies. A longitudinal study implies the existence of repeated measurements (more than two) across follow-up. According to these ideas, a longitudinal study can be considered a subtype of cohort study that, in contrast with life-table cohort studies, allows inference to the subject level, to analyze changes in variables (exposures and outcomes) and transitions among different health states. The characteristics of this design force to paid special attention to quality control during data collection, losses during follow-up, and missing data in some measurements. The statistical analysis should take repeated measures into account, and it is what finally gives the longitudinal character to a study with repeated measurements.

[Impact of regulations on translational research in cell and gene therapy: the American experience]

The increasing utilization of cell and gene therapy in the treatment of human diseases, particularly cancers, has led lawmakers to institute stringent rules to regulate this new area of medicine and optimally protect patients. Cell and gene therapy centers, often located within academic institutions, are becoming subject to rules previously applied only to pharmaceutical companies. Based on the US experience, we review here the regulations that currently regulate or are being proposed to cover cell and gene therapy centers. We describe the principles of good manufacturing practices, quality assurance and quality control and accreditation. Finally, we discuss the future of cell and gene therapy in the context of the increasingly rigorous regulatory environment implemented in the US.

Where is the evidence that animal research benefits humans?

Much animal research into potential treatments for humans is wasted because it is poorly conducted and not evaluated through systematic reviews

Sources of variation and bias in studies of diagnostic accuracy: a systematic review

BACKGROUND

Studies of diagnostic accuracy are subject to different sources of bias and variation than studies that evaluate the effectiveness of an intervention. Little is known about the effects of these sources of bias and variation.

PURPOSE

To summarize the evidence on factors that can lead to bias or variation in the results of diagnostic accuracy studies.

DATA SOURCES

MEDLINE, EMBASE, and BIOSIS, and the methodologic databases of the Centre for Reviews and Dissemination and the Cochrane Collaboration. Methodologic experts in diagnostic tests were contacted.

STUDY SELECTION

Studies that investigated the effects of bias and variation on measures of test performance were eligible for inclusion, which was assessed by one reviewer and checked by a second reviewer. Discrepancies were resolved through discussion.

DATA EXTRACTION

Data extraction was conducted by one reviewer and checked by a second reviewer.

DATA SYNTHESIS

The best-documented effects of bias and variation were found for demographic features, disease prevalence and severity, partial verification bias, clinical review bias, and observer and instrument variation. For other sources, such as distorted selection of participants, absent or inappropriate reference standard, differential verification bias, and review bias, the amount of evidence was limited. Evidence was lacking for other features, including incorporation bias, treatment paradox, arbitrary choice of threshold value, and dropouts.

CONCLUSIONS

Many issues in the design and conduct of diagnostic accuracy studies can lead to bias or variation; however, the empirical evidence about the size and effect of these issues is limited.

Better governance in academic health sciences centres: moving beyond the Olivieri/Apotex Affair in Toronto

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair (OAA) regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are.

Professional responsibilities of biomedical scientists in public discourse

This article describes how a small but vocal group of biomedical scientists propagates the views that either HIV is not the cause of AIDS, or that it does not exist at all. When these views were rejected by mainstream science, this group took its views and arguments into the public domain, actively campaigning via newspapers, radio, and television to make its views known to the lay public. I describe some of the harmful consequences of the group's activities, and ask two distinct ethical questions: what moral obligations do scientists who hold such minority views have with regard to a scientifically untrained lay audience, and what moral obligations do mainstream newspapers and government politicians have when it comes to such views. The latter question will be asked because the "dissidents" succeeded for a number of years in convincing the South African government of the soundness of their views. The consequences of their stance affected millions of HIV infected South Africans severely.

How do institutional review boards apply the federal risk and benefit standards for pediatric research?

CONTEXT

Federal regulations allow children in the United States to be enrolled in clinical research only when the institutional review board (IRB) determines that the risks are minimal or a minor increase over minimal, or that the research offers a prospect of direct benefit. Despite this reliance on IRBs, no data exist on how IRBs apply the risk and benefit categories for pediatric research.

OBJECTIVE

To determine how IRB chairpersons apply the federal risk and benefit categories for pediatric research.

DESIGN, SETTING, AND PARTICIPANTS

Telephone survey, conducted between May and August 2002 of 188 randomly selected chairpersons of IRBs in the Unites States. The survey consisted of 21 questions to assess the application of federal risk standards to research procedures, whether certain interventions offer a prospect of direct benefit to participating children, and the extent to which IRBs use the federal definition of minimal risk when categorizing the risks of research procedures in children.

MAIN OUTCOME MEASURES

Responses regarding categorization of the risk level and direct benefits of pediatric research procedures.

RESULTS

A single blood draw was the only procedure categorized as minimal risk by a majority (152 or 81%) of the 188 respondents. An electromyogram was categorized as minimal or a minor increase over minimal risk by 100 (53%) and as more than a minor increase over minimal risk by 77 (41%). Allergy skin testing was categorized as minimal risk by 43 IRB chairpersons (23%), a minor increase over minimal risk by 81 (43%), and more than a minor increase over minimal risk by 51 (27%). Regarding benefits, 113 chairpersons (60%) considered added psychological counseling to be a direct benefit, while participant payment was considered a direct benefit by 10% (n = 19).

CONCLUSIONS

Application of the federal risk and benefit categories for pediatric research by IRB chairpersons is variable and sometimes contradicted by the available data on risks and the regulations themselves. To protect children from excessive risks while allowing appropriate research, IRB chairpersons need guidance on applying the federal risk and benefit categories and also need data on the risks children face in daily life and during routine physical or psychological tests.

What is ethically important in clinical research? A preliminary study of attitudes of 73 psychiatric faculty and residents

The ethical caliber of psychiatric research ultimately rests upon the shoulders of psychiatric clinicians and investigators who perform protocols and are directly responsible for the welfare of study volunteers. Little is known, however, about ethically relevant attitudes of psychiatrists toward human research. Working as part of a larger study, we surveyed all psychiatry faculty and residents at one institution in 1999 regarding the relative importance of 12 elements in the ethical conduct of human research. Responses of 73 participants were analyzed, and three factors emerged: Safeguards and Scientific Merit, Investigator Integrity and Relationship, and Patient Benefit. Safeguards and Scientific Merit, as a set, were the most salient considerations for both psychiatry faculty and residents. We found that residents placed greater importance on all factors and nearly every element than did faculty. Future research is needed to clarify the understanding of the perspectives and priorities of different stakeholders involved in human studies.

The MD-medical doctorate or mandatory doctorate?

The introduction in the UK of the Calman Registrar training scheme envisaged seamless progression from Senior House Officer (SHO) grade through to Consultancy. Within this framework research was acknowledged to be a valuable (but optional) part of the training programme, as laid out by the 'Orange Guide' to Specialist Registrar (SpR) Training [A Guide to Specialist Registrar Training 1998; HM Press]. Time is provided for this activity within the SpR training scheme, but it is becoming increasingly evident that the majority of formal research (towards post graduate degrees) is being carried out by so-called 'gap' SHO's in order to gain entry into Higher Surgical Training (HST) programmes [Ann R Coll Surg Engng 81 (1999) 182], [Br J Plast Surg 55 (2002) 463-468]. With this in mind, a survey of all Plastic Surgery SHO's in the UK was undertaken to assess the extent of clinical research undertaken by individuals, and the perceived need for formal research for career progression.

Assessing the quality of research

Inflexible use of evidence hierarchies confuses practitioners and irritates researchers. So how can we improve the way we assess research?