Guy Tsafnat, me, Paul Glasziou and Enrico Coiera have written an editorial for the BMJ on the automation of systematic reviews. I helped a bit, but the clever analogy with the ticking machines from Player Piano fell out of Guy’s brain.
In the editorial, we covered the state-of-the-art in automating specific tasks in the process of synthesising clinical evidence. The basic problem with systematic reviews is that we waste a lot of time and effort in trying to re-do systematic reviews when new evidence becomes available – and in a lot of cases, systematic reviews are out-of-date nearly as soon as they are published.
The solution – using an analogy from Kurt Vonnegut’s Player Piano, which is a dystopian science fiction novel in which ticking automata are able to replicate the actions of a human after observing them – is to replace the standalone systematic reviews with dynamically and automatically updated reviews that change when new evidence is available.
At the press of a button.
The proposal is that after developing the rigorous protocol for a systematic review (something that is already done), we should have enough tech so that clinicians can simply find the review they want, press a button, and have the most recent evidence synthesised in silico. The existing protocols determine which studies are included and how they are analysed. The aim is to dramatically improve the efficiency of systematic reviews and improve their clinical utility by providing the best evidence to clinicians whenever they need it.
G Tsafnat, AG Dunn, P Glasziou, E Coiera (2013) The Automation of Systematic Reviews, BMJ 346:f139
A new study published in the BMJ shows the prevalence of financial conflicts of interest in the panel members producing clinical guidelines. For consumers of healthcare delivery (that means everyone), I think it is valuable to know that doctors get their information from guidelines, and about half of the people developing those guidelines have financially-based conflicts of interest (e.g. they get money from pharmaceutical companies). The fact that this is not a surprise is probably the most worrying issue.
This is the second time that we’ve heard that journals have become “an extension of the marketing arm of pharmaceutical companies”.
Unfortunately, the double-edged sword is that many talented people do excellent work, and get money from pharmaceutical companies. Removing financial conflicts of interest would remove their talent from the construction of evidence and guidelines.
In a data briefing published in the last couple of days in the BMJ, there was an interesting graphic that indicated the public perception of the healthcare system. Although it isn’t particularly easy to find the source of the information in the Health Affairs cited by Appelby (an article with open access), the results are particularly striking for Australia.
While over 60% of the public in the UK believe that only minor changes are needed, around 75% of Australians believe that our health system needs fundamental changes or a complete rebuild. This perception is even more negative than the US, for which the system is widely known to be overly expensive and suffering from huge gaps in access for the disadvantaged.
A nice editorial about the kinds of data available from industry-funded clinical trials, which was published yesterday in the BMJ and written by an inter-continental group of authors.
Ensuring safe and effective drugs: who can do what it takes?
In an article in BMJ, Deborah Cohen and Philip Carter (a journalist) have written down the links between the people giving expert advice to the World Health Organisation about the severity of the H1N1 epidemic and the financial ties they had to the drug company that manufactures the vaccine, tamiflu. Sadly, this sort of biased information is rife throughout medicine – how else will these people buy bigger yachts and fancier mansions without taking more money from stupid people?
WHO found to be lacking in credibility, again?
From the freely-accessible abstract linked above: “Since the serendipitous discovery that drugs used to treat narcolepsy (modafinil) and attention deficit hyperactivity disorder (such as methylphenidate and atomoxetine) can improve the brainpower of healthy people, public and scientific interest has grown. Although the current level of use among doctors is unknown, data indicate that a large proportion of other groups in society (such as students and more senior academics) are currently choosingto use these substances.”
The article goes on to say that the use of these drugs by doctors is likely to be tolerated by society because they are not prone to misuse (coupled with the trust and responsibility we have for doctors, I suppose) and because they are being used for ‘the public good’.
Would you use modafinil? Do you know the risks?
A pro-use stance on performance-enhancing drugs for doctors