Sponsorship of Medical Textbooks by Drug or Device Companies

Background: To study whether medical textbooks are sponsored by drug or device companies, and if so, whether they have tried to influence their contents. Methods: Cross-sectional study of the medical textbooks written in Danish for graduate clinical courses at the University of Copenhagen and anonymous web-based survey of editors. For sponsored books, we also contacted the authors.  Results: Eleven of 71 medical textbooks (15%) were sponsored. We contacted 11 editors, and for 8 books that had authors that were not editors, we also contacted one author. Ten editors and 5 authors replied. One editor was contacted 5 times by the various sponsors concerning the content of specific chapters and in another case the sponsor had the content of a chapter changed regarding its own drug. Two of the authors noted that they did not know that the book was sponsored. Conclusions: Sponsorship of medical textbooks was not uncommon and may lead to lack of academic freedom. Medical students may be particularly vulnerable to commercial influences, as they have had little or no training in commercial biases and generally believe what they read in textbooks

Screening for health risks: A social science perspective

Health screening promises to reduce risks to individuals via probabilistic sifting of populations for medical conditions. The categorisation and selection of 'conditions' such as cardiovascular events, dementia and depression for screening itself requires prior interpretive labour which usually remains unexamined. Screening systems can take diverse organisational forms and varying relationships to health status, as when purported disease precursors, for example 'pre-cancerous' polyps, or supposed risk factors, such as high cholesterol themselves, become targets for screening. Screening at best yields small, although not necessarily unworthwhile, net population health gains. It also creates new risks, leaving some individuals worse-off than if they had been left alone. The difficulties associated with attempting to measure small net gains through randomised controlled trials are sometimes underestimated. Despite endemic doubts about its clinical utility, bibliometric analysis of published papers shows that responses to health risks are coming to be increasingly thought about in terms of screening. This shift is superimposed on a strengthening tendency to view health through the lens of risk. It merits further scrutiny as a societal phenomenon

Readers as research detectives

Flaws in research papers are common but it may require arduous detective work to unravel them. Checklists are helpful, but many inconsistencies will only be revealed through repeated cross-checks of every little detail, just like in a crime case. As a major deterrent for dishonesty, raw data from all trials should be posted on a public website. This would also make it much easier to detect errors and flaws in publications, and it would allow many research projects to be performed without collecting new data. The prevailing culture of secrecy and ownership to data is not in the best interests of patients

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

Objective To estimate the extent of overdiagnosis (the detection of cancers that will not cause death or symptoms) in publicly organised screening programmes