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Psychiatry is, to an extent, a looking glass world, in which the evidence base can be shrunk, expanded, or, the same as Alice, made to descend down a deep, deep hole.
Joanna Moncrieff for anti- psychotics (1), and Irving Kirsch for anti- depressants, have been suspicious that the drugs concerned may often be not much better than placebo- or that the complexity of the drugs makes comparison with placebo problematic. (Moncrieff cites the impossibility of true double blinding because side effects are, unfortunately, so evident for patients and clinicians alike).
The problem is money. Big Pharma tends to be avaricious, and how soon greed may make one disregard that silly obstacle known as truth!
Spin can be the case even if there appears to be statistical significance. A large sample size- as in meta-analysis- will conclude a tiny difference, of no medical worth, is statistically significant. 'Overpowering' is spin too.
Big Pharma, roaming around its own psychopharmacological 'wonderland', is ensuring, in the most bizarre and baffling ways possible, that everything is 'curiouser and curiouser'.
(1) The Bitterest Pills. The Troubling Story of Anti-Psychotics. Joanna Moncrieff. Palgrave Macmillan. 2013.
We welcome the publication of the Jellinson study (9) which is consistent with the focus on research integrity lead by the BJPsych editorial team (please see our most recent retraction (1) and associated editorial (2)).
The issue of ‘spin’ is a widespread problem across the whole research community and is not unique to psychiatry as recognised by the authors of this study (3, 4, 5). We note that according to the protocol the authors are carrying out and publishing similar studies in the fields of cardiology, otolaryngology (6), orthopaedic surgery, obesity medicine (7), anaesthesiology (8) and emergency medicine.
It is unclear from the article or protocol why this subset of journals was chosen for evaluation. We would be interested to know why the number of journals was limited to 6 and what were the parameters for a journal to be considered ‘influential’. It is also interesting to note that none of the journals chosen exclusively publish psychology research (2 publish psychiatry and psychology research and the remaining 4 journals solely publish psychiatric research). Do the authors infer that the problem is more prevalent in influential psychiatry journals? The authors also acknowledge that identifying spin is subjective, highlighting the difficulties faced by journal editors and reviewers who are also trying to identify instances of spin.
Since December 2017 (the end of data extraction in the study), the BJPsych has proactively t...
Since December 2017 (the end of data extraction in the study), the BJPsych has proactively taken steps to reduce spin in the reporting of randomised control trials by mandating submission of the appropriate research reporting checklist (CONSORT) which is accessible to editors and reviewers, introducing additional stages for editors to carefully check manuscripts, mandating the prospective registration of clinical trials and increasing the length of abstracts to avoid over-simplification.
Research integrity is a priority for the journal and we welcome partnerships to develop, improve and implement further guidelines surrounding these issues.
1. Guo Z-H, Li Z-J, Ma Y, Sun J, Guo J-H, Li W-X, et al. Brief cognitive–behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China – RETRACTION. The British Journal of Psychiatry. Cambridge University Press; 2019;215(1):435–: https://doi.org/10.1192/bjp.2019.91
2. Bhui KS, Lee W, Kaufman KR, Lawrie SM. Ensuring research integrity: setting standards for robust and ethical conduct and reporting of research. The British Journal of Psychiatry. Cambridge University Press; 2019;215(1):381–2: https://doi.org/10.1192/bjp.2019.109
3. Lazarus C, Haneef R, Ravaud P, et al. Classification and prevalence of spin in abstracts of non-randomized studies evaluating an intervention. BMC Med Res Methodol 2015;15:85 https://doi.org/10.1186/s12874-015-0079-x
4. Patel SV, Van Koughnett JA, Howe B, et al. Spin is common in studies assessing robotic colorectal surgery: an assessment of reporting and interpretation of study results. Dis Colon Rectum 2015;58:878–84. https://doi.org/10.1097/DCR.0000000000000425
5. Mathieu S, Giraudeau B, Soubrier M, et al. Misleading abstract conclusions in randomized controlled trials in rheumatology: comparison of the abstract conclusions and the results section. Joint Bone Spine 2012;79:262–7. https://doi.org/10.1016/j.jbspin.2011.05.008
6. Cooper, C. M., Gray, H. M., Ross, A. E., Hamilton, T. A., Bea Downs, J. , Wayant, C. and Vassar, M. (2019), Evaluation of spin in the abstracts of otolaryngology randomized controlled trials. The Laryngoscope. doi:10.1002/lary.27750
7. Austin, J, Smith, C, Natarajan, K, Som, M, Wayant, C, Vassar, M. Evaluation of spin within abstracts in obesity randomized clinical trials: A cross‐sectional review. Clin Obes. 2019; 9:e12292. https://doi.org/10.1111/cob.12292
8. Presence of ‘spin’ in the abstracts and titles of anaesthesiology randomised controlled trials Kinder, N.C. et al. British Journal of Anaesthesia, Volume 122, Issue 1, e13 - e14 https://doi.org/10.1016/j.bja.2018.10.023
9. Jellinson, S., Roberts, W., Bowers, A., et al. Evaluation of spin in abstracts of papers in psychiatry and psychology journals. BMJ Evidence-Based Medicine. Published Online First: 05 August 2019. doi: 10.1136/bmjebm-2019-111176