Gaming of Impact Factors: New tactic or did they just get caught?

Ben Goldacre, one of this blog's favorite journalists/authors/doctors/critics, has a fascinating new post up on his secondary blog.  We all know that a journal's impact factor is largely useless for grading the quality of an individual paper. This follows from the old idiom, that you can't judge a book by it's cover. However, impact factors are also a poor way of comparing the quality of journals themselves. For one, journals that contain many review articles have higher impact factors since reviews are cited more frequently than original research. Journals game their impact scores by publishing more review articles. Now there is evidence that editors are gaming impact scores by forcing authors to cite articles from their journals before accepting the paper! Craziness.

The evidence from a revise and resubmit letter: “The Editors would also greatly appreciate you adding more than two but fewer than six references of articles published in [the Journal involved], above all articles published over the past two years.” Even more evidence that you can't judge a book by the cover.

I would write more, but I gotta go round, so I leave it to Mr. Bo Diddley...

references:
(1) Ben Goldacre Secondary Blog - 16 January 2012
(2) F. Avanzini et al. Journal of Thrombosis and Haemostasis

Science Friday (the 13th): TDR-TB

Maryn McKenna (@marynmck) of Superbug fame will be on Science Friday (Hour 1: 2-3pm ET) tomorrow to discuss Totally Drug-Resistant TB.  She has had some very informative posts recently on the topic, including discussion of the two earliest known patients in Italy who died in 2003.  She also reports on the latest twelve TDR-TB cases in a single Indian hospital and points us to an ahead-of-print letter in CID posted in December that discusses the diagnosis and care of the first four of these patients in India.  Turn on, tune in...


Superbug post #2: Earliest Cases of TDR-TB
Superbug post #1: Latest Cases of TDR-TB in India

(Eli @eliowa)

Support open access!

There is an excellent OpEd piece in today's New York Times by Michael Eisen, one of the founders of the Public Library of Science. A few years ago, the NIH mandated that any studies performed that were federally funded must be made available free of charge to citizens since they had paid for the research through their tax dollars. This obviously had an impact on journals that use the traditional business model of publishing, wherein the reader bears the cost of publication via subscription, either individually or through a library. Several years ago, the open access model of publishing emerged. In this business model, the cost of publication is borne by the author, often via funds from the research sponsor. However, papers published in this model are free to the reader.

The OpEd piece today points out that some notable journals in the traditional publishing model, including the New England Journal of Medicine, are now lobbying Congress to pass a law reversing the NIH rule so that they would no longer be required to make the papers available at no cost to readers. In response, Dr. Eisen calls on researchers to publish their studies only in open access journals and for libraries to cancel their subscriptions to journals that are not open access. The greed demonstrated by journals that are financially healthy is unpalatable. However, open access is a problem for investigators who publish papers that do not have a funding source, since the publication fees are often in excess of $1000 per paper. This is particularly a problem for hospital epidemiology, a field in which much research is unfunded, and is likely one of the reasons that the open access journal Antimicrobial Resistance and Infection Control has had a slow start. Open access is clearly a great concept and it should be maintained for studies that are federally funded. And for those of us who believe that medical and scientific research is a public good, further expanding open access by reducing or eliminating authors' fees via novel approaches is a worthy goal.

Tragedy of the commons: Antibiotics in Agriculture

@marynmck broke the story right before Christmas that FDA had silently posted that they are backing-off of their long-held (1977) plan to limit overuse of agricultural antibiotics. Instead of formal bans and policy change the FDA now hopes to “focus its efforts for now on the potential for voluntary reform and the promotion of the judicious use of antimicrobials in the interest of public health.”

So here is the current US policy for protecting a critical and diminishing resource for public health:  Please Please Please don't use antibiotics!  Please?  How about if I'm nice? No? Pretty Please. Sugar on top?  Perhaps we should call this the "Don't let the Pigeon Drive the Bus Policy."  I guess it kinda worked in the book. Kinda.

So after burying the bad news on a Thursday before a major holiday weekend, the FDA posted some sort of half-good news right after the new year. You guys excited?  So what was the good news?  They will limit cephalosporins (woo woo) but with so many loopholes and restrictions that it won't matter much. Today, a NYT Editorial in frustration pointed out that FDA "will ban the injection of the antibiotics into chicken eggs and halt the practice of giving large, sustained doses to cattle and pigs. But it still allows widespread use in animals like rabbits and ducks, and veterinarians will still be able to use the drugs in ways not specifically approved by the FDA."

We've written about this issue many times before.  It's amazing that we continue to squander critical antibiotics in animal populations, while at the same time barely funding efforts to develop new antibiotics or new infection prevention strategies. The NYT stated today that "it’s time for the FDA to consider the public’s health as carefully as it considers the interests of intensive agriculture and pharmaceutical companies." Hear Hear.

Sources:

1) Maryn McKenna, Superbug Blog 12/23/2011
2) NYT Editorial "FDA Creeps Forward" 1/11/2012

Break-bone Fever in the Conch Republic

Key West by Kerne Erickson

I love Key West! With its predictably warm weather (even in January!), its lack of pretentiousness, and its welcoming attitude, what is there not to like about this little island? Well, apparently there is one thing: the latest issue of Emerging Infectious Diseases has a paper (full text here) on the reemergence of dengue in Key West.

Three clinical cases of dengue were acquired there in 2009, which prompted the CDC to investigate further. A serosurvey done in September 2009 showed that 3-5% of residents in the Old Town area had been recently infected. In 2010, an additional 63 clinical cases were reported.

I guess I'll have to take along some mosquito repellent next time I head to Margaritaville.

Hospital + fountain = trouble

Photo: Urban Review STL

A report in this month's Infection Control and Hospital Epidemiology describes an outbreak of Legionellosis involving 8 patients who ended up hospitalized at two hospitals. Via good old fashioned shoe leather epidemiology, it was determined that the only common exposure among these patients was exposure to a hospital with a wall-type water fountain in the lobby. Environmental cultures revealed that the fountain was heavily contaminated with Legionella pneumophila serogroup 1. A few years ago, Dan blogged about another Legionella outbreak associated with a indoor fountain in a hospital. If your hospital has one of these, shut it down!

The long road to fast and accurate resistance detection

I’d like to say that molecular diagnostics will soon provide nearly instantaneous detection of antimicrobial resistance in clinical samples, allowing for rapid targeting of appropriate therapy. I’d like to say that, but I can’t. Even MRSA, a bug with a relatively simple resistance mechanism (simple relative to, say, MDR Acinetobacter), is proving to be a tough nut to crack. Remember this post of mine, about Cepheid’s recall of their Xpert SA/MRSA blood culture assay? Well, another “valued customer” notice went out last week, informing users that this product requires “additional test optimization” and “clinical re-validation”—so it will be unavailable until at least the end of 2012. Labs and hospitals that have come to rely on this test to improve their antimicrobial management of S. aureus bacteremia will now have to find another approach.

I’m posting not to knock Cepheid, but to make the point that bringing new rapid diagnostic methods to a clinical microbiology laboratory environment, and applying them to clinical care in unforgiving situations (e.g. would you like to have your MRSA bacteremia treated with nafcillin for the first 2-3 days?) is difficult! The makers of agar plates will be keeping their day jobs for a while….