Even when published in the top journals, cardiology research is not immune to investigators putting a positive spin on results that are neutral at best, according to a systematic review.
Among 93 randomized trials for which the primary endpoints missed statistical significance, 57% of abstracts and 67% of main report papers were subject to some spin, or "the manipulation of language to potentially mislead readers from the likely truth of the results," reported Richard Krasuski, MD, of Duke University Health System in Durham, North Carolina, and colleagues.
Main reports featured a spin in 11% of titles, 38% of results sections, and 54% of conclusion sections, while abstracts had a spin noted in 41% of results sections and 48% of conclusion sections, Krasuski's group reported online in JAMA Network Open
Faced with non-significant primary efficacy outcomes, trialists tended to divert attention to statistically significant secondary endpoints, within-group analyses, and subgroup analyses, Krasuski and colleagues noted.
"To best apply evidence to patient care, consumers of cardiovascular research should be aware that peer review does not always preclude the use of misleading language in scientific articles," the study authors wrote. "Our results align well with findings of spin in reports from other medical areas."
The study analyzed 93 parallel-group trials published from 2015 to 2017 in six high-impact journals: The New England Journal of Medicine, The Lancet, JAMA, The European Heart Journal, Circulation, and The Journal of the American College of Cardiology.
Pilot studies, research letters, non-inferiority trials, cluster trials, and crossover trials were among those excluded.
Limitations of the study were the focus on such a short period and the few journals, the researchers acknowledged.
"We can only speculate on the reason authors use [a] positive spin," they wrote. "Incentives likely play a role. Publication in high-impact journals fosters career advancement and future grant funding."
"Nevertheless, failure to maintain a critical and dispassionate perspective is a disservice to the research community, funding agencies, the practicing physicians who must decide which treatments to use, and the lay public," commented Stephan Fihn, MD, MPH, of the University of Washington, Seattle, in a linked editorial.
"As editors of JAMA Network Open, we pay extremely close attention to accurate reporting," he said. "We meet twice weekly to review and discuss submissions, and almost invariably there are one or more manuscripts for which the authors have placed their results in a more favorable light than we consider justified."
Fihn noted that he and his fellow journal editors have requested on several occasions that authors recast the conclusions of a manuscript from weakly positive to categorically negative.
"In an era in which truth is seen as a scarce commodity, dedication to fair and responsible reporting of scientific results is essential to preserving trust in the clinical research enterprise," he wrote.
This could take more publication of neutral findings by the high-impact journals, Krasuski's group suggested, adding that more robust editorial and peer review might also reduce the level of spin in the literature.
Krasuski reported receiving grants from Edwards Lifesciences and Abbott; receiving grants and personal fees from Actelion; and serving as a nonfunded scientific advisor for Ventripoint.
Fihn disclosed no relevant conflicts of interest.
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JAMA Network Open
Source Reference: Khan MS, et al "Level and prevalence of spin in published cardiovascular randomized clinical trial reports with statistically nonsignificant primary outcomes: a systematic review" JAMA Network Open 2019. DOI: 10.1001/jamanetworkopen.2019.2622.
JAMA Network Open
Source Reference: Fihn SD "Combating misrepresentation of research findings" JAMA Network Open 2019. DOI: 10.1001/jamanetworkopen.2019.2553.
Read the original article on Medpage Today: 'No-Spin Zone'? Not in Cardiology