Monthly Archives: July 2008

Statins “R” US

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The American Academy of Pediatrics has stirred up a controversy with its new recommendations for childhood cholesterol management. Appearing in this month’s edition of Pediatrics, the guidelines instruct doctors to begin cholesterol screening in children ages two to ten with risk factors such as obesity, diabetes and a family history of high cholesterol. For interventions, the authors recommend a healthy diet, nutritional counseling and physical activity – nothing surprising. But here’s the kicker: doctors should consider prescribing cholesterol-lowering statins for children as young as eight with high cholesterol.

This last recommendation has concerned people for a number of reasons. Although research shows that statins can lower cholesterol in adults and children, critics argue that no studies have lasted long enough to assess the long-term effects of taking the drugs so early in life. Furthermore, the article contains no conflict-of-interest disclosures from its seven authors, one of whom has worked as a consultant for Merck & Co., a company that makes statins, and another who has been involved in industry-backed clinical trials on cholesterol meds. Finally, there is concern that the recommendations will put pressure doctors to prescribe statins to kids with borderline high cholesterol – those who could otherwise control it with diet and exercise.

“This report has taken on a new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension and cardiovascular disease in older children and adults,” the authors assert. But is it possible that pushing statins for certain kids will actually worsen the obesity epidemic by shifting emphasis away from the more fundamental issues of diet and lifestyle?

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Photo by striatic via Flickr

Ignorance is bold

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Hi.

I haven’t been blogging for quite a while now. A combination of factors got on the way: I’ve been traveling, I’ve been covering at the journal for some of my colleagues who have been traveling, Coco and Roxanne have been doing a great job blogging about much more interesting stuff than I had, and, to be perfectly honest, I lost a lot of the motivation I need in order to sit down in front of the computer and type.

But the reaction elicited by last Friday’s report about the PLoS journals published in Nature was of sufficient importance to help me muster the energy to say one or two things about the many writings that have appeared in relation to that piece.

First, having previously commented on open-access publishing in this forum, I explicitly want to distance my journal and myself from any pejorative descriptors that might have been applied to the science published by the PLoS journals. I’m not an advocate of open access, but the quality of what open-access journals publish has never been an issue I have cared to discuss in public.

Second, I want to commend my colleague Maxine Clarke for being one of our few senior members of staff to face the backlash elicited by the Nature report, exposing herself to more vitriol in the process. Bravo, Maxine!

Third, to say that the Nature Publishing Group decided to publish Declan Butler’s report to intentionally damage the reputation of the PLoS journals shows a profound degree of ignorance about how editorial decisions are made in our journals. The business side of our trade never has any input on the editorial decisions to run whichever piece we care to publish, and the editors take a lot of pride in this fact.

To say that Nature ran the story because our firm is afraid of the open-access publishing model (another reaction to the news piece that I’ve encountered far too frequently) is also absurd. It’s like saying that we are afraid of Science, Cell or any other of our competitors. Our firm is not afraid of competition; we respect our competitors and observe what they do, the same way that our rivals are surely familiar with our strengths and weaknesses.

Furthermore, although I’m not free to discuss figures, our business model continues to be very successful, thankyouverymuch. Last, our firm has always been proactive in taking part in the open-access debate, and our directors have always engaged in productive discussions with some of the most influential advocates of open access (e.g. the NIH). So, to say that we are afraid of the open-access movement is also a very ignorant comment to make.

Fourth, I take strong exception to the comment I’ve seen in several blogs regarding the qualifications of journal editors to do their job, referring to them as failed postdocs who couldn’t cut it in academia. The job of editor is not fundamentally different from any other profession, scientists included — it pays the rent and puts bread on the table. To argue that someone who decided to pursue a career in academia is, almost by definition, more successful than an editor is not only absurd, but extremely arrogant.

In fact, I’d argue that many more practicing scientists than editors are frustrated with their careers; I know many mediocre scientists, but couldn’t think of a single mediocre research editor, not only at the Nature Publishing Group, but also among my many colleagues from journals that also employ professional editors. At a personal level, I’m convinced that to have the opportunity to work surrounded by so many intellectually sharp and well informed colleagues as there are at our journals is a privilege that many people who stay in academia don’t ever get to experience.

These comments should not be construed as an attempt to defend Butler’s article. As I implied above, I prefer to distance myself from some of his comments. Instead, I’m simply trying to defend the integrity of my profession and the integrity of those of us in the publishing world who care about the advancement of science and are proud of what we do.

“La ignorancia es atrevida” goes a saying in Spanish that, roughly translated, means “Ignorance is bold”. Judging from some of the comments I’ve read in response to the Nature article, it seems that the anonymity cloak provided by the blogosphere is very conducive to this purposeless kind of boldness. And speaking of Spanish sayings, this recent cartoon by (in my opinion) Spain’s best cartoonist — Forges — that appeared in the newspaper El Pais perfectly summarizes this point.

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“The blogosphere is a blessing. Thanks to it, he doesn’t bray at home any more.”

“Congratulations!”

A premature recommendation for IVF?

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This week fertility experts have descended on Barcelona for the annual meeting of the European Society for Human Reproduction & Embryology. Thirty years after scientists created the first ‘test tube’ baby Louise Brown, the discussion among these experts is not just about the ability to achieve pregnancy through in vitro fertilization (IVF) but also access to such treatment.

Many women in parts of Africa have inadequate access to cheap fertility treatments, including IVF, according to Willem Ombelet, head of an ESHRE task force at the focused on infertility in developing countries. Crucially, infertility can carry a huge stigma in Africa, causing women to lose inheritance rights and suffer accusations of witchcraft, for example.

One solution to the problem suggested at the conference was the development of low-cost clinics that substitute traditional IVF incubators with a water bath for the cells. This revised procedure could, if supported by the right infrastructure, potentially reduce the cost of IVF to around $200, claim its developers.

But women living in certain developed countries also suffer from a lack of access to fertility care, according to Guido Pennings, who recently published an ESHRE task force paper on cross-border reproductive care. One might also call this ‘reproductive tourism’, though Pennings voiced his dislike for this phrase. Essentially he and the other members of the task forced reached a conclusion that when a woman cannot receive the fertility treatment she wants in her country – for example because the waiting list is too long or the type of treatment she needs is forbidden by law – her physician has a “moral obligation” inform her about the option of seeking fertility care abroad.

The recommendation seems relatively harmless, until one considers that given the current demands of health care systems it’s unlikely that physicians have the time to closely track the success of uncertified foreign clinics. Pennings notes that ESHRE can certify clinics as meeting certain standards; but it will take years for such certifications to be widely adopted. For now, many women and doctors must rely on word-of-mouth and internet searches to choose the right fertility clinic abroad.

In my view, these recommendations supporting cross-border reproductive care come too soon. In fact, with the current lack of monitoring, increased reproductive tourism could create an environment where local women are exploited in egg donation and surrogacy. Pennings, meanwhile, maintains that it’s best for physicians to advise their patients on reproductive care abroad since these women will likely seek it anyway. Do you think the recommendations are premature?

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Photo by Morten Liebach via Flickr

An oath for lIfe scientists?

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Life scientists sometimes work with dangerous pathogens and chemicals capable of causing grave damage to human health; they engineer novel organisms and conduct high-stakes clinical trials. These scientists are also under incredible pressure to produce results, publish papers and get ahead in their fields. One would hope that all researchers, especially those in the life sciences, adhere to the highest ethical standards. But a recent study by the US Department of Health and Human Services suggests this might not always be the case. The survey by the agency’s Office of Research Integrity found that 9% of US scientists believed they had observed possible research misconduct, such as fabricated research records and misleading grant applications.

To address this issue, the Institute of Medical Science at the University of Toronto has its students recite an oath before embarking upon their graduate studies. The oath is short and pithy; students pledge, among other things, to “pursue knowledge and create knowledge for the greater good, but never to the detriment of colleagues, supervisors, research subjects or the international community of scholars.” They swear never to allow “financial gain, competitiveness, or ambition” cloud their judgment in research and scholarly endeavors.

This strikes me as an excellent idea. Providing students with an opportunity to proclaim their good intent in front of peers is a great way to cultivate a responsible culture. I think all life science graduate programs should be doing this. What do you think?

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Photo by The Opus

Screening sunscreens

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A watchdop group has called on the US Food and Drug Administration to shed some light on sunscreens. The government agency has failed to finalize standards for testing and labeling sunscreens, says a report by the Washington, DC-based nonprofit Environmental Working Group. The report also concludes that 85% of sunscreens on the market either contain potentially toxic ingredients or fail to provide enough protection from both UVB and UVA radiation. Most products shield the skin from UVB rays, which cause sunburn as well as DNA damage associated with skin cancer.

A study published yesterday in the journal of the Federation of American Societies for Experimental Biology (FASEB), provides details to support the idea that UVB rays are more likely to cause cancer. However, research published in May suggests that the deeper-penetrating UVA rays that cause skin aging also suppress the immune system, compromising the body’s ability to protect itself against the development and spread of skin cancer.

The FDA is currently considering sunscreen labeling changes to help consumers make better choices, but in the meantime, the American Academy of Dermatology offers this advice: Use broad spectrum sunscreen products of SPF 15 that protect against UVA and UVB rays. Lather it on everyday and wear protective clothing.

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Image by Daquella manera