850 e-Letters

  • Editor's Note

    This is a note to indicate that BMJ Open is still looking into the disagreement between Albert Donnay and the authors of the paper.

    We will post further updates on the article in due course.

  • Response to letter from Alasdair Philips

    We recently reported on brain tumour incidence time trends in 20 to 59 year old Australians, from 1982 to 2013, and analysed these in terms of mobile phone usage patterns and diagnostic improvements over that interval1. This was designed to determine whether claims that mobile phone use causes brain tumours, are consistent with the pattern of brain tumour incidence in Australia, and in particular to compare such incidence patterns with the results of the multinational Interphone case control study2. In summary, we reported that: 1/ Overall brain tumour incidence rates did not change over time; 2/ Increased glioblastoma incidence was seen during intervals that coincided with improvements in diagnostic technologies (CT, MRI); 3/ Decreased incidence of ‘unspecified’ tumours was seen during the same intervals; and 4/ No evidence of increased tumour incidence (including glioblastoma) related to mobile phone use was found (based on incidence rates seen during the period of substantial mobile phone use and on modelling using a range of hypothetical relative risks and latency periods).

    Philips submitted a Letter to the Editor3 of BMJ Open, where he purports to show that there are ‘significant flaws and unjustifiable conclusions’ in the above paper. Although he may firmly hold this view, his letter does not provide any evidence of this, and we strongly disagree with his statement. We have addressed the substance of his letter below to hopefully obviate potential misunderstan...

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  • Research Assistant - Error correction.

    Page 8/9; Acknowledgements.
    The spelling of research assistant Rohan Navani was misspelt as Rohan Navari.

  • Significant flaws and unjustifiable conclusions

    Karipidis et al report that in Australia, glioblastoma (GBM) incidence increased significantly only during the period 1993-2002. They conclude that this was due to diagnostic improvements and that there has been no increase in any brain tumour histological type or glioma location that can be attributed to mobile phones.

    I am lead author of an ecological study published early in 2018 that examined detailed underlying incidence trends for 81,835 biologically malignant (ICD10 C70) brain tumours, recorded in England over the period 1995-2015 [1]. Karipidis et al cite our study and note that we reported that the overall incidence of GBM more than doubled over that time period (from 2.4 to 5.0 per 100,000 person years, age-standardised to the European Standard Population ESP2013, with annual case numbers rising from 983 to 2531). Zada et al (2012) [2] and Ho et al (2014) [3] have reported similar trends.

    Although we briefly discussed five possible causal factors that might have contributed to the rise in incidence, we stated that our article reported incidence data trends and did not provide additional evidence for the role of any particular risk factor. We showed that most of the rise in incidence was in people over 55 years of age. We discussed the possible mix of promotion of lower grade tumours and de-novo tumours. We also discussed the effect of better imaging and more accurate diagnosis and concluded that although it did have an effect, especially for topogra...

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  • Biased Study and Misrepresentation of Actual Rates of Plagiarism in African Medical Journals

    We write to express our concern about the prevalence estimate of plagiarism in African medical journals in the study reported by Rohwer et al.(1) The authors’ finding that 63% of African medical journal articles are plagiarized to some degree is a gross overestimate.

    The study definitions of “some,” “moderate,” and “extensive” plagiarism are unvalidated and, as the authors admit in the fourth paragraph of their Discussion section, lack inter-rater reliability and precision. Articles were classified as having “some” plagiarism if there were as few as 1-2 sentences that included identical words or sentences in another article by different authors even if the sentences were properly referenced. Numerous publishing organizations, including the Council of Science Editors,(2) the World Association of Medical Editors,(3) and the US Office of Research Integrity,(4) reserve the use of plagiarism for instances when another’s words are used without proper credit or attribution. The authors developed their definition based on suggestions from the Committee on Publication Ethics (COPE), yet even COPE’s Flowchart for managing suspected plagiarism in a submitted manuscript defines plagiarism as “unattributed use of large portions of text and/or data.”(5)

    In fairness to the African journals implicated in the study, we request the authors go back to their data, identify all instances in which identical wording with formal source citations were defined as plagiarism, recalcu...

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  • Decline in neonatal mortality in Northern Ghana: Non-specific effects of BCG vaccination or Improvements in health systems?

    Decline in neonatal mortality in Northern Ghana: Non-specific effects of BCG vaccination or Improvements in health systems?

    In an ecological study carried out in Northern Ghana, Welaga et al., assessed changes in neonatal mortality rates (NMR) and BCG vaccination age from 2002 to 2012. The authors found that among home deliveries, median BCG vaccination age declined from 46 days in 1996 to 4 days in 2012. Within the same period , NMR decreased from 46 to 12 per 1000 live births (1). The authors concluded their study by suggesting that the significant decline in mortality observed may be due to the beneficial non-specific effects of early BCG vaccination. The authors should be commended for studying whether BCG vaccination may have non-specific effects. However, several issues need to be raised when interpreting these results.
    1) Adjustment for other vaccine effects
    The authors did not expand on the potential role that improvements on the Expanded Programme on Immunization (EPI) in Ghana may have played in reducing neonatal mortality. Diarrhea and Pneumonia are the main causes of neonatal mortality. Although still sub-optimal, Rotac and PCV3 immunization coverage estimates for Ghana in 2012 were significantly better than in 1996 or 2002 (2). A similar trend was observed for almost all the vaccines in the EPI schedule. For example, UNICEF immunization coverage estimates for Ghana indicate that DTP3 vaccine coverage increased from 71 % in 1996 to 92 %...

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  • In-hospital dementia deaths

    Dear Sirs,

    My research has detected curious patterns of on/off switching in international deaths. Basically, deaths run at a baseline level and then suddenly switch-on to a new and higher level for around 12 to 18 months after which they switch-off and revert back to the baseline. They stay at baseline until the next switch-on event. Deaths in person's with Alzheimer's and other dementias seem highly sensitive to the switch-on events. This curious behaviour is most readily revealed using a rolling (running or moving) 12-month total or average.

    In England, in-hospital deaths show the same on/off-switching.

    Should you have access to monthly data it may be useful if you could apply such a rolling 12-month analysis of the data.

    You can access a list of publications relating to this research at http://www.hcaf.biz/2010/Publications_Full.pdf

    I have proposed that this behaviour may reflect some new type or kind of disease outbreak, however, this is open to further research.

    I hope this response is helpful.

  • Brain damage and chronic kidney disease may be caused by exposure to toxic chemicals

    There is much evidence that exposure to various chemicals, such as lead, chromium, tin, mercury, welding fumes, silicon and in particular organic solvents, may cause both brain damage1-3 and chronic kidney disease,4-7 including diabetic kidney disease.8 Therefore, I suggest that the authors, assisted by occupational hygienists, investigate whether their patients are exposed to such chemicals.

    1. Edling C, Ekberg K, Ahlborg G Jr et al. Long-term follow up of workers exposed to solvents. Br J Ind Med 1990;47:75-82.
    2. Kukull WA, Larson EB, Bowen JD et al. Solvent exposure as a risk factor for Alzheimer's disease: a case-control study. Am J Epidemiol. 1995;141:1059-71.
    3. Yamanouchi N, Okada S, Kodama K, Sato T. Central nervous system impairment caused by chronic solvent abuse-a review of Japanese studies on the clinical and neuroimaging aspects. Addict Biol. 1998;3:15-27. doi: 10.1080/13556219872317.
    4. Zimmerman SW, Groehler K, Beirne GJ. Hydrocarbon exposure and chronic glomerulonephritis. Lancet. 1975;2(7927):199–201.
    5. Ravnskov U, Lundström S, Nordén Å. Hydrocarbon exposure and glomeru-lonephritis: evidence from patients’ oc¬cupation. Lancet. 1983;2(8361): 1214–6.
    6. Nuyts GD, Van Vlem E, Thys J et al. New occupational risk factors for chronic renal failure. Lancet 1995;346(8966):7–11
    7. Ravnskov U. Hydrocarbons may worsen renal function in glomerulonephritis: a meta-analysis of the case-control studies. A...

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  • Results?

    Where can I find the results to this study? email me either the results or the article please

  • From conclusion to action

    Dear Editor,

    This paper highlights the reasons behind high stillbirth in India. The authors have underlined the importance of recording stillbirths to know the reasons why. Now the need is to translate the conclusions of this study into actions. Immediate action is needed to incorporate the reasons highlighted in this study into modules recently published by National Health Mission like, Induction Training Module for ASHAs in Urban Areas and Guidebook for Enhancing Performance of Auxiliary Nurse Midwife (ANM) in Urban Areas, March 2017. Both of these key modules don't focus on stillbirth and its reasons beautifully highlighted in this study. Translating knowledge into action is the first step in controlling the problem in question and this needs to be done at the earliest opportunity to have safe outcome of pregnancy.