1328 e-Letters

  • Methodological concerns regarding "Identifying features of quality in rural placements for health students: scoping review"

    A potential methodological limitation with regard to the use of Campbell et al.'s work-integrated learning (WIL) framework is a remaining concern for this otherwise competent and revealing review.

    Authors describe this framework as follows: "Campbell et al’s framework to support assurance of institution-wide quality in WIL is an evidence-based and comprehensive instrument that groups elements required for high quality WIL into four domains: student experience, curriculum design, institutional requirements and stakeholder engagement." (p.3). The two sources cited for this description are the framework itself and Campbell et al. IJWIL 2021;22:505–19. Examining the first source reveals this framework evolved from a partnership between three universities in Australia, and it is not clear to what extent the WIL framework been adopted outside of this network domestically nor internationally. Clarifying this is necessary given the international scope of this evidence overview, and authors state this in the Discussion.

    However, the claim the framework is an "evidence-based and comprehensive instrument" is problematic if it is based on the cited literature. The second citation quotes interviews with Australian higher-education faculty and administrators in a workshop setting, but this kind of self-assessment is not empirical evidence of the "quality" of learner experience. Campbell et al. appear cognizant of this when writing,...

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  • Acceptance of COVID-19 vaccines in sub-Saharan Africa over time

    The question of COVID-19 vaccine acceptance in Sub-Saharan Africa remains of considerable interest as vaccination campaigns are finally underway but vaccination rates are still lagging in most countries in the region.
    Since publishing this paper, we have reported the results from new survey rounds in our High Frequency Phone Surveys (HFPS) series in a blog post. The focus of this new set of results is on vaccine acceptance rates over time. Our surveys in Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda allowed us to observe the vaccine acceptance of the same respondents once in 2020 and then a second time in 2021. We asked: How stable have the high levels of COVID-19 vaccine acceptance in Sub-Saharan Africa remained between 2020 and 2021?
    We found that overall vaccine acceptance remained high – but with some caveats. In Burkina Faso, Ethiopia, and Nigeria acceptance rates started high at above 75 percent, and then fell by between 1.5 and 6 percentage points over time (Burkina Faso, 2020: 75.7%, 2021: 69.4%; Ethiopia, 2020: 98%, 2021: 96.6%; Nigeria: 2020, 87.5%, 2021: 83.2%). However, these differences are not statistically significant. In contrast, in Malawi, we observed a larger relative drop in acceptance of nine percentage points which was statistically significant (Malawi, 2020: 82.6%, 2021: 73.4%). Finally, in Uganda we observed a statistically significant increase in vaccine acceptance from 84.2% in 2020 to 88.8% in 2021.
    Beyond the aggregate fi...

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  • In regard to Arlotto et al.

    In BMJ Open, Arlotto and colleagues reported the results of a retrospective single center study in Marseille, about the life-years lost by COVID-19 patients during the first pandemic wave from 1 March 2020 to 15 June 2020 (1). The authors concluded that a mortality due to COVID-19 lead to a limited number of years of life lost (YLL) due to both old age and preexisting comorbidities in the most vulnerable patients. As written in the conclusion, theses results should be interpreted “with caution”.
    Crucially, we report several methodological bias:
    -the Charlson Comorbidity Index (CCI) is used to assess what would have been the probability of death within 1 year of these patients in the absence of COVID-19. The 1-year mortality rates used are from the original study based on an inception cohort study of 604 patients admitted to the medical service at New York Hospital during 1 month in 1984. The comorbidity index was then tested for its ability to predict risk of death from comorbid disease in a cohort of 685 patients who were treated for primary breast cancer at Yale New Haven Hospital between 1962 and 1969 (2).

    -Several studies have shown that the weighting of comorbidities is no longer appropriate. Moreover, medical progress since 1984 has not been taken into account at all, as the authors point out in the discussion (3).
    A recent and exhaustive study has been conducted based on 6,602,641 subjects hospitalized in 2010, from medical, surgical, or o...

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  • Concerns regarding methodology part


    Recently, I have been working on ethical analysis of Salt Substitute and Stroke Study (SSaSS). I read it protocol very carefully but I forgot to download it after reading. When I searched it using some paragraphs I pasted in my document, I found it is highly similar to SSaSS's protocol especially in describing informed consent process.

    I am not sure whether this is accepted.


  • From a non-scientist - practical considerations stopped the GBD rather than Twitter

    I’m prefacing this with the fact that I’m not an epidemiologist, virologist, medical scientist in any way, or healthcare worker. I’m therefore VERY hesitant to pop up and appear to be criticizing those who have spent decades in scientific research.

    I am, however, a Councillor in Local Government in the UK with some minimal scientific training (two degrees – physics and military electronic systems engineering), and was therefore a bit involved in the local response to covid (For example, the seventh suggestion by the GBD for focused protection was to offer home delivery to vulnerable people; I assisted in setting up and funding local networks to do just that from March 2020, as did councillors across the UK), so the subject under discussion had immediate impact upon us. Should there have been acceptance of the GBD, I’d have been one of those involved in trying to carry it out (albeit only in a very minor way in comparison to many others). I'm also a qualified and experienced project manager who has had to translate strategies into practice many times.

    It might therefore be of some use to give feedback from that side of things - the core of the question seemed to be "Was it Twitter that stopped implementation of the GBD rather than practical considerations." I can say that my own views of the GBD were not impacted by any Twitter publicizing (I only started reading Twitter some months ago), but because, when reading it with the view of “how wou...

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  • On "weaponization," revisited

    I realize that I stated in my last Rapid Response (RR) [1] that it would probably be my last one, but, given Prof. Ioannidis’ most recent RR [2], I changed my mind.

    Once more unto the breach…

    It remains painfully clear that Prof. Ioannidis still does not understand the utter inadequacy of Twitter follower counts as a measure of social media impact, despite multiple patient and respectful efforts by several RR authors to educate him, most notably Gideon Meyerowitz-Katz [3]. Given all the excellent critiques of this problem with his study, I will not attempt to add mine to them. Instead, I will address something that I can address, the part of his response primarily directed at me, because it betrays a further misunderstanding of science communication that I cannot leave unanswered.

    In his most recent RR [2], Prof. Ioannidis asserts, “The best way for any scientist to ‘control’ use/misuse is to try to do better science, arriving at less biased estimates. I consider science communicators my heroes exactly because they can clarify important points, countering weaponization. They can explain why scientific papers or quotes are not aligned with conspiracy theories. Conversely, if science communicators lambast scientific papers or quotes as being aligned with such theories, they officially surrender science to conspiracy. We should dismantle conspiracy theories, not the science or scientists they misuse.” In the context of his study [4], this criticism widely...

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  • A Simple Request to Professor Ioannidis: Please Address Our Concerns

    We write as a group of scientists who are concerned about ethical and methodological flaws that we have found in Professor John Ioannidis’ paper [1]. These include factual errors, statistical shortcomings, failure to protect the named research subjects from harm, and potentially undeclared conflicts of interest that entirely undermine the analysis presented. We have previously published our concerns about this study in 8 Rapid Responses authored by each of us as individuals [2-9], but since Prof. Ioannidis has declined to address them substantively, we are now writing collectively in the hope that he might consider our joint response more seriously.

    We undertake this effort because, unfortunately, the author’s Rapid Responses to our concerns and criticisms have devolved into what are inarguably personal attacks on some of us. Thus, we wish to state the issues with the study simply and directly and, once again, ask Prof. Ioannidis to address them, but this time in a more objective fashion, free of deflection and personal hostility. There is no doubt that Professor Ioannidis has been one of the foremost scientists of our times. Indeed, he is the most cited living scientist. However, as scientists we believe that we should base beliefs on facts and science over opinions, even if those opinions come from an academic as eminent as Prof. Ioannidis.

    We believe that the facts outlined below completely undermine the paper published in BMJ Open. While individual scient...

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  • Re: Re: Trends in acid suppressant drug prescriptions in primary care in the UK

    We thank the author for their interest in our paper on the prescribing trends of acid suppressant drugs in the UK.1 Our paper found that new users of proton pump inhibitors (PPIs) were slightly older than new users of histamine-2 receptor antagonists (H2RAs), though the prevalence of both drug classes increases with age. As highlighted by the meta-analysis by Wang et al. the observational evidence regarding the risk of dementia associated with acid suppressant use has been inconclusive, with some studies finding an increased risk and others a decreased risk.2 Based on the pooled estimates of 17 studies, the authors did not conclude that the use of acid suppressant drugs is associated with an increased risk of dementia. An important aspect of these studies is that acid suppressant users were compared to non-users, which makes it challenging to separate the effects of the drug from the underlying indication, limiting conclusions that may be drawn regarding the dementia risk. However, as described in our paper,1 there are other serious adverse effects associated with the use of PPIs that have not been associated with H2RAs, including gastrointestinal malignancies, H. pylori infection and hypomagnesemia. We agree with the author that certain indications favour the prescribing of PPIs over H2RAs, though a careful assessment of the risk-benefit profile is warranted.

    1. Abrahami D, McDonald EG, Schnitzer M, et al. Trends in acid suppressant drug prescripti...

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  • Fourth set of replies

    I thank Helling, Meyerowitz-Katz (second comment) and Yamey and Gorski (third comments). I learned a lot in this exchange.
    Meyerowitz-Katz is probably less critical of my work than I am myself. I acknowledged face and construct validity limitations in Twitter metrics. Indeed, number of followers are a surrogate. However, the difference between the two compared groups is extraordinary. Following his comments, I collected also data on number of tweets. Differences are immense: 20 JSM key signatories versus only 2 GBD signatories exceed 6000 tweets each. The top-10 (26900 to 177900 tweets per scientist) are all JSM key signatories. The JSM key signatories unleashed almost a million tweets, roughly 10-fold higher than GBD signatories. Even adding AIER and GBD accounts (25600 and 579 tweets, respectively), the difference remains enormous. Other social media platforms are worth exploring, but access to data is problematic, as Altmetric has also witnessed. Regardless, the stated primary aim of the paper was not to “evaluate the social media visibility of signatories, as denoted by Twitter followers”, but “to examine whether the prevailing narrative that GBD is a minority view among experts is true”: the paper provides strong evidence that this is untrue. Both GBD and JSM are supported by many stellar scientists. The Twitter analysis offers one potential explanation why GBD was dismissed as “unscientific nonsense” by Meyerowitz-Katz (...

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  • Masking of Risk for a Minority

    As recently reported (1), we wonder whether improvement of quality of life for a majority of people (benefiting from the medication) can dilute or completely mask a drastic deterioration of mood in a significant minority? This might explain conflicting data in the literature as expressed in the “highly significant heterogeneity” found in the above systematic review.

    Mayer Brezis, MD MPH, Professor of Medicine (Emeritus), Hebrew University, Jerusalem, Israel
    Former Director of the Center for Clinical Quality & Safety, Hadassah Medical Center

    1. Baldessarini, R.J. and Pompili, M., 2021. Further Studies of Effects of Finasteride on Mood and Suicidal Risk. Journal of clinical psychopharmacology, 41(6), pp.687-688.