As discussed by Toronto Star‘s Stuart Laidlaw and Pharmalot’s Ed Silverman, the journal Psychotherapy and Psychosomatics recently drew attention to the practice of publishing multiple journal articles from the results of one clinical trial in a study they titled “A Case Study of Salami Slicing: Pooled Analyses of Duloxetine for Depression” (PDF). Duloxetine, for the record, is an Eli Lilly drug better known as Cymbalta.
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Salami slicing is well known (and disliked) by top-flight journal editors who, Laidlaw said, often require authors to “declare if any part of the underlying research has been – or soon will be – published elsewhere.” Still, the researchers behind the Psychotherapy and Psychosomatics paper found it remains widespread, at least in the case of Cymbalta.
The authors speculate that the practice is propelled by two key factors: researchers who want to increase their exposure and publication counts and pharmaceutical manufacturers who want to “widely disseminate” the results of positive studies and create an artificially inflated base of scholarly support for their products.
Researchers defend the practice as cost-effective, saying that medical trials can be prohibitively expensive, and salami slicing is one way to extract as much research as possible from one trial. Additionally, they say that trials are intentionally designed to be sliced, and that there are often multiple separate issues that each warrant their own manuscript.
Laidlaw also found at least one researcher who took issue with the semantics of the practice’s sensation-friendly label.
“I would be careful of anything that’s given a folksy name,” says Dr. Ralph Meyer, director of the National Cancer Institute of Canada’s Clinical Trials Group at Queen’s University.
On MSNBC.com, University of Pennsylvania bioethics professor Arthur Caplan takes a tough stand on flu vaccines for health professionals, imploring them to stop “whining” and “moaning.” “Doctors, nurses, respiratory therapists, nurses’ aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work,” Caplan writes. According to Caplan, a 100 percent workers’ vaccination rate can cut patient flu deaths and worker sick days by about 40 percent, and thus health workers who claim mandated flu shots are an infringement of their rights are forgetting a key ethical tenet of their profession, that they put the interests of the patient above their own.
It’s the idea of rights infringement that really sets Caplan off:
Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?
Caplan’s a fellow and former associate director of the Hastings Center, a nonpartisan bioethics think tank.
A just-released survey conducted by the American Society of Health-System Pharmacists finds that health workers are asking pharmacists the same questions (PDF) that patients are asking:
- Is the H1N1 vaccine safe? (Patients: 52%, Hospital Employees: 54%)
- Do I need to get the H1N1 vaccine? (Patients: 33%, Hospital Employees: 43%)
- Will there be enough H1N1 vaccine to around? (Patients: 27%, Hospital Employees: 27%)
The ASHP also says that “While pharmacists are authorized to administer vaccinations to adults [in most states], the survey also finds that most hospitals are not planning to utilize pharmacists for this service. ” The organization – made up of 35,000 members who include pharmacists, pharmacy technicians and pharmacy students – is encouraging hospitals and health systems to use pharmacists to administer vaccines to increase vaccination rates. The survey also looks at other H1N1 influenza preparedness issues as well.