Almost 5 years ago something interesting happened in Edinburgh. REWARD and EQUATOR teamed up and organized a joint conference on “Increasing value and reducing waste in biomedical research “. Over the last five years, that topic has dominated Meta-research and research improvement activities all over the world. Now 5 years later, it is again time for another REWARD and EQUATOR conference, this time in Berlin. And I have the honor to serve on the local organizing committee.
My role is so small, that the LOC is currently not even mentioned on the website. But the website does show some other names, promising a great event! it starts with the theme. which is “Challenges and opportunities for Improvement for Ethics Committees and Regulators, Publishers, Institutions and Researchers, Funders – and Methods for measuring and testing Interventions”. That is not a sexy title like 5 years ago, but it shows that the field has outgrown the alarmistic phase and is now looking for real and lasting changes for the better – a move I can only encourage. See you in Berlin?
My interests are broader than stroke, as you can see my tweets as well as my publications. I am interested in how the medical scientific enterprise works – and more importantly how it can be improved. The latest paper looks at both.
The paper, with the relatively boring title “Results dissemination from clinical trials conducted at German university medical centres was delayed and incomplete.” is a collaboration with QUEST, and carried by DS and his team. The short form of the title might just as well have been “RCT don’t get published, and even if they do it is often too late.”
Now, this is not a new finding, in the sense that older publications also showed high rates of non-publishing. Newer activities in this field, such as the trial trackers for the FDAA and the EU, confirm this idea. The cool thing about these newer trackers is that they rely on continuous data collection through bots that crawl all over the interwebs to look for new trials. This upside thas a couple of downsides though: with constant being updated, these trackers do not work that well as a benchmarking tool. Second, they might miss some obscure type of publication which might lead to underreporting of reporting. Third, to keep the trackers simple they tend to only use one definition as what counts as “timely publication” even though the field, nor the guidelines, are conclusive.
So our project is something different. To get a good benchmark, we looked at whether trials executed by/at German University medical centers were published in a timely fashion. We collected the data automatically as far as we could, but also did a complete double check by hand to ensure we didn’t skip publications (hint, we did, hand search is important, potentially because of the language thing). Then we put all the data in a database, made a shiny app so that readers themselves can decide what definitions and subsets they are interested in. The bottomline, on average only ~50% of trials get published within two years after their formal end. That is too little and too slow.
This is a cool publication because it provides a solid benchmark that truly captures the current state. Now, it is up to us, and the community to improve our reporting. We should track progress in the upcoming years by automated trackers, and in 5 years or so do the whole manual tracking once more. But that is not the only reason why it was so inspiring to work on the projects; it was the diverse team of researchers from many different groups that made the work fun to do. The discussions we had on the right methodology were complex and even led to an ancillary paper by DS and his group. But the way this publication was published in the most open way possible (open data, preprint, etc) was also a good experience.
I am happy and honored that I can share that I am going to be part of the PLOS Biology editorial board. PLOS Biology has a special model for their editorial duties, with the core of the work being done by in-house staff editors – all scientist turned professional science communicators/publishers. They are supported by the academic editors – scientists who are active in their field and can help the in-house editors with insight/insider knowledge. I will join the team of academic editors.
Next to the meta-research manuscripts that need evaluation, I am also looking forward to just working with the professional and smart editorial office. The staff editors already teased a bit that a couple of new innovations are coming up. So, next to helping meta-research forward, I am looking forward to help shape and evaluate these experiments in scholarly publishing.
Every year there is a Neurology symposium organized in the quiet and beautiful town of Kuopio in Finland. Every three years, just like this year, the topic is stroke and for that reason, I was invited to be part of the faculty. A true honor, especially if you consider the other speakers on the program who all delivered excellent talks!
But these symposia are much more than just the hard cold science and prestige. It is also about making new friends and reconnecting with old ones. Leave that up to the Fins, whose decision to get us all on a boat and later in a sauna after a long day in the lecture hall proved to be a stroke of genius.
So, it was not for nothing that many of the talks boiled down to the idea that the best science is done with friends – in a team. This is true for when you are running a complex international stroke rehabilitation RCT, or you are investigating whether the lower risk in CVD morbidity and mortality amongst frequent sauna visitors. Or, in my case, about the role of hypercoagulability in young stroke – pdf of my slides can be found here –
I am writing this as I am sitting in the train on my way back to Berlin. I was in Augsburg today (2x 5.5 hours in the train!), a small University city next to Munich in the south of Berlin. SB, fellow epidemiologist and BEMC alumnus, invited me to give a talk in their Vortragsreihe.
I had a blast – in part because this talk posed a challenge for me as they have a very mixed audience. I really had to think long and hard how I could provide something a stimulating talk with a solid attention arc for everybody on the audience. Take a look at my slides to see if I succeeded: http://tiny.cc/beyondbinary
In 6 weeks or so I will be traveling to Finland to speak at the Kuopio stroke symposium. They asked me to talk about my favorite subject, hypercoagulability and ischemic stroke. although I still working on the last details of the slides, I can already provide you with the abstract.
The categories “vessel wall damage” and “disturbance of blood flow” from Virchow’s Triad can easily be used to categorize some well known risk factors for ischemic stroke. This is different for the category “increased clotting propensity”, also known as hypercoagulability. A meta-analysis shows that markers of hypercoagulability are stronger associated with the risk of first ischemic stroke compared to myocardial infarction. This effect seems to be most pronounced in women and in the young, as the RATIO case-control study provides a large portion of the data in this meta-analysis. Although interesting from a causal point of view, understanding the role of hypercoagulability in the etiology of first ischemic stroke in the young does not directly lead to major actionable clinical insights. For this, we need to shift our focus to stroke recurrence. However, literature on the role of hypercoagulability on stroke recurrence is limited. Some emerging treatment targets can however can be identified. These include coagulation Factor XI and XII for which now small molecule and antisense oligonucleotide treatments are being developed and tested. Their relative small role in hemostasis, but critical role in pathophysiological thrombus formation suggest that targeting these factors could reduce stroke risk without increasing the risk of bleeds. The role of Neutrophilic Extracellular Traps, negatively charged long DNA molecules that could act as a scaffold for the coagulation proteins, is also not completely understood although there are some indications that they could be targeted as co-treatment for thrombolysis.
I am looking forward to this conference, not in the least to talk to some friends, get inspired by great speakers and science and enjoy the beautiful surroundings of Kuopio.
postscript: here are my slides that I used in Kuopio
The answer: no. For a long time there has been doubt whether or not we should believe the observational data whether or not limited alcohol use is in fact good for. You know, the old “U-curve” association. Now, with some smart thinking from the KADORIE guys from China/ Oxford as well as some other methods experts, the ultimate analyses has been done: A Mendelian Randomization study published recently in the Lancet.
If you wanna know what that actually does, you can read a paper I co-wrote a couple of years ago for NDT or the version in Dutch for the NTVG. In short, the technique uses genetic variation as a proxy for the actual phenotype you are interested in. This can be a biomarker, or in this case, alcohol consumption. A large proportion of the Chinese population has some genetic variations in the genes that code for the enzymes that break down alcohol in your blood. These genetic markers are therefore a good indicators how much you can actually can drink – at least on a group level. And as in most regions in China alcohol drinking is the standard, at least for men- how much you can drink is actually a good proxy of how much you actually do drink. Analyse the risk of stroke according the unbiased genetic determined alcohol consumption instead of the traditional questionnaire based alcohol consumption and voila: No U curve in sight –> No protective effect of drinking a little bit of alcohol.
Why I am writing about that study on my own blog? I didn’t work on the research, that is for sure! No, it is because the Dutch newspaper NRC actually contacted me to get some background information which I was happy to do. The science section in the NRC has always been one of the best in the NL, which made it quite an honor as well as an adventure to get involved like that. The journalist, SV, did an excellent job or wrapping all what we discussed in that 30-40 video call into just under 600 words, which you can read here (Dutch). I really learned a lot helping out and I am looking forward doing this type of work sometime in the future.