Public Library of Science - PLoS Medicine

PLoS Author Surveys 2009 – Summary Presentation

Mark Patterson — Wed, 23 Dec 2009 02:45:25 -0800

Earlier this year, PLoS sent out a series of surveys to authors whose work was considered by our journals in 2008. We wanted to find out what authors think about all aspects of our services – from submission and peer review, through to publication and the functionality of the PLoS journal web sites.

We have learned a lot from the surveys, primarily that levels of satisfaction amongst authors are generally very good. We also identified areas where services can be improved, and we’ve adjusted our services in a number ways during 2009.

We have now summarized the results of the surveys along with how we have responded to some of the suggestions during 2009 in a short presentation, which is publicly available. We feel it’s important to share these results in particular with the authors who were kind enough to complete the questionnaires, and we would like to express our thanks to the hundreds of authors who took part. We are planning to repeat the surveys next year, so that we can monitor how views have changed and can respond to suggestions for further improvements.

Meanwhile, we welcome feedback from anyone who is using our services, as an author, reviewer, editor or reader.

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PLoS Journals – measuring impact where it matters

Mark Patterson — Mon, 13 Jul 2009 05:22:00 -0700

In 2009, in this online world, how do most scientists and medics find the articles they need to read? The answer for the content published by PLoS (and no doubt by many other publishers) is via one of the now ubiquitous search engines, be it one that only searches the scientific literature, or more likely, one that searches the entire web. Given that readers tend to navigate directly to the articles that are relevant to them, regardless of the journal they were published in, why then do researchers and their paymasters remain wedded to assessing individual articles by using a metric (the impact factor) that attempts to measure the average citations to a whole journal? We’d argue that it’s primarily because there has been no strong alternative. But now alternatives are beginning to emerge.

A few months ago, PLoS initiated a program to provide a series of metrics on the individual articles published in all the PLoS Journals. You can see some examples here, here, here and here. There are two complementary benefits to the new approach.

First, we are focusing on articles rather than journals. The dominant paradigm for judging the worth of an article is to rely on the name and the impact factor of the journal in which the work is published. But it’s well known that there is a strong skew in the distribution of citations within a journal – typically, around 80% of the citations accrue to 20% of the articles. So the impact factor is a very poor predictor of how many citations any individual article will obtain, and in any case, journal editors and peer reviewers don’t always make the right decision. Indicators at the article level circumvent these limitations, allowing articles to be judged on their own scientific merits.

Second, we are not confining article-level metrics to a single indicator. As summarized by Michael Jensen, and discussed by many others including recently over at the Scholarly Kitchen, there’s a lot more to scientific impact than citations in the selection of journals covered by the Web of Science – the proprietary source of data that provides the impact factor calculation. Citations can be counted more broadly, along with web usage, blog and media coverage, social bookmarks, expert/community comments and ratings, and so on. Our own efforts are so far confined to citations (as measured by Scopus and PubMed Central), social bookmarks (as made by users of Connotea and CiteULike), and blog coverage (as recorded by Bloglines, Postgenomic and Nature Blogs), and these metrics will be improved and expanded over the coming months. The good news is that many of these indicators can be collated automatically, using openly available web tools that constantly update information on the article itself.

The presentation of a comprehensive array of this data is an enticing prospect. When an article has been published, we have tended to regard that as the end of the story (barring corrections or the occasional retraction). But if, as frequently happens, a very good article has been published in a specialist journal after being rejected from a highly selective one, it would be great to indicate to a user that this article is actually looking pretty significant, and show how its influence develops over the months and years.

Rather than basing judgments on the importance of research on the opinions of two or three reviewers and editors, article-level metrics will attempt to capture the actions and opinions of entire communities of readers to give a rich and sophisticated picture of research impact that will be helpful to authors and readers alike. Readers may then frame that picture in the context of their particular field and their own work.

To realize the vision for article-level metrics there are still some significant hurdles to clear: it won’t be enough simply to provide indicators without some context or guidance on how to interpret them; some indicators (particularly citations) take months to build up limiting their value as early indicators of impact; and standards will need to be developed so that the indicators are reliable and as free as possible from gaming and manipulation.

A clear editorial selection process will always have a place before publication in a scholarly journal. But a reduction in the reliance on the impact factor for so many aspects of research assessment could be massively liberating. PLoS Medicine, to cite an example close to home, has recently restated its mission – focusing on the diseases and risk factors that have the most profound impacts on global health. By carefully selecting articles that are likely to have the biggest influence on global health and using innovative and diverse approaches to assess and indicate that influence, PLoS Medicine will be a greater force, regardless of how many citations an average article accrues

Looking towards other modes of publishing, PLoS ONE is predicated on the notion that judgements about impact and relevance can be left almost entirely to the period after publication. By peer-reviewing submissions purely for scientific rigour, ethical conduct and proper reporting before publication, articles can be assessed and published rapidly. Once articles have joined the published literature, the impact and relevance of the article can then be determined on the basis of the activity of the research community as a whole. Article-level metrics and indicators, along with other post-publication features are part and parcel of the PLoS ONE approach, and could help readers to filter and sort literature after it is published. Ultimately, the aim of adding value to articles after publication is to improve the whole process of scientific communication and accelerate research progress itself. You can read more about article-level metrics in the context of PLoS ONE, and a talk is also available online from Pete Binfield (Managing Editor of PLoS ONE).

Article-level metrics and indicators will become powerful additions to the tools for the assessment and filtering of research outputs, and we look forward to working with the research community, publishers, funders and institutions to develop and hone these ideas. As for the impact factor, the 2008 numbers were released last month. But rather than updating the PLoS Journal sites with the new numbers, we’ve decided to stop promoting journal impact factors on our sites all together. It’s time to move on, and focus efforts on more sophisticated, flexible and meaningful measures.

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The PLoS Medicine blog channel is moving

Liz Allen — Mon, 22 Jun 2009 12:49:01 -0700

PLoS Medicine now blogs at Speaking of Medicine, and we won't be posting here any more. We outgrew this site in terms of functionality and ease of use a few months ago and it's time to redirect everyone that visits this channel to our new home. You can sign up for updates from our new blog via RSS or e-newsletter.

The new blog site allows us to stream podcasts from our editorial board members, show a video series from our editor-in-chief, post a daily click (picks of interest from the PLoS Medicine team) and quickly and seamlessly keep you updated on what gives in our world and hear from you about what is happening in yours.

Not only do PLoS Medicine and PLoS ONE now have their own blogs, we also have a lively social media program:

@PLoS on Twitter was recommended at the 140 Characters Conference as being "one to watch to learn about science". We have over 1400 followers but we'd like more so please sign up.

We also have a thriving Facebook page with over 4,500 fans so please join us there too.

Thanks for following us here in the past, we look forward to welcoming you to our new home.

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World Hepatitis Day: Prospects for the Future - Guest blog by Paul Klenerman and colleagues

Andrew Hyde — Tue, 19 May 2009 07:41:34 -0700

"World Hepatitis Day...does not usually make the headlines in the same way that World AIDS day does, but viral hepatitis affects about half a billion people globally (perhaps 1 in 12 of the global population) and so the relative publicity associated with World Hepatitis Day does not accurately reflect the importance of hepatitis as a public-health problem.”

In this World Hepatitis Day blog ahead of the formal publication of their Perspective article in PLoS Medicine, Paul Klenerman, Vicki Fleming and Ellie Barnes of the University of Oxford describe research by Christian Drosten and colleagues about a new low-cost diagnostic test for Hepatitis C for use in developing countries. The research was recently published in PLoS Medicine.

The Perspective article by Paul Klenerman and colleagues will be formally published in PLoS Medicine on 16th June 2009.

What Are the Prospects for Controlling Hepatitis C?

Paul Klenerman*, Vicki Fleming, Ellie Barnes

May 19 this year marked World Hepatitis Day [1].This event does not usually make the headlines in the same way that World AIDS Day does, but viral hepatitis affects about half a billion people globally (perhaps one in 12 of the global population), and so the relative publicity associated with World Hepatitis Day does not accurately reflect the importance of hepatitis as a public health problem.

The two major hepatitis viruses—hepatitis C virus (HCV) and hepatitis B virus (HBV)—share a number of features. Both viruses are readily spread through the transfer of infected blood or blood products. Both cause persistent infections and share an insidious progression after decades of asymptomatic carriage that creates a huge burden of end-stage liver disease and liver cancer. Thus, both viruses are major public health problems across the globe. However, there are substantial differences between these infections in terms of the risk groups affected, the geographical distribution of the viruses, and the tools at our disposal to deal with them.

Prospects for Controlling HBV and HCV

For HBV we have a well-established vaccine and an emerging panel of well-tolerated oral agents for the treatment of chronic infection. Although there is still a massive burden of complex and severe infection to tackle, the pathway towards effective combination therapy has already been trodden in HIV, and careful clinical trials in this area for HBV should bring some clarity. Delivery of such drug combinations in resource-poor settings where the prevalence of carriage is high will create its own significant challenges.

For HCV we have no current vaccine, and current therapies are toxic, complex, and expensive, as well as only partially effective. Treatment is further complicated by HIV coinfection, which is increasingly encountered in some risk groups [2]. So why is the prevention and treatment of HCV infections apparently so far behind that of HBV infections? One reason is that HCV was only identified in 1989, and only successfully cultured in 2005 [3,4]. However, the major biological hurdle to controlling HCV is the hTuge diversity of the virus, both within patients and among populations [5].

HCV is an RNA-based virus with a variable genome and the capacity to evolve over time to evade drug and immunologic pressure. HCV has coevolved with human populations for centuries, if not millennia [6], and has diversified widely over this period (Figure 1). By comparison, the phylogenetic tree of HIV is much more compact because this virus has had less than a century in which to diversify in humans.

The net result of this diversification is the existence of seven major genotypes of HCV (the last added very recently) that share less than 80% sequence homology with one another, and more than 50 HCV subtypes [7]. Although these genotypes may have arisen over long periods as endemic strains in geographically distinct regions (e.g., genotype 6 in southeast Asia [8]), most have now spread globally. Genotype 1 is particularly common in western Europe and the United States, although genotype 3 is also now very common in the United Kingdom as a result of its spread through intravenous drug–using populations and through immigration from the Indian subcontinent.

Multiple genotypes occur in many other viruses, including HBV, but their importance in HCV is particularly high because both the duration and success rate of current treatments for HCV infection (pegylated interferon-alpha and ribavirin) are highly genotype dependent. Thus, genotypes 2 and 3 are typically associated with much greater response rates than genotypes 1 and 4 (70%–80% long-term clearance versus 40%–50%) and require shorter treatment periods (six months versus one year) [9]. The biological basis for these differences is unclear—the genomes of these genotypes are so diverse that such differences could result from multiple complex changes. Even within a single genotype (e.g., genotype 1), the fundamental mechanisms behind relative resistance to treatment of different HCV subtypes are not fully defined, although an interferon-sensitivity determining region has been described [10].

The Role of Nucleic Acid Tests for HCV

Given these important clinical and virologic differences between HCV genotypes, robust and sensitive nucleic acid tests for HCV have a major role to play in virus detection and in guiding treatment and thus are at the core of current clinical practice in developed countries. However, these tests are relatively complex molecular tests and are therefore not universally available. Additionally, they may not be equally sensitive at detection of all genotypes. In a recent article in PLoS Medicine, however, Christian Drosten and colleagues described a new approach to nucleic acid testing in HCV [11].

The authors generated a test based on a highly conserved region in the 3? end of the virus (most current tests are based on the 5? end) and validated their assay to show that it was sensitive in detection of a wide range of genotypes from geographically diverse populations. They also attempted to reduce the overall cost of their approach and have thus provided a novel system that uses an open (i.e., nonproprietary) protocol that might be particularly appropriate for resource-poor settings. This new assay is potentially an important step forward for laboratories in such regions and, if rolled out effectively, could provide novel information relevant to the prevalence, clinical impact, and treatment response of HCV genotypes that are currently poorly studied—most clinical analyses, and vaccine and treatment trials have focused on genotype 1.

Although very simple and cost-effective tests to detect, quantify, or genotype HCV in resource-poor areas could be of great value in future, the overall costs and usefulness of any such test in comparison to other methods and in relation to other public health priorities in such regions will need to be considered carefully. Thus, although conventional PCR methods as used by Drosten and colleagues look promising, non-PCR-based methods such as loop-mediated isothermal amplification (LAMP) also need to be considered, since little specialist equipment is required for LAMP and the sensitivity appears to be high [12]. In the end, however, the definitive test for any new method of HCV analysis will be clinical utility in the field.

The Extreme Viral Diversity of HCV

As we mark World Hepatitis Day, the recent paper by Drosten and colleagues once more draws our attention to one of the key features of HCV: its extreme viral diversity, which brings enormous challenges for the future. The capacity for HCV to evolve creates a complex target for both vaccine and drug development. Nevertheless, recent advances in both these areas provide some cautious hope for the future—at least in the case of genotype 1 infection [13,14]. Key to successful vaccine development will be the generation of effective, sustained, and broad anti-HCV immune responses. However, the immune responses to non–genotype 1 viruses are very poorly described, and recent data suggest that there is relatively little overlap between immune responses to genotypes 1 and 3. Thus, at present it is unclear whether HCV vaccines against specific genotypes will provide any cross-protection against other genotypes [15]. The situation with drugs may be even more complex, with pre-existing diversity even within genotype 1 already providing some level of drug resistance [16].

Future studies of the diverse HCV genotypes that exist globally—hopefully facilitated by the recently published methods—will, therefore, help us understand the overall clinical impact of HCV in affected populations and will determine our potential to intervene. Since HCV emerged from the shadows 20 years ago, it has shown itself to be “smarter than the average virus.” Thus, it may take longer than 20 years for us to put it back into the shadows, and it will probably take all our efforts to do so.

References
1. World Hepatitis Alliance (2009) World Hepatitis Day. Available: http://www.worldhepatitisday.org/. Accessed 11 May 2009.
2. Klenerman P, Kim A (2007) HCV–HIV coinfection: Simple messages from a complex disease. PLoS Med 4: e240. doi:10.1371/journal.pmed.0040240
3. Houghton M (2009) Discovery of the hepatitis C virus. Liver Int 29 (Suppl 1): 82- 88.
4. Wakita T, Pietschmann T, Kato T, Date T, Miyamoto M, et al. (2005) Production of infectious hepatitis C virus in tissue culture from a cloned viral genome.
Nat Med 11: 791-796.
5. Simmonds P (2004) Genetic diversity and evolution of hepatitis C virus—15 years on. J Gen Virol 85: 3173-3188.
6. Pybus OG, Charleston MA, Gupta S, Rambaut A, Holmes EC, et al. (2001) The epidemic behavior of the hepatitis C virus. Science 292: 2323-2325.
7. Kuiken C, Simmonds P (2009) Nomenclature and numbering of the hepatitis C virus. Methods Mol Biol 510: 33-53.
8. Pybus OG, Barnes E, Taggart R, Lemey P, Markov PV, et al. (2009) Genetic history of hepatitis C virus in East Asia. J Virol 83: 1071-1082.
9. Zeuzem S, Berg T, Moeller B, Hinrichsen H, Mauss S, et al. (2009) Expert opinion on the treatment of patients with chronic hepatitis C. J Viral Hepat 16: 75-90.
10. Torres-Puente M, Cuevas JM, Jimenez-Hernandez N, Bracho MA, Garcia-Robles I, et al. (2008) Genetic variability in hepatitis C virus and its role in antiviral
treatment response. J Viral Hepat 15: 188-199.
11. Drexler JF, Kupfer B, Petersen N, Grotto RMT, Rodrigues SMC, et al. (2009) A novel diagnostic target in the hepatitis C virus genome. PLoS Med 6: e1000031. doi:10.1371/journal.pmed.1000031
12. Nagamine K, Hase T, Notomi T (2002) Accelerated reaction by loop-mediated isothermal amplification using loop primers. Mol Cell Probes 16: 223-229.
13. Thompson AJ, McHutchison JG (2009) Review article: Investigational agents for chronic hepatitis C. Aliment Pharmacol Ther 29: 689-705.
14. Thimme R, Neumann-Haefelin C, Boettler T, Blum HE (2008) Adaptive immune responses to hepatitis C virus: From viral immunobiology to a vaccine. Biol Chem 389: 457-467.
15. Schulze Zur Wiesch J, Lauer GM, Timm J, Kuntzen T, Neukamm M, et al. (2007) Immunologic evidence for lack of heterologous protection following resolution of HCV in patients with non-genotype 1 infection. Blood 110: 1559-1569.
16. Gaudieri S, Rauch A, Pfafferott K, Barnes E, Cheng W, et al. (2009) Hepatitis C virus drug resistance and immune-driven adaptations: Relevance to new antiviral therapy. Hepatology 49: 1069-1082.
17. Bao Y, Bolotov P, Dernovoy D, Kiryutin B, Zaslavsky L, et al. (2008) The influenza virus resource at the National Center for Biotechnology Information. J Virol 82: 596-601.
18. Combet C, Penin F, Geourjon C, Deleage G (2004) HCVDB: Hepatitis C virus sequences database. Appl Bioinformatics 3: 237-240.
19. Division of AIDS, National Institute of Allergy and Infectious Diseases (2009) HIV databases. Available: http://www.hiv.lanl.gov/. Accessed 11 May 2009.

Figure 1 Legend

Complete genome trees of the hepatitis C virus, HIV-1 (M-group), and the hemagglutinin region of influenza A. Nucleotide sequences were randomly selected from their respective databases representing each of the major subtypes from each virus [17–19]. Only non-recombinant genomes were included. Maximum likelihood trees were built using GARLI (Genetic Algorithm for Rapid Likelihood Inference, available at http://www.nescent.org/). Trees have been drawn to the same scale.

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Focusing PLoS Medicine on the diseases and risk factors that cause the greatest losses in years of healthy life worldwide

Virginia Barbour — Tue, 28 Apr 2009 03:30:08 -0700

The editorial published in this week’s PLoS Medicine looks back over the 5 years since the journal made its first call for papers and describes a new evidence-based approach to the aims and scope of the journal, which emphasizes the focus of PLoS Medicine on the diseases and risk factors that cause the greatest losses in years of healthy life worldwide.

We also want to emphasise the need to look beyond just the biological causes of disease. As the world faces up to the challenges of a changing climate, a turbulent economic system, continued global conflict – and now a possible influenza pandemic - we now wish to reinforce the important place in health research of work that encompasses the social, environmental, and political determinants of health, as well as the biological.

All articles published this week in the journal illustrate the journal’s priorities.

In the research section the following articles are published: Anders Bjorkman and colleagues’ trial of rapid diagnostic testing for malaria diagnosis in Zanzibar; Majid Ezzati and colleagues’ study of US data on risk factor exposures and disease-specific mortality; and Matthias Egger and colleagues'comparison of mortality rates between African patients starting HIV treatment and the general population. In the magazine section a Health in Action article by Yibeltal Assefa and colleagues describes scale-up of antiretroviral treatment across Ethiopia, Bruno Marchal and colleagues argue in a Policy Forum that strategies which strengthen health systems are overly selective, and Daniel Reidpath and colleagues use the fourth Millennium Development Goal (MDG) as an example of the potential to neglect equity in the race to achieve the MDGs.

We conclude the editorial by saying that we believe our new, evidence-based, approach will not only ensure that open-access publishing reflects the health priorities of the 21st century, but will also reaffirm and revitalize the long tradition of medical journals leading, rather than following, the debate over research priorities.

See the guidelines in the journal for more details.

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In the news: "silent" heart attacks

Virginia Barbour — Fri, 17 Apr 2009 14:41:12 -0700

A couple of news sites jumped the gun on a paper on “silent” heart attacks by Han Kim and colleagues of Duke University scheduled for publication next week. Because of the embargo break we released the paper early. Until it is featured on our home page the paper and its associated perspective by Clara Chow can be found easily by clicking on the links in this blog.

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Easier commenting - and now rating - on PLoS Medicine papers

Virginia Barbour — Wed, 15 Apr 2009 03:38:02 -0700

It’s been a couple of weeks since PLoS Medicine moved to our open source publishing platform and apart from saboteurs cutting cables (which caused problems to not only us but a number of other businesses) all is working very well. As well as the new article level metrics in the article re-design, the major change readers of PLoS Medicine will notice is probably the way in which it is possible to submit feedback on the articles. It’s now much easier to post comments and notes on articles (see below for a definition of these and a summary of our guidelines) and even to rate articles.

Notes: These provide a way of anchoring short comments to specific parts of the text of an article, or to linking out to external material. To add a note, use your cursor to select the specific text you want to comment on. A pop-up box will then appear with a link to our commenting and rating guidelines if you select "continue", you will then see another pop up box where you can enter the text of your comment, and your competing interests. Anchored "comment" icons then show where in the text notes have been entered, and notes also appear on the "comments" tab at the top of each article. This tool provides a good way of, for example, linking out to additional resources such as entries for datasets in the public domain.

Comments: This tool allows readers to provide more extensive discussion of an entire article. All discussion threads are also listed on the "comments" tab at the top of each article, and to add a new comment, go to this tab and click the link "make a new comment on this article". These comments can subsequently become threaded, since the authors of the original article or other readers can then respond to the original comments.

Ratings: Any user can assign ratings to an individual article, in relation to its insight, reliability, and style. Ratings are then aggregated and displayed on the right hand side of each article.

We will feature notable discussions on the journal's homepage, in order to highlight the papers which are getting our readers talking. We also have a mechanism for talking down unsuitable comments - but please do flag up any you have concerns with.

We’d encourage everyone looking at our papers to try out the new functionality. If you’d like more information on posting or rating please get in touch via our email - plosmedicine@plos.org.

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News reporting of suicide in ex-military personnel

Gavin Yamey — Tue, 17 Mar 2009 09:17:20 -0700

In this month's PLoS Medicine editorial, we discuss the public health risks associated with sensationalized media reporting of suicide, including the risk of promoting copycat suicides.

We decided to write the piece because we knew we were going to publish a study about suicide, and we were concerned that reporters might sensationalize the findings.

The study, by Nav Kapur and colleagues, examined the suicide rate in those who had left the UK Armed Forces. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. The researchers found that the overall suicide rate in the ex-military personnel was similar to that in the general population. However, young men aged 24 years or less who left the UK Armed Forces had a two to three times higher risk of suicide than young men in the general population or those still in active service. The absolute risk in these young ex-military personnel was small (the crude rate of suicide was 29.9 per 100,000 person years in 16-19 year olds, and 34.0 per 100,000 person years in 20-24 year olds).

As we say in our editorial, there are previous examples of dramatic media portrayals of suicide in soldiers. In 1995, for example, there was a stream of dramatic Canadian newspaper reports about military personnel who committed suicide during or after UN peacekeeping duties in Bosnia. Yet a subsequent case control study found no increased suicide risk in peacekeepers as a whole (although it did find an increase in a subgroup of air force personnel).

One of the problems with sensationalized media reporting of suicide is that some research has found that it can be associated with "copycat" suicides. In our editorial, we therefore addressed three related questions: What types of media reports are most likely to have an effect upon suicidal behavior? What constitutes safe media reporting? what could PLoS Medicine do to promote the responsible reporting of the study?

Media portayals of suicide, we say, "are more likely to be associated with suicidal behavior when they are prominent on the page (e.g., large headlines, photos of the body), appear in multiple places (e.g., several TV networks and newspapers), report celebrity deaths, and are based on real rather than fictional (e.g., TV soap opera) suicides."

Several organizations, such as the US Centers for Disease Control, the Samaritans, and the Canadian Psychiatric Association (CPA), have issued guidelines to the media on safe reporting of suicides. The CPA, for example, urges reporters to avoid the following: giving details of the suicide method; repetitive, excessive, or front page coverage; “exciting” reporting; romanticized or simplistic reasons for the suicide; and the idea that suicide is unexplainable.

So what steps did we take to encourage non-sensationalized reporting of Kapur and colleagues' study? We wrote a sober press release, adopting principles that we laid out in a previous editorial. In the press release about the study, we included links to guidelines on safe media reporting and suggested to journalists that they include in their reports information about organizations (e.g. the Samaritans) offering support to those with suicidal thoughts. And, with Professor Kapur’s consent, we contacted these organizations ahead of the paper’s publication to let them know about the study’s findings and the likely upcoming media attention.

What kind of news coverage did the study elicit, and what was the quality of the reporting?

The study was covered internationally (the UK, Spain, India, the US, and elsewhere), in print, online, and on TV, and as a whole the coverage was factually accurate and not overly hyped. There were, however, a few exceptions.

For example, the Sunday Mirror broke the embargo in what they called an "exlusive" (“Young War Veterans are Three Times More Likely to Kill Themselves-Exclusive”). The reporter, Rupert Hamer, called the study "a shocking new report" and stated that it "shows that suicide rates among vets from the Army, Navy and RAF have rocketed in recent years." Rocketed in recent years? The study found no such thing.

And The Times did go into detail about the suicide methods used by the young ex-military personnel, something that the CPA advises reporters to avoid.

One of the best reports was by BBC News. They interviewed Nav Kapur to ask him what he thought might be the explanation for the higher suicide rate in young ex-military personnel. The news report gave the absolute numbers of people in the cohort study and of those who killed themselves. It gave one of the fullest pictures of the study' findings--for example, it stated that "the overall suicide risk was no greater for ex-military personnel than for civilians when all age groups were considered, from 16 to 49 years" and that "men aged 30-49 years had a lower rate of suicide than the general population." And the BBC included a helpful figure showing the age-related risk of suicide in ex-military personnel compared with the general population.

It was disappointing that reporters failed to give readers details about organizations that can offer help and support to those experiencing suicidal thoughts. And I'd also argue that, by and large, they missed an opportunity to discuss and de-mystify suicide more broadly, including the fact that suicide is usually related to a treatable mental illness. As Jeremy Paxman says in his introduction to the Samaritans' guidelines on safe media reporting: "Positive outcomes of suicide reporting include bringing a subject that remains somewhat taboo into the public arena, helping to de-mystify it and challenging the stigma that still surrounds people willingly taking their own lives."

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False claim about a PLoS Medicine editor and PLoS board member

Gavin Yamey — Thu, 12 Feb 2009 06:13:33 -0800

I wanted to alert you to an e-mail that is in circulation, advertising an upcoming journal called Scientific Medicine. The e-mail states that the journal ‘comprises of several top-end basic science researchers, practicing clinicians, medical scientists and international journal editors from across the world (Mainly US, Europe and India)’ and then it goes on to name me and Richard Smith (a member of the PLoS Board of Directors) in the list of those involved. However, neither Richard nor I have ever heard of the journal, and we did not give our permission to be named as editorial board members, nor is PLoS or PLoS Medicine in anyway associated with the journal. We have written to the Managing Editor of Scientific Medicine, asking that the journal immediately stops attaching our names to the launch.

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FDA's "Good" Reprint Practices Now Policy

Emma Veitch — Mon, 26 Jan 2009 08:54:45 -0800

Quick update on the FDA's draft policy regarding promotion of off-label drug use, which Gavin blogged about last July. Despite widespread negative publicity in the blogosphere along with opposition from health organisations and consumer advocates, the proposals have now been released as formal guidance from the agency. Essentially this policy now means that drug companies can promote off-label drug use by circulating reprints of journal articles describing those uses to doctors. Providing the FDA's guidance is followed, FDA does not see the activity as "establishing intent that the product be used for an unapproved new use..." We know, for all the reasons described in Gavin's blog (and in a recent PLoS Medicine article), that promoting off-label use is potentially harmful to patients. (Note also this week Eli Lilly has been reported in BMJ as settling "the largest individual corporate fine in history", in relation to off-label promotion of olanzapine). Despite this, the policy is described as only "guidance", with the document stating that "FDA's guidance documents do not establish legally enforceable rights or responsibilities". I, and presumably others, are left wondering how it will be possible for the agency to enforce pharmaceutical promotion in the future.

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