Monday, February 25, 2013

JAMA & Procalcitonin

Someday, I'll publish another article summary that doesn't involve a conflict-of-interest skewering.  I'm really not as angry as Rob Orman says I am.  This article, at least, is directly relevant to the Emergency Department.

There's been significant research into biomarkers for infectious/inflammatory processes, with the goal of identifying a sufficiently sensitive assay to use as a "rule-out" for serious infection.  The goal is to use such an assay to prevent the overuse of antibiotics without increasing morbidity/mortality.  This is a good thing.


Procalcitonin is the latest darling of pediatrics and intensive care units.  However, to call the literature "inconclusive" is a bit of an understatement – which is why I was surprised to see an article in JAMA squarely endorsing procalcitonin-guided antibiotic-initiation strategies.  After all, I've previously covered negative trials in this blog (pubmedpubmed).  However, these authors seem to have intentionally narrowed their trial selection to exclude these trials – and publish no methods regarding their systematic selection of articles.


The disclosures for all three authors includes "BRAHMS/Thermofisher".  Who is this, you might ask?  Google points me to: http://www.procalcitonin.com – where BRAHMS/Thermofisher will sell you one of seven procalcitonin assays.  JAMA, third-ranked medicine journal in Impact Factor, reduced to advertising masquerading as peer-reviewed science.


"Clinical Outcomes Associated With Procalcitonin Algorithms to Guide Antibiotic Therapy in Respiratory Tract Infections"http://www.ncbi.nlm.nih.gov/pubmed/23423417

8 comments:

  1. Misleading science is probably worse than bad science.

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    1. Probably? No, it's definitely worse.

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  2. Glad to see someone shine a light on this.

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  3. Good point Ryan, as usual!
    After I read carefully those papers, seems that Jensen was also paid by that Brahms company for the negative paper too! is it the same?

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  4. It ought to be the same company. This is not a topic I'm innately familiar with, other than to be aware that it's hardly settled science - which makes the JAMA article at least befuddling, at the minimum.

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  5. Yeah, I think that anyway the best way to judge a biomarker value is to try it on patients and then make a local retrospective evaluation. Opinions in papers, good or bad are just that, opinions! I know it's not used as much in USA as in Europe, any of you tried it?

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