Box 93 Ways to enhance the impact of positive studies or reduce the impact of negative studies

• Withhold "negative" trials from being published at all by keeping them as "data on file"

• Delay release of such "negative" studies into the public domain

• Publish negative studies in an obscure or non-English language journal

• Select outcome measures that show the treatment in a better light

• "Torture" the data by performing multiple statistical tests on subgroups

• Select one of many statistical techniques to show the results in the best light

• Divert attention from the main "negative" findings by emphasising biomedical markers and "mechanism of action"

• Incorrectly interpret equivalence studies, for example by suggesting that two drugs are the same when the confidence intervals surrounding their differences are large

• Use a comparator that other studies have not used in order to avoid a head-to-head comparison with a current established treatment

• Do not highlight adverse events in the abstract and discussion sections

• Use optimistic language and writing styles when discussing essentially negative studies - for example repetition for positive results

• Publish positive study results in duplicate or triplicate - overtly or even covertly conclusions about an existing treatment may be equally susceptible to being influenced by their own prejudices when testing and writing up the results for that treatment. In assessing a study, readers should always consider who sponsored the study, and ask themselves whether such sponsorship could have influenced the results or the way that they are presented. Absence of declared sponsorship may not mean absence of sponsorship.24

Attempts to overcome limitations in the conduct, reporting and publication of clinical trials

To overcome many of the difficulties discussed in this section, calls for better standards of reporting of trials have led to the CONSORT statement.25 This contains a structured checklist for reporting the details of clinical trials, including methods of randomisation and concealment, blinding, ITT analysis and a flow diagram to illustrate the progress of trial participants. Several dermatology journals now require that submitted clinical trial reports meet CONSORT standards to be published.26

Whereas CONSORT may help with better reporting of trials, the creation of prospective clinical trial registers has been seen as one possible way of ensuring that the trial results eventually reach the public domain, and for checking that the investigators adhered to their original protocol.27

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