Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: A meta-epidemiological investigation

Narrative bias ("spin") is common in randomised trials and systematic reviews of cannabinoids for pain

ABSTRACT

We define narrative bias as a tendency to interpret information as part of a larger story or pattern, regardless of whether the facts support the full narrative. Narrative bias in title and abstract means that results reported in the title and abstract of an article are done so in a way that could distort their interpretation and mislead readers who had not read the whole article. Narrative bias is often referred to as "spin." It is prevalent in abstracts of scientific papers and is impactful because abstracts are often the only part of an article read. We found no extant narrative bias instrument suitable for exploring both efficacy and safety statements in randomized trials and systematic reviews of pain. We constructed a 6-point instrument with clear instructions and tested it on randomised trials and systematic reviews of cannabinoids and cannabis-based medicines for pain, with updated searches to April 2021. The instrument detected moderate or severe narrative bias in the title and abstract of 24% (8 of 34) of randomised controlled trials and 17% (11 of 64) of systematic reviews; narrative bias for efficacy and safety occurred equally. There was no significant or meaningful association between narrative bias and study characteristics in correlation or cluster analyses. Bias was always in favour of the experimental cannabinoid or cannabis-based medicine. Put simply, reading title and abstract only could give an incorrect impression of efficacy or safety in about 1 in 5 papers reporting on these products.

Increasing Use of Promotional Language in Orthopaedic Surgery Abstracts-An Analysis of 112,916 Abstracts 1985 to 2020

BACKGROUND

Increasing use of "hype" language (eg, language overstating research impact) has been documented in the scientific community. Evaluating language in abstracts is important because readers may use abstracts to extrapolate findings to entire publications. Our purpose was to assess the frequency of hype language within orthopaedic surgery.

METHODS

One hundred thirty-nine hype adjectives were previously identified using a linguistics approach. All publicly available abstracts from 18 orthopaedic surgery journals between 1985 and 2020 were obtained, and hype adjectives were tabulated. Change in frequency of these adjectives was calculated.

RESULTS

A total of 112,916 abstracts were identified. 67.0% (948/1414) of abstracts in 1985 contained hype adjectives, compared with 92.5% (5287/5714) in 2020. The average number of hype adjectives per abstract increased by 136% (1.1 to 2.6). Of the 139 adjectives, 87 (62.5%) increased in frequency and 40 (28.7%) decreased in frequency while 12 (9%) were not used. The hype adjectives with the largest absolute increases in frequency were quality (+324wpm), significant (+320wpm), systematic (+246wpm), top (+239wpm), and international (+201wpm). The five hype adjectives with the largest relative increases in frequency were novel (+10500%), international (+2850%), urgent (+2600%), robust (+2300%), and emerging (+1400%).

CONCLUSION

Promotional language is increasing in orthopaedic surgery abstracts. Authors, editors, and reviewers should seek to minimize the usage of nonobjective language.

'Spin' among abstracts of randomised controlled trials in sleep medicine: A research-on-research study

STUDY OBJECTIVES

'Spin', using reporting strategies to distort study results, can mislead readers of medical research. This study aimed to evaluate the prevalence and characteristics of 'spin' among randomised controlled trial (RCT) abstracts published in sleep medicine journals, and to identify factors associated with its presence and severity.

METHODS

The search for RCTs published between 2010 and 2020 were conducted in seven reputable journals of sleep medicine. Abstracts of RCTs with statistically nonsignificant primary outcomes were included and analysed for 'spin', according to pre-determined 'spin' strategies. Chi-square tests or logistic regression analyses were performed to detect the association between characteristics of included abstracts and the presence and severity of 'spin'.

RESULTS

A total of 114 RCT abstracts were included in this study, of which 89 (78.1%) were identified as having at least one type of 'spin' strategy. Sixty-six abstracts (57.9%) had 'spin' in the Results section, 82 (71.9%) abstracts presented with 'spin' in the Conclusions section. The presence of 'spin' varied significantly among RCTs based on the different categories of research area (P=0.047) and the statistician involvement (P=0.045). Furthermore, research area (P=0.019) and funding status (P=0.033) were significant factors associated with the severity of 'spin'.

CONCLUSIONS

The prevalence of 'spin' is high among RCT abstracts in sleep medicine. This raise the need for researchers, editors and other stakeholders to be aware of the issue of 'spin' and make joint efforts to eliminate it in future publications.

Misreporting of Results of Research in Psychiatry

Few studies address publication and outcome reporting biases of randomized controlled trials (RCTs) in psychiatry. The objective of this study was to determine publication and outcome reporting bias in RCTs funded by the Stanley Medical Research Institute (SMRI), a U.S. based, non-profit organization funding RCTs in schizophrenia and bipolar disorder. We identified all RCTs (n = 280) funded by SMRI between 2000 and 2011, and using non-public, final study reports and published manuscripts, we classified the results as positive or negative in terms of the drug compared to placebo. Design, outcome measures and statistical methods specified in the original protocol were compared to the published manuscript. Of 280 RCTs funded by SMRI between 2000 and 2011, at the time of this writing, three RCTs were ongoing and 39 were not performed. Among the 238 completed RCTs, 86 (36.1%) reported positive and 152 (63.9%) reported negative results: 86% (74/86) of those with positive findings were published in contrast to 53% (80/152) of those with negative findings (P < .001). In 70% of the manuscripts published, there were major discrepancies between the published manuscript and the original RCT protocol (change in the primary outcome measure or statistics, change in a number of patient groups, 25% or more reduction in sample size). We conclude that publication bias and outcome reporting bias is common in papers reporting RCTs in schizophrenia and bipolar disorder. These data have major implications regarding the validity of the reports of clinical trials published in the literature.

Over-promotion and caution in abstracts of preprints during the COVID-19 crisis

The abstract is known to be a promotional genre where researchers tend to exaggerate the benefit of their research and use a promotional discourse to catch the reader's attention. The COVID-19 pandemic has prompted intensive research and has changed traditional publishing with the massive adoption of preprints by researchers. Our aim is to investigate whether the crisis and the ensuing scientific and economic competition have changed the lexical content of abstracts. We propose a comparative study of abstracts associated with preprints issued in response to the pandemic relative to abstracts produced during the closest pre-pandemic period. We show that with the increase (on average and in percentage) of positive words (especially effective) and the slight decrease of negative words, there is a strong increase in hedge words (the most frequent of which are the modal verbs can and may). Hedge words counterbalance the excessive use of positive words and thus invite the readers, who go probably beyond the 'usual' audience, to be cautious with the obtained results. The abstracts of preprints urgently produced in response to the COVID-19 crisis stand between uncertainty and over-promotion, illustrating the balance that authors have to achieve between promoting their results and appealing for caution.

Mapping the nomenclature, methodology, and reporting of studies that review methods: a pilot methodological review

BACKGROUND

A relatively novel method of appraisal, methodological reviews (MRs) are used to synthesize information on the methods used in health research. There are currently no guidelines available to inform the reporting of MRs.

OBJECTIVES

This pilot review aimed to determine the feasibility of a full review and the need for reporting guidance for methodological reviews.

METHODS

Search strategy: We conducted a search of PubMed, restricted to 2017 to include the most recently published studies, using different search terms often used to describe methodological reviews: "literature survey" OR "meta-epidemiologic* review" OR "meta-epidemiologic* survey" OR "methodologic* review" OR "methodologic* survey" OR "systematic survey."Data extraction: Study characteristics including country, nomenclature, number of included studies, search strategy, a priori protocol use, and sampling methods were extracted in duplicate and summarized.Outcomes: Primary feasibility outcomes were the sensitivity and specificity of the search terms (criteria for success of feasibility set at sensitivity and specificity of ≥ 70%).Analysis: The estimates are reported as a point estimate (95% confidence interval).

RESULTS

Two hundred thirty-six articles were retrieved and 31 were included in the final analysis. The most accurate search term was "meta-epidemiological" (sensitivity [Sn] 48.39; 95% CI 31.97-65.16; specificity [Sp] 97.56; 94.42-98.95). The majority of studies were published by authors from Canada (n = 12, 38.7%), and Japan and USA (n = 4, 12.9% each). The median (interquartile range [IQR]) number of included studies in the MRs was 77 (13-1127). Reporting of a search strategy was done in most studies (n = 23, 74.2%). The use of a pre-published protocol (n = 7, 22.6%) or a justifiable sampling method (n = 5, 16.1%) occurred rarely.

CONCLUSIONS

Using the MR nomenclature identified, it is feasible to build a comprehensive search strategy and conduct a full review. Given the variation in reporting practices and nomenclature attributed to MRs, there is a need for guidance on standardized and transparent reporting of MRs. Future guideline development would likely include stakeholders from Canada, USA, and Japan.

Expert quotes and exaggeration in health news: a retrospective quantitative content analysis

Background This research is an investigation into the role of expert quotes in health news, specifically whether news articles containing a quote from an independent expert are less often exaggerated than articles without such a quote. Methods Retrospective quantitative content analysis of journal articles, press releases, and associated news articles was performed. The investigated sample are press releases on peer-reviewed health research and the associated research articles and news stories. Our sample consisted of 462 press releases and 668 news articles from the UK (2011) and 129 press releases and 185 news articles from The Netherlands (2015). We hand-coded all journal articles, press releases and news articles for correlational claims, using a well-tested codebook. The main outcome measures are types of sources that were quoted and exaggeration of correlational claims. We used counts, 2x2 tables and odds ratios to assess the relationship between presence of quotes and exaggeration of the causal claim. Results Overall, 99.1% of the UK press releases and 84.5% of the Dutch press releases contain at least one quote. For the associated news articles these percentages are: 88.6% in the UK and 69.7% in the Netherlands. Authors of the study are most often quoted and only 7.5% of UK and 7.0% of Dutch news articles contained a new quote by an expert source, i.e. one not provided by the press release. The relative odds that an article without an external expert quote contains an exaggeration of causality is 2.6. Conclusions The number of articles containing a quote from an independent expert is low, but articles that cite an external expert do contain less exaggeration.

Expert quotes and exaggeration in health news: a retrospective quantitative content analysis

Background This research is an investigation into the role of expert quotes in health news, specifically whether news articles containing a quote from an independent expert are less often exaggerated than articles without such a quote. Methods Retrospective quantitative content analysis of journal articles, press releases, and associated news articles was performed. The investigated sample are press releases on peer-reviewed health research and the associated research articles and news stories. Our sample consisted of 462 press releases and 668 news articles from the UK (2011) and 129 press releases and 185 news articles from The Netherlands (2015). We hand-coded all journal articles, press releases and news articles for correlational claims, using a well-tested codebook. The main outcome measures are types of sources that were quoted and exaggeration of correlational claims. We used counts, 2x2 tables and odds ratios to assess the relationship between presence of quotes and exaggeration of the causal claim. Results Overall, 99.1% of the UK press releases and 84.5% of the Dutch press releases contain at least one quote. For the associated news articles these percentages are: 88.6% in the UK and 69.7% in the Netherlands. Authors of the study are most often quoted and only 7.5% of UK and 7.0% of Dutch news articles contained a new quote by an expert source, i.e. one not provided by the press release. The relative odds that an article without an external expert quote contains an exaggeration of causality is 2.6. Conclusions The number of articles containing a quote from an independent expert is low, but articles that cite an external expert do contain less exaggeration.

Physician characteristics associated with proper assessment of overstated conclusions in research abstracts: A secondary analysis of a randomized controlled trial

OBJECTIVES

Little is known about the physician characteristics associated with appraisal skills of research evidence, especially the assessment of the validity of study methodology. This study aims to explore physician characteristics associated with proper assessment of overstated conclusions in research abstracts.

DESIGN

A secondary analysis of a randomized controlled trial.

SETTING AND PARTICIPANTS

We recruited 567 volunteers from the Japan Primary Care Association.

METHODS

Participants were randomly assigned to read the abstract of a research paper, with or without an overstatement, and to rate its validity. Our primary outcome was proper assessment of the validity of its conclusions. We investigated the association of physician characteristics and proper assessment using logistic regression models and evaluated the interaction between the associated characteristics and overstatement.

RESULTS

We found significant associations between proper assessment and post-graduate year (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.49 to 0.91, for every 10-year increase) and research experience as a primary investigator (PI; OR = 2.97, 95% CI 1.65 to 5.34). Post-graduate year and PI had significant interaction with overstatement (P = 0.015 and < 0.001, respectively). Among participants who read abstracts without an overstatement, post-graduate year was not associated with proper assessment (OR = 1.04, 95% CI 0.82 to 1.33), and PI experience was associated with lower scores of the validity (OR = 0.58, 95% CI 0.35 to 0.96).

CONCLUSION

Physicians who have been in practice longer should be trained in distinguishing overstatements in abstract conclusions. Physicians with research experience might be informed that they tend to rate the validity of research lower regardless of the presence or absence of overstatements.

TRIAL REGISTRATION

UMIN000026269.

Influence of overstated abstract conclusions on clinicians: a web-based randomised controlled trial

OBJECTIVES

To investigate whether overstatements in abstract conclusions influence primary care physicians' evaluations when they read reports of randomised controlled trials (RCTs) DESIGN: RCT setting: This study was a parallel-group randomised controlled survey, conducted online while masking the study hypothesis.

PARTICIPANTS

Volunteers were recruited from members of the Japan Primary Care Association in January 2017. We sent email invitations to 7040 primary care physicians. Among the 787 individuals who accessed the website, 622 were eligible and automatically randomised into 'without overstatement' (n=307) and 'with overstatement' (n=315) groups.

INTERVENTIONS

We selected five abstracts from published RCTs with at least one non-significant primary outcome and overstatement in the abstract conclusion. To construct a version without overstatement, we rewrote the conclusion sections. The methods and results sections were standardised to provide the necessary information of primary outcome information when it was missing in the original abstract. Participants were randomly assigned to read an abstract either with or without overstatements and asked to evaluate the benefit of the intervention.

OUTCOME MEASURES

The primary outcome was the participants' evaluation of the benefit of the intervention discussed in the abstract, on a scale from 0 to 10. A secondary outcome was the validity of the conclusion.

RESULTS

There was no significant difference between the groups with respect to their evaluation of the benefit of the intervention (mean difference: 0.07, 95% CI -0.28 to 0.42, p=0.69). Participants in the 'without' group considered the study conclusion to be more valid than those in the 'with' group (mean difference: 0.97, 95% CI 0.59 to 1.36, P<0.001).

CONCLUSION

The overstatements in abstract conclusions did not significantly influence the primary care physicians' evaluations of the intervention effect when necessary information about the primary outcomes was distinctly reported.

TRIAL REGISTRATION NUMBER

UMIN000025317; Pre-results.