Opening up influenza research with a new kind of journal

Today is the launch of a new type of online publication, a cross between website and a "real" journal, called PLoS Currents: Influenza. What is it? Well, it's a website for immediate publication of new findings about the influenza virus. Submissions are screened by a panel of moderators (I'm one of them) and if they are appropriate, we will publish them immediately - no delays - and they will be freely available for anyone to read. They will also be given a permanent, searching PubMed identification, just like a regular journal paper.

What's the difference between this and a regular journal? Well, first of all, submissions won't be thoroughly reviewed, which means they don't "count" as journal papers, but it also means you can publish them later in a peer-reviewed journal. The Public Library of Science has already bought into this model - they're sponsoring PLoS Currents, after all - and we expect other journals to do so also. So why publish, you might ask? That's easy: in a highly competitive field such as influenza research, different scientists are often racing to answer the same question. By publishing super-rapidly in PLoS Currents, you will get a citable, time-stamped reference that establishes your discovery, and most importantly, establishes when you made it.

The big win here, we hope, is that scientists will be empowered to announce their results to the world without worrying about being "scooped" - a common fear that leads to many results being kept secret for months while papers are prepared and revised. This in turn will speed up scientific progress overall, which is the real goal behind PLoS Currents.

Also, because we aren't looking for complete manuscripts (although those are fine too), we'll accept new observations, new data, and more speculative ideas (as long as they have some data to support them) in PLoS Currents.

We're also pioneering a new way to author papers, using the Google Knol software. After writing your contribution in Google Knol, submission will require little more than a few mouse clicks. To launch the journal, four of its moderators (with colleagues) have posted the first few contributions just these week. Check it out here.

If PLoS Currents: Influenza is successful, it will open the door to an almost unlimited set of new publications in virtually any scientific field. We chose influenza because, with the recent emergence of the new H1N1(A) pandemic flu strain, it became clear to many of us that waiting the typical 3-4 months (at best) for results to appear was just too slow. Similar delays occur in virtually every other area of biomedical research, and it's time we took fuller advantage of the web to speed things up.

Bad medicine at M.D. Anderson Cancer Center

M.D. Anderson Cancer Center (at the University of Texas) is one of the top cancer treatment centers in the United States, and probably in the world. This makes it especially disheartening to see that they have a new website, Cancerwise, that endorses pseudoscientific treatments; in other words, it promotes bad medicine. From what I can see, most of the site discusses perfectly reasonable topics, which makes their endorsement of “woo” especially insidious – how is a patient, or even a scientist from another discipline, supposed to distinguish the real science from the quackery?

What caught my notice in particular – although this is not the only example – is the article “The 3 Most Common Questions People Ask About Acupuncture” written by Lorenzo Cohen. As I and many others have pointed out in previous blog posts, and as the scientific literature shows quite clearly now, acupuncture does not work. When compared to placebo in published trials, the benefits of ‘sham’ acupuncture, where the needles don’t even pierce the skin, are the same as those for ‘real’ acupuncture. Likewise, when the needles are inserted in random positions instead of the ‘real’ acupuncture points, the effects are indistinguishable. So it doesn’t matter where you place the needles, and it doesn’t matter if they pierce the skin – in other words, the only effect is the placebo effect: if a patient believes in acupuncture, and he/she thinks he/she is getting treatment, then they report a mild, subjective improvement in certain types of pain.

With that in mind, here is a disturbing bit of pseudoscience from Cohen’s article:

“The effects of acupuncture also tend to be cumulative, so it's important not to expect too much too soon. At M. D. Anderson, we consider 8-10 treatments as one course, and for long-term problems, multiple courses may be necessary. I often tell patients with chronic conditions, ‘It's like fertilizing your garden -- don't expect the flowers to bloom tomorrow. In the long-term, though, you should end up with a better result.’ "

This is complete nonsense - there is no scientific data to support it. But what is a patient supposed to think when he/she reads that M.D. Anderson recommends 8-10 acupuncture treatments for their patients?

Cohen also throws in this canard, a quote from his own “integrative medicine” director: “"Can't hurt, might help, why not!" Here’s why: there are real risks to acupuncture, such as infection, and the scientific evidence says the benefit is zero. So here’s my reply: can’t help, might hurt, why do it?

Then, in the section titled “What should I use acupuncture for?”, Cohen writes:

“...it's always a good idea to recommend acupuncture when the patient is:
* Experiencing uncontrolled nausea, vomiting or pain.
* Experiencing side effects from treatment or medications.
* Has failed conventional treatment for symptom control.”

Always? Always? How about “never”? There isn’t a single well-done clinical trial demonstrating the effectiveness of acupuncture for any of these conditions. (For a summary of some of the evidence showing its ineffectiveness, see this link at Science-Based Medicine.) Other scientists at M.D. Anderson (are they even paying attention?) should step in and do something to make it clear that the institution doesn’t recommend pseudoscientific, unproven therapies for anything.

There are other articles promoting pseudoscientific methods on the Cancerwise site, including this one, which applauds Sen. Tom Harkin for his support of NCCAM (which I’ve written about multiple times) and alternative/integrative medicine. I’m sure we’ll see more such articles there, and it’s very dismaying to see woo-meisters like Lorenzo Cohen make progress in their attempts to drag us back into the past, when medicine was little more than guesswork and superstition.

One of our jobs in academia is to be especially critical of ourselves, so when we see an academic center making mistakes, we call them out on it. So I’m joining other bloggers in doing so – notably Orac, who wrote about this same topic last week. (I highly recommend Orac’s lengthy discussion – he thoroughly dismantles Cohen’s claims, including Cohen’s references to studies that supposedly support those claims.) I don’t know who at M.D. Anderson is responsible for the Cancerwise site, but they have a list of 18 authors on that page, and I hope that at least some of them will be concerned to know that they are endorsing pseudoscience.

Here's an idea for another article at Cancerwise: the title can be identical to one of Cohen's section headings: "What should I use acupuncture for?" And the article can be very short, just one word: nothing.