University of Pittsburgh psychiatrist urges more rigor in clinical research and careful wording when reporting results

May 23 2005

The general public may not be reading the Archives of General Psychiatry or the New England Journal of Medicine, but they are basing important health care decisions and lifestyle changes on the research findings that these and other journals publish, particularly when such findings concern risk factors. Moreover, these scientific reports frequently are interpreted by clinicians, policy makers and the news media as calls to action, only later to be refuted or questioned by conflicting studies that may even claim serious and harmful consequences from those actions.

"What is a risk? What is a risk factor? Are all risk factors equal? What is the threshold for true clinical significance? The general public can't be expected to understand these questions, let alone know the answers. Yet, ultimately, they are the ones who are most affected by journal articles that include words like 'risk' that even some of us working in research are not accurately defining," David J. Kupfer, M.D., the Thomas P. Detre Professor and chairman of the department of psychiatry at the University of Pittsburgh School of Medicine, told his colleagues at the American Psychiatric Association Annual Meeting.

Researchers must be more rigorous in how they design and conduct clinical studies as well as be more mindful of the language they use to describe their findings in the scientific literature or in writing reviews of other research, asserted Dr. Kupfer in a session devoted to discussion about risk factors in medicine and psychiatry.

Dr. Kupfer is co-author of the recently published To Your Health: How to Understand What Research Tells Us About Risk (Oxford University Press, 2005).

According to Dr. Kupfer, a look at the past year's newspaper headlines about antidepressants being linked to increased risk of suicide in children and adolescents exemplifies how research influences society and yet can paint a confusing picture.

"In truth, these studies, which received much attention from the press, overestimated the risk and underestimated the benefit of prescribing antidepressants to children and teens. But clinicians and parents alike were at a loss to understand their meaning."

"How do we sort out these contradictions?" questioned Dr. Kupfer. "We have a responsibility to the general public, who on a daily basis hear about new findings or ways to reduce risks of disease that are extrapolated from a study and then reported by the media. But too often, these reports are confusing or include data taken out of context and offer conflicting information about what puts us at risk for diseases."

Dr. Kupfer believes that to advance medical science and promote public health, research must be both flawless and accurately presented.

In order to generate more reliable and meaningful findings, Dr. Kupfer urges researchers to be more precise in defining, understanding and evaluating types of risk factors, including their statistical and clinical significance, and be more discerning of others' published results that may form the basis to their own research or can be cited in their own publications.

"If we are rigorous in organizing, conducting, presenting and evaluating scientific research – specifically psychiatric research – then we are taking important steps in fitting this research into the larger framework of discovering the causes and ways to prevent diseases and disorders. Researchers are on the front line of accomplishing these changes. We are responsible for the quality of the studies that we conduct and for the interpretation of our studies to the media, the general public and our colleagues. These new standards are aimed at raising the bar and will ultimately encourage well-designed and correctly interpreted research that will help in our shared goal of advancing science," said Dr. Kupfer.