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February 17, 2009

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Miriam Lippel Blum

Just want to say that I participated when Rand Corp. developed their "Quality of Life" instrumentation. I was a PD patient then and they were looking for renal patients to test their new questionnaire and give feedback, so I agreed. I gave them an earful about how their criteria were poor and most of what they asked about really didn't say too much about life quality and therefore, wouldn't give results that had much credibility if they were really looking for truth. I saw the final form...and it was clear they didn't take what I said into account. I was not impressed with what was passing off as scientific standards or integrity.

But they gave me a coffee mug. I guess they thought that would improve my quality of life.

Michael Fraase

If I was a betting man, I'd lay good money that a marketeer of some flavor wrote the headline, not the author or editor of the article. It's happened to me more than once.

Also, I'd like to add the tenant of *transparency* to your laundry list of what advances science. I'm going to be writing more about its importance later today about the launch of Medpedia.

Qais Al-Awqati

Please allow me to correct certain misconceptions here. It is true that the Editors of Kidney International have the last word on titles and they change them to be more consonant with the major findings of the paper. We then send the changed Title and Abstract to the lead author, in this case Dr Braden Manns who made additional changes to finally come up with the title that he approved. After Dr Manns approved the Title and Abstract the paper was sent to the copy editors who suggest additional changes in the main text. The title and abstract and the contents of the paper are a result of a dynamic process where the authors, the anonymous reviewers and the editors suggest changes and respond to the critiques by changing the text to come up with the final version. In no case are the Title, Abstract or contents determined by anyone without the final agreement of the authors. Hence I believe that your ire or skepticism is rather misplaced.
Qais Al-Awqati
Editor in Chief
Kidney International

Peter Laird, MD

Dear Qais Al-Awqati,

I believe that you are missing the essence of my opinion on your article and your editorial duties as the final approving authority for all content in your journal. For anyone that reads the concluding remarks and then compares that to the title, they are completely discordant. Further, the title suggests a completely negative outcome with proof of that outcome that does not exist. The trends in some of the parameters were not against nocturnal dialysis as your title declares emphatically, but simply did not have enough power in this study to reach the opposite that your authors adctully draw with the conclusion of another postitve confirmation of improvements of quality of life with nocturnal dialysis that your authors correctly note:

The magnitude of differences in EQ-5D index scores observed in secondary analyses (if confirmed in adequately powered randomized trials) would be of substantial clinical significance. These findings support the increased use of nocturnal hemodialysis in selected groups of patients.

How do you as an editor resolve the conclusion of your author above who is in support of nocturnal dialysis based on the findings of his study with the final emphatic title declaring a negative outcome for nocturnal dialysis quality of life? Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis.

It is my continued opinion that those who simply read the title of this article would find this same discord between title and the content of your article that I did. I believe that the editorial staff does have the final authority for all works published in your journal to represent accurately the content of an article thus sharing the greater duty than even that of the authors. It is my opinion that this was not accomplished with the article in question above.

It is my further opinion that this type of sensational title in complete opposition to dozens of prior articles on nocturnal dialysis could be misleading at best and thus could be used by opponents of nocturnal dialysis simply by virtue of the title without regard to the content which did in fact trend towards support of nocturnal dialysis but did not have the power or size to reach that conclusion.

In my opinion, I must simply question whether it was appropriate for KI to approve such a controversial title usually reserved for landmark studies that reverse the findings of prior studies when your study does not in the least reverse those findings.

It is simply a study too small and underpowered to conclude any reversal of prior studies on nocturnal dialysis in contradistinction to previous findings of significant benefit in other studies. It did not in fact prove anything, positive or negative because it is an underpowered study. The best that we can say that further study is warrented with a larger study group of sufficient power to confirm the trends of this study, which your authors so concluded.

I was quit surprised to see that in the end of my review, there was no proof of such a controversial claim because your small study lacks the power to so declare a reversal of all prior postive outcome studies from nocturnal dialysis that your title emphatically implies. In stated fact, the authors found trends supporting an improvement of quality of life in direct opposition to the final title.

I appreciate your input on the editorial and review process for all of your articles as well as final approval of the authors which is of paramount importance in my opinion. Nevertheless, in my opinion, in the case of the article in question, the final product of that process did not represent the content accurately and could, in my opinion, be considered sensationalism which I would assume by the statement of conclusion, was not the author's intentions.

I stand by my opinion that medical journals should overcome the need for sensational titles to compete against other journals readership share, and do what they are charged to do, report the truth accurately and without bias. That is what science represents.

It is my continued opinion that KI failed to keep their fuduciary duty to the tenants of science to avoid bias by virtue of such a contradictory title unsupported by facts in the content of the article. I would hope KI and ISN would consider correcting this discordancy by rewriting the title at this time to better reflect the true content of this article in a more accurate fashion.


Zach

Interesting "Viewpoint" article on this very subject from the June issue of "Nephrology News & Issues:"

http://www.nephronline.com/article.asp?IndexID=171

Peter Laird, MD

Zach, thanks for the link, I was not aware of the editorial. I believe that Dr. Mendelssohn spoke very eloquently on the issue at hand. Truth and integrity are the hallmark of science and must be protected at all costs.

I just wish to thank Bill for letting me be a part of DSEN. I have learned much in the last year from Bill and my main goal on any article is to get past his red editing pen if possible. I stand firm in supporting Bill and his long lasting advocacy for not only truth in dialysis, but most importantly equality of health based on the highest standards we know.

Bill Peckham

I wish he would have properly credited you as the author Peter and it is routine to link to a referenced article.

I applaud the sentiment. Thanks for the link Zach.

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