For a researcher, the arrival of a peer review article may set off feelings of angst, duty, resentment and sheer frustration. On a good day, the article fits with the research agenda, is of sufficient relevance to impact on healthcare, and it feels a worthy duty to undertake the review.

Recently, there has been considerable interest in the limitations of peer review as a credible system for improving the quality of submitted research.

Henderson’s article in the BMJ this year highlights leaked emails at the Climate Research Unit, the Lancet’s retraction of the Wakefield paper ‘the most controversial medical paper of the past 15 years’ and allegations in stem cell research peer review was failing their field.

With regard to the latter Professor Lovell-Badge states: "It's turning things into a clique where only papers that satisfy this select group of a few reviewers who think of themselves as very important people in the field is published."

One major problem is studies which are scientifically flawed, or offer modest increments in the evidence-base often attract undue attention, particularly the media. Whilst at the same time truly original findings may be delayed or rejected. If you are not convinced then consider the case of H Pylori. The Gastroenterological Society of Australia rejected Barry Marshall’s abstract to present his research at their yearly conference. They deemed it in the bottom 10% of papers submitted. In 2005, Barry Marshall with Robin Warren were awarded the Noble Prize for the discovery that peptic ulcers were caused by Helicobacter pylori.

Some notable changes have occurred in the journals, principally reviewers are now asked to sign reviews. The BMJ undertook a randomised controlled trial of signed versus unsigned reviews and found “it was acceptable to authors and reviewers, and that it made no significant difference to the reviews."

This is a two edged sword, in that the quality of the review is probably unchanged. Yet, given there is a slightly greater tendency to recommend acceptance, reviwers are probably less likely to offend common researchers (the ones they know) who may require the reciprocal favour in the future. The BMJ is about to take this one step further—publishing its signed reviews alongside published papers after a second randomised trial found this feasible and acceptable to authors and reviewers.

When the amiable doctorblogs (see I’m already in peer review mode) asked on twitter ‘Peer review is broken. But we know that. What wld you do instead? see @richard56j #bmj

My one suggestion to improve the review process is, to not see it as ending at the journal publication but starting, thus allowing analysis of trial results over and above traditional peer review.

Publication of all relevant documents, which is now possible with the internet, including protocol reviews, ethic reviews, amendments to the protocol and publication of the raw data, will allow interested parties to further review and discover the truth.

The question is which journal is going to stand up to the plate first?

In the BMJ this week is a case control study on Mobile phone base stations and early childhood cancers. A case control study is an epidemiological study design in which persons with and without a disease, in this case cancer, are studied to identify factors (mobile phone masts) associated with the disease. The gold standard would be a prospective study (not a trial as this would be unethical); however, when the disease is rare it is too difficult, costly and would involve following millions of children to detect the cases.

Concerns has been raised due to there being a few clusters of cancers in people living nearby to mobile masts. Participants in a survey were concerned about or attributed adverse health effects to mobile phone base stations and those living within 500 m reported slightly more health complaints than others.

In the present study for two years (1999 to 2001) researchers obtained data on all registered cases of cancer in children aged 0 to 4 in Great Britain. From 1,926 cases, 1,397 (73%) were included. Four controls per case were obtained and matched by sex and date of birth.
Further to this mobile phone operators provided data on antennas to an accuracy of about 10m and the researchers estimated exposure in relation to the distance and the total power output across base stations within 700 m (the typical peak is not nearest the mast, but normally is 200 to 500 m from the base station). They also and used a model to compute power density (dBm) which was validated with data from two further surveys.

The results of the study showed the mean age at diagnosis of cancer was two years and the mean distance at birth from a base station was not different between the cases, 1107 m and the controls, 1073 m (P=0.31). Also there was no difference in terms of the mean total power output of base stations within 700 m (P=0.54) for both groups; and no difference in the mean modelled power density (P=0.41).

The evidence presented in this paper for lack of effect is backed up by the dramatic increase in the use of mobile telephones not giving rise to a subsequent increase in the incidence of brain tumours. The one major limitation of this study is that they were unable to account for movement of the mother during pregnancy, which could have reduced the ability of the study to detect any true excess in risk.

Overall this is a well done study and allows us to feel more certain about the evidence base that there is no association between risk of cancer in young children and exposure to mobile phone base stations. It seems we can all relax a little more about mobile phone masts, the radiofrequency exposures are extremely low and backs up the World Health Organization, view that cancer is unlikely to be caused by cellular phones or their base stations.

If you want ot know a bit more then follow the excellent story tracker.

Right now, you would have to have been asleep to not realize implementing cost-effective change based on evidence is the key challenge for health systems around the world. beciause this its the most pressing problem we decided to bring together a conference of the evidence creators and evidence users to define the processes for implementing best clinical practice and forging efficient and cost-effective solutions for healthcare.

We would like you to join us at Evidence 2010, the leading evidence-based healthcare event at the forefront of EBM debate and innovation.

The conference is a collaboration between the BMJ and the Centre for Evidence Based Medicine CEBM.

The aims of the conference are to:

* Improve evidence-based decision making and provide practical, evidence-based ideas that can be implemented in practice
* Foster effective innovation
* Guide efficient commissioning
* Provide education and training to improve evidence-based healthcare.


We've got some great speakers lined up including:
Jim Easton, Sir Iain Chalmers, Sir Muir Gray Victor Montori,
Paul Glasziou, Mike Clarke, Sharon Straus,
Giordano Perez Gaxiola, Steven Woloshin, Fiona Godlee, Bill Summerskill, Helen Lester, Rubin Minhas, Amanda Burls, Dan Lasserson, Dyfrig Hughes, Tony Rudd, Tim Ringrose, Tom Jefferson, Ann McPherson, and Fiona Fox
Oh and not to mention Ben Goldacre Bad Science.Net

Look forward to seeing you there, Carl