Indian J Med Res 2010;131:588-9
Incomplete reporting of research in press releases: Et tu, WHO?
Head of Department of Pediatrics, St Stephens Hospital, Delhi, India
Assistant Professor of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
Associate Professor Centre of Social Medicine and Community Health
Jawaharlal Nehru University, New Delhi, India
Address for correspondence
St Stephens Hospital
Tis Hazari, Delhi. 110054 India
Press releases reporting research findings and interpretations have recently been the subject of research and editorials (1,2). Woloshin et al pointed out that press releases from academic medical centers often do not provide key facts or acknowledge important limitations (1). Press releases represent the public face of science and research. Tight control on research methods and reporting in scientific journals can be negated by loose misrepresentation of those facts to the public in the press releases. We were made aware of this recently in the context of the debate about introducing Hib vaccination in India, when a press release (3,4) reporting the internationally funded Bangladesh Hib Probe Study (5) was quoted rather than the study itself. On the face of it, this press release issued by a number of international agencies sponsoring the research, seems to selectively report the study findings. We are concerned because such statements are taken very seriously globally. By publishing this comment we hope to raise the standards to which such organizations are held, while providing them an opportunity to explain any aspects we may have overlooked.
Referring to the research (5), the press release stated:
1. “Results showed that routine immunization of infants with a Hib conjugate vaccine prevented over one-third of life-threatening pneumonia cases and approximately 90% of Hib meningitis cases.”
2. “This vaccine study builds on the evidence of the real burden of Hib pneumonia … shown in …Indonesia.”
Both these statements that appear to argue in favor of Hib vaccination in developing countries actually reflect selective interpretation/presentation of the research findings.
Bangladesh study details
The Bangladesh study compared Hib vaccination status among children with confirmed pneumonia or meningitis (cases), against those without these diseases (controls). Two groups of children constituted controls viz community based controls (matched for age, sex, season and distance from the hospital) and hospital-based controls with no matching. 93.4% children received all 3 doses of Hib-DPT or DPT vaccine as per protocol. The numbers that received fewer than 3 doses was relatively small.
The major findings of the Bangladesh study were as follows:
1. There was no difference in the Hib vaccination status of children with pneumonia compared to community controls, irrespective of how radiological pneumonia was defined. The authors reported differences in the vaccination status of children attending the hospital for other diseases, compared to those referred to the hospital with pneumonia for the purposes of this study [Vaccine effectiveness 39% (CI 14 to 56) per protocol]. The fact that there was no difference in the matched community controls was omitted in the press release.
2. The study found only 15 cases of confirmed Hib meningitis and 41 ‘probable meningitis’. Among those who received all 3 doses of vaccine there was no statistically significant protective effect against either confirmed meningitis or probable meningitis, irrespective of comparison with hospital or community controls. The authors observed statistical significance in the sub-group that received only two dose of vaccine [Vaccine effectiveness 93% (CI 53 to 100)]. This point was highlighted in the press release in a manner suggesting benefit of the vaccine, without mentioning that no significant difference was found with three doses of vaccine.
The press statement that the study ‘builds on’ evidence of the burden of Hib pneumonia from Indonesia, is another misrepresentation. The Indonesia study (6) actually reported more pneumonia (though not statistically significant) in the Hib vaccinated group than controls. In fact the Indonesia study paper concludes by saying “Hib vaccine will not have a major role in efforts to reduce the overall burden of respiratory illness….. as improvements in nutritional status, maternal education and socioeconomic status” (can have). (5). Paradoxically the press release, that the Bangladesh study ‘builds on’ the evidence of the Indonesian study, is true. They both actually argue against the vaccine.
Table 1 summarizes the key findings of both studies (5,6). Health-care stakeholders and decision-makers in developing countries need to be cognizant of these issues when confronted with such information.
1. Woloshin S, Schwartz LM, Casella SL, Kennedy AT, Larson RJ. Press releases by academic medical centers: not so academic? Ann Intern Med. 2009;150:613-8
2. Editorial. Incomplete reporting of research in academic press releases. Lancet 2009; 373: 1920.
3. The Hib Initiative. Hib vaccine: A critical ally in Asia’s effort to reduce child deaths. (Press release) http://www.hibaction.org/news/2007/20070627.pdf accessed on 18/9/09
4. WHO. Hib vaccine: A critical ally in Asia’s effort to reduce child deaths
http://www.who.int/immunization/newsroom/Hib_vaccine/en/ accessed 18/9/09
5. Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, Moulton LH, Black RE, Santosham M. Effectiveness of Haemophilus influenzae type B conjugate vaccine on prevention of pneumonia and meningitis in Bangladesh children: a case control study. Pedaitr Infect Dis J. 2007;26: 565-571
6. Gessner BD, Sutanto A, Linehan M, Djelantik IG, Fletcher T, Gerudug IK, Ingerani, Mercer D, Moniaga V, Moulton LH, Moulton LH, Mulholland K, Nelson C, Soemohardjo S, Steinhoff M, Widjaya A, Stoeckel P, Maynard J, Arjoso S. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 2005; 365: 43-52.