Abstract
What is breaking news in medicine? Our world is full of breaking news. The ticker tape on 24-h news programmes, half-hourly radio bulletins, the Internet and Twitter, all lend themselves to sensationalism. Breaking news is murder, terrorism or the transfer of Gareth Bale to Real Madrid. Health isn't breaking news, unless a government minister has resigned or a health professional's callousness or ineptitude has killed patients.
Advances in medicine are almost never breaking news. Perhaps they don't happen anymore? When medicine was capable of news worthy of breaking there was nobody to break it except a town crier or a homing pigeon. Today, we talk about innovation, entrepreneurship and efficiencies in medicine. We don't talk about breaking news. You won't find a breaking news ticker on the websites of the BMJ, The Lancet, or even the New England Journal of Medicine.
Perhaps that's a good thing? Medical advance is based on science. The standards of our age demand that the scientific process is as open as possible. Even companies with conflicts of interest are pressurized to comply. If they don't, the research that backs up their proposed ‘breaking news' will not be published in a leading medical journal. That may not be much of a pressure but clinical trials of new interventions are meant to be registered. We expect to know about the new intervention, drug or device, before we know about the findings.
Even the publication of the findings of a new trial is never the final word, however encouraging. The trial will need to be repeated in the same population and setting, in different populations and settings, and the adverse effects carefully assessed. We know that the early published trials of a new intervention are often misleading or tell only half the story, essentially the positive spin. Take rofecoxib, for example. 1 The medical breaking news of our age tends to be a direct consequence of a well-executed marketing plan devised by an ingenious brand or product manager. Therein lies danger. Evidence presented at the latest peer-review congress confirmed that publication bias, a favoured means of creating spin around research evidence, is usually because authors and companies fail to submit negative trials and studies for publication, and not because editors refuse to publish them. 2
Only after many years of experience can we be certain that a new intervention is an important medical advance. By that time it is no longer breaking news. Even the breaking news about the man who grew a new nose on his forehead to replace his injured nose wasn't really breaking news. 3 A mouse had already grown a human ear on its back. In which case, perhaps this issue of breaking news requires qualification? While breaking news is possible in basic or animal science, it is absent in clinical science. That would explain why clinicians rarely win Nobel prizes. Clinical science isn't sexy. Abandon gongs, all ye who enter here, there is no breaking news in our world. But, of course, clinicians do win gongs. They win them for heading royal colleges and medical associations, or working for the government as senior civil servants or as party sympathizers in the House of Lords. These may be well deserved but how often do clinicians win gongs for excellent patient care or outstanding clinical science? It does happen but not enough.
Not that gongs matter, except they are a symbol of what society values. Perhaps society needs to value simpler virtues, like safe clinical practice and compassionate patient care? Perhaps any item labelled breaking news in medical discovery should be considered dangerous news unless proved otherwise? It took Ignaz Semmelweis 13 years to write up his thesis on the effects of handwashing on maternal mortality, and almost 40 years before his contribution to medical discovery was recognised.4,5 The value of hand-washing was never breaking news but few medical interventions have been more beneficial. 6