Risk

At recent journal clubs, we discussed 2 articles from the New England Journal of Medicine. The first was a trial on rectal non-steroidal anti-inflammatory drugs to prevent pancreatitis after endoscopic retrograde cholangiopancreatogram (N Engl J Med 2012;366:1414-22). The other tested how aggressive transfusion should be given in patients with acute upper gastrointestinal bleeding (N Engl J Med 2013;368:11-21). Both were multi-center studies involving hundreds of patients.

On both occasions, our Dean remarked how brave the investigators were. “The studies will change clinical practice,” he explained. “However, if the results were negative, the authors would have a hard time publishing their work despite their huge efforts.”

I felt deeply with his remarks, not least because I was the unfortunate investigator he described who invested much resource to produce a negative study last year. We made a bold move to a human trial because of very promising results from our own animal studies. Unfortunately, since the trial results were negative and the compound was new to the field, most journal editors considered the findings irrelevant.

During a meeting in Taiwan, I chatted with WC and mentioned my experience. “Do you think it is foolish to invest one’s time and energy this way? If I used the same study design and chose another compound that other doctors had been using, the results would be important even if they were negative.”

The Singaporean professor kindly advised, “How else can breakthroughs in medicine occur? Keep working, and remember to send me your paper when it is published.”

Under the current climate, it is easy to forget that our primary aim is to contribute to science rather than to have just another big paper. It is lucky to be reminded of what we are doing.