Special article
If the results of an article are noteworthy, read the entire article; do not rely on the abstract alone
Si le llaman la atención los resultados de un artículo, léalo completo, no se fíe solo del resumen
a Investigación Clínica, Programa BUC (Biociencias UAM+CSIC), Centro de Excelencia Internacional, Universidad Autónoma de Madrid, Madrid, Spain
b Centro de Salud Dr. Castroviejo, DA Norte, Servicio Madrileño de Salud, Madrid, Spain
c Unidad Metabólico Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
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Dal-Ré, M.V. Castell, J. García-Puig" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Dal-Ré" "email" => array:1 [ 0 => "rafael.dalre@fuam.uam.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.V." "apellidos" => "Castell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "García-Puig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Investigación Clínica, Programa BUC (Biociencias UAM<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CSIC), Centro de Excelencia Internacional, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud Dr. Castroviejo, DA Norte, Servicio Madrileño de Salud, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Metabólico Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Si le llaman la atención los resultados de un artículo, léalo completo, no se fíe solo del resumen" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dr. Arthur Ammann, President of Global Strategies for Human Immunodeficiency Virus (HIV) Prevention, reported some 10 years ago that the program for preventing perinatal HIV transmission in South Africa was modified after a physician had read the abstract of an online article. It turned out that the introduced program was less effective than the discontinued program.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> This example demonstrates how numerous physicians get their information essentially through free access to abstracts of scientific articles published in PubMed<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> or simply Google, and that they make clinical or public health decisions from the information obtained. In addition to the fact that the amount of information that can be included in abstracts is limited, in many cases the abstracts can lead to mistakes because they do not accurately and rigorously report the findings described in the article.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Access to medical information</span><p id="par0010" class="elsevierStylePara elsevierViewall">There are numerous information sources to which clinicians have access for improving their professional activity, which range from clinical sessions and expert consultations to having access to the results of clinical research. The application of the acquired knowledge to a specific case will depend on several factors, which should include consideration of the usage protocols in the healthcare center and the patient's preferences.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A survey showed that 75% of physicians in Spain used the Internet to update their knowledge,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> a similar percentage to that of other countries.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6,7</span></a> Keeping up to date with the reading of scientific publications influences the quality of care.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8–10</span></a> The enormous increase in the number of openly published journals and articles<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> increasingly speeds access to the required information. However, many physicians have little time to read articles and tend to trust the information from abstracts. In fact, it is assumed that the editorial teams of journals ensure the rigor and quality of articles they publish, such that physicians limit themselves to reading the abstracts of 63% of the articles.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> It is only after reading the abstract do the physicians decide to read (or not) the rest of the article.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> Making an attractive abstract is thus the first step in encouraging the reader to finish the whole article.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The communication of the design and results of clinical trials is often deficient in the articles and abstracts,<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14,15</span></a> as is those of studies on diagnostic tests.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> The CONSORT guidelines were drawn up in 1996 and were subsequently updated with the objective, among others, of systematizing the information that must be communicated from randomized clinical trials.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> In 2003, the STARD guidelines were published with the same objective for diagnostic tests.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> However, we are still far from this communication being optimal.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19,20</span></a> Because for many physicians, the information in the articles’ abstracts is the main (or only) source of information, in 2008, CONSORT published a list of the elements of information that the abstracts should include<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> and that has shown usefulness.<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21,22</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Biases in the publication of clinical trial results</span><p id="par0025" class="elsevierStylePara elsevierViewall">It is common knowledge that the publication of results from studies is subject to various types of biases. These include the well-known publication bias,<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23,24</span></a> which leads many authors to not send studies with negative results for publication,<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> and the selective publication of results bias, which can take various and subtle forms.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Occasionally, a clinical trial shows no significant differences in the results of the main study endpoints, but the results are presented in the article in such a way as to lead to misinterpretations in favor of the experimental treatment. This can include, for example, an emphasis on the benefit achieved in a secondary variable or in a specific patient subgroup.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> That is what is known as spin, which in effect communicates distorted and misleading information on the results of a trial. Spin can occur unconsciously, due to ignorance of the scientific problem at hand or with the intention of fooling the reader<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> and can appear from the article's title to its conclusion.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The reporting of conflicting results (with spin) is very common.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27,28</span></a> Spin occurs in 38% of the results and 58% of the conclusions of abstracts, as well as in 50% of the conclusions in the body of the article for clinical trials whose primary endpoint results do not achieve statistical significance.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> Moreover, the complete reporting in the abstracts of the endpoint results of systematic reviews is associated with the statistical significance they possess.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> The problem of publishing studies with conflicting information in the abstract also affects articles that report on diagnostic tests.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discrepancies between the information in the abstract and in the rest of the article</span><p id="par0040" class="elsevierStylePara elsevierViewall">In this case, the authors properly report the findings of their study in the body of the article, but not in the article's abstract. Typically, the results reported in the abstract are more impressive for readers and are generally directed toward increasing the risk/benefit ratio of the experimental treatment.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In articles on clinical trials in Rheumatology published in 2006–2008 in which the primary endpoint was clearly defined, it was observed that 23% of the abstracts contained conflicting information with respect to that included in the article.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Thus, 10% of the abstracts did not specify the trial's primary endpoint, and 7% listed results that disagreed with those in the body of the article. Negative results in the trial were the only factor that predicted the presence of conflicting conclusions in the abstract.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Two studies in Oncology reported something similar to that described in Rheumatology. Thus, 10% of 114 phase 3 confirmatory efficacy clinical trials of lung cancer published in 2004–2009 showed conflicting results between the abstract and the rest of the article. The most common (82%) situation was that the abstract very positively assessed the experimental treatment, which was not the case in the body of the article, although the opposite was also observed (18%).<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> It has been observed that 59% of the 92 phase 3 trials published in 1995–2011 on breast cancer that achieved negative results for the primary endpoint reported the results of secondary endpoints in the abstracts to suggest a positive result.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> The adverse effects of drugs are also frequently omitted. In this sample, only 32% of the abstracts reported the most severe toxicity (grade 3 and 4). Achieving positive results for the study's primary endpoint is associated with a deficient reporting of the medicinal product's toxicity.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It has been observed that the use of structured abstracts improves their quality.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> A recent review of 60 high-impact articles published in prestigious journals observed that 45% of the structured abstracts showed discrepancies with the results that were reported in the body of the articles.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> However, only 1 (2%) contained a conflicting, clinically relevant interpretation but which did not affect the abstract's conclusion.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As has been mentioned, the ultimate consequence of abstracts that contain conflicting information is the distortion of the risk–benefit ratio of the experimental treatment. Poor communication of the treatments’ safety profile also contributes significantly to this problem, which is practically the norm.<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36,37</span></a> What is more, in abstracts there is an excessive use of adjectives that can be inaccurate and deceptive and which have different patterns depending on whether the trials have been sponsored or not by industry.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Lastly, the perverse effect of including conflicting information (with spin) in the abstracts of articles that report the results of clinical trials has recently been shown. For example, in a study that included 300 oncologists with experience in clinical research, the conflicting abstracts influenced the interpretation of the trials’ results, which showed no statistically significant differences in the studies’ primary endpoints. The oncologists therefore interpreted the experimental treatment as beneficial and also showed more interest in reading the full article,<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> which would have enabled the alert reader to discover the conflicting results of the abstract.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Given that we can only freely access 50% of articles published in biomedicine,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> it is clear that the abstract is the only source of information available for the considerable majority (or entirety) of articles that report the results of clinical trials or other design types. Although there are multiple information sources for making clinical decisions,<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> there is always the possibility that a physician will make diagnostic and therapeutic decisions after reading an abstract of a trial. Thus, if you the reader have little time in your professional activity and are thinking of changing your regular diagnostic or therapeutic strategy in a specific case after reading an article's abstract, we recommend reading the full article to avoid running the risk of being misled by the abstract.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres797711" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec795735" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres797712" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec795736" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Access to medical information" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Biases in the publication of clinical trial results" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discrepancies between the information in the abstract and in the rest of the article" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-27" "fechaAceptado" => "2015-05-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec795735" "palabras" => array:9 [ 0 => "Clinical trials" 1 => "Abstracts" 2 => "Biases" 3 => "Spin" 4 => "Treatment" 5 => "Diagnosis" 6 => "Articles" 7 => "Clinical decision" 8 => "Dissemination of results" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec795736" "palabras" => array:9 [ 0 => "Ensayos clínicos" 1 => "Resúmenes" 2 => "Sesgos" 3 => "Spin" 4 => "Tratamiento" 5 => "Diagnóstico" 6 => "Artículos" 7 => "Decisión clínica" 8 => "Comunicación de resultados" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinicians typically update their knowledge by reading articles on the Internet. Easy access to the articles’ abstracts and a lack of time to access other information sources creates a risk that therapeutic or diagnostic decisions will be made after reading just the abstracts. Occasionally, however, the abstracts of articles from clinical trials that have not obtained statistically significant differences in the primary study endpoint have reported other positive results, for example, of a secondary endpoint or a subgroup analysis. The article, however, correctly reports all results, including those of the primary endpoint. In the abstract, the safety information of the experimental treatment is usually deficient. The whole article should be read if a clinical decision is to be made.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Es habitual que los clínicos actualicen sus conocimientos con la lectura de artículos a través de Internet. El fácil acceso al resumen de los artículos y la falta de tiempo para acceder a otros tipos de fuentes de información hace que exista el riesgo de que, en ocasiones, se puedan tomar decisiones terapéuticas o diagnósticas tras la sola lectura de los resúmenes. Ocasionalmente, sin embargo, en los resúmenes de artículos de ensayos clínicos que no han obtenido diferencias estadísticamente significativas en la variable principal de evaluación, se informa de otros resultados positivos, por ejemplo, de una variable secundaria o en un subgrupo de participantes. En el artículo, no obstante, se informa correctamente de todos los resultados obtenidos, incluso de los de la variable principal de evaluación. En el resumen, la información de seguridad del tratamiento experimental suele ser deficiente. Se debe leer el artículo completo si se va a tomar una decisión clínica.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Dal-Ré R, Castell MV, García-Puig J. Si le llaman la atención los resultados de un artículo, léalo completo, no se fíe solo del resumen. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 5 | 7 |
| 2018 February | 5 | 0 | 5 |
| 2018 January | 9 | 0 | 9 |
| 2017 December | 10 | 0 | 10 |
| 2017 November | 7 | 0 | 7 |
| 2015 November | 0 | 2 | 2 |
| 2015 September | 0 | 1 | 1 |
