Acronym-Named Randomized Trials in Medicine — The ART in Medicine Study
http://www.100md.com
《新英格兰医药杂志》
To the Editor: The use of acronyms to name clinical trials is increasingly popular yet controversial.1,2 We evaluated whether the naming of a trial with an acronym is associated with a distinctive effect on research, measured as the citation rate after publication. We identified consecutive randomized trials published between 1953 and 2003 from all systematic reviews completed by the Cochrane Heart Group as of January 31, 2004. The trials were classified as having or not having a name composed of an acronym and were analyzed as clusters according to research question, with the use of hierarchical linear modeling.3
Of the 173 studies identified, 59 (34 percent) were named with an acronym. Three journals (Circulation, the Lancet, and the New England Journal of Medicine — listed alphabetically) accounted for 61 percent of the acronym-named studies. As compared with studies without acronym names, acronym-named studies had higher Jadad methodologic quality scores,4 enrolled five times as many patients, had follow-up periods half as long, but were not more likely to report positive results. Acronym-named studies were four times as likely to be funded by the pharmaceutical industry and eight times as likely to be authored by an industry employee.
Acronym-named randomized trials were cited at twice the rate of trials that were not named with acronyms (13.8 vs. 5.7 citations per year; relative rate of citation, 2.43; 95 percent confidence interval, 1.50 to 3.95; P<0.001) (Table 1). This association persisted after multivariable adjustment (relative rate of citation, 1.66; 95 percent confidence interval, 1.02 to 2.69; P=0.04). A subanalysis of 42 articles matched according to the journal in which they were published yielded similar results (relative rate of citation, 2.04; 95 percent confidence interval, 1.02 to 4.09; P=0.04).
Table 1. The Association of the Use of Acronyms to Name Clinical Trials and the Rate of Citation after Publication.
Although other explanations are possible (for example, exemplary investigators may generate both clever acronyms and important research), these results support the hypothesis that naming randomized trials with an acronym may enhance the citation rate. This is consistent with the function of acronyms in human language as effective mnemonic tools.2 Their influence might also be subliminal, since specific acronyms could invoke subconscious value-laden associations that might enhance positive perceptions of the studies they name, a phenomenon in cognitive psychology known as "automatic attitude activation."5
Enhanced attention to and recall of studies through the use of acronyms may facilitate the appropriate translation of research findings into clinical practice. If acronyms exert influence independently of normative markers of clinical credibility, however, such influence is not rational scientifically, even if it is understandable psychologically. Consequently, this subtle linguistic tool could undermine evidence-based practice. The observed close association between acronym use and sponsorship by the pharmaceutical industry amplifies this concern.
Matthew B. Stanbrook, M.D., Ph.D.
Peter C. Austin, Ph.D.
Donald A. Redelmeier, M.D.
University of Toronto
Toronto, ON M4N 3M5, Canada
m.stanbrook@utoronto.ca
Supported by a fellowship award from the Canadian Institutes of Health Research and by the Clinician-Scientist Program of the Department of Medicine, University of Toronto (to Dr. Stanbrook); by a new investigator award from the Canadian Institutes of Health Research (to Dr. Austin); and by a Canada Research Chair in Medical Decision Science and a grant from the Canadian Institutes of Health Research (to Dr. Redelmeier).
References
Berkwits M. CAPTURE! SHOCK! EXCITE! Clinical trial acronyms and the "branding" of clinical research. Ann Intern Med 2000;133:755-759.
Orlowski JP, Christensen JA. The potentially coercive nature of some clinical trial research acronyms. Chest 2002;121:2023-2028.
Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks, Calif.: Sage, 2002.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
Bargh JA, Chaiken S, Govender R, Pratto F. The generality of the automatic attitude activation effect. J Pers Soc Psychol 1992;62:893-912.
Of the 173 studies identified, 59 (34 percent) were named with an acronym. Three journals (Circulation, the Lancet, and the New England Journal of Medicine — listed alphabetically) accounted for 61 percent of the acronym-named studies. As compared with studies without acronym names, acronym-named studies had higher Jadad methodologic quality scores,4 enrolled five times as many patients, had follow-up periods half as long, but were not more likely to report positive results. Acronym-named studies were four times as likely to be funded by the pharmaceutical industry and eight times as likely to be authored by an industry employee.
Acronym-named randomized trials were cited at twice the rate of trials that were not named with acronyms (13.8 vs. 5.7 citations per year; relative rate of citation, 2.43; 95 percent confidence interval, 1.50 to 3.95; P<0.001) (Table 1). This association persisted after multivariable adjustment (relative rate of citation, 1.66; 95 percent confidence interval, 1.02 to 2.69; P=0.04). A subanalysis of 42 articles matched according to the journal in which they were published yielded similar results (relative rate of citation, 2.04; 95 percent confidence interval, 1.02 to 4.09; P=0.04).
Table 1. The Association of the Use of Acronyms to Name Clinical Trials and the Rate of Citation after Publication.
Although other explanations are possible (for example, exemplary investigators may generate both clever acronyms and important research), these results support the hypothesis that naming randomized trials with an acronym may enhance the citation rate. This is consistent with the function of acronyms in human language as effective mnemonic tools.2 Their influence might also be subliminal, since specific acronyms could invoke subconscious value-laden associations that might enhance positive perceptions of the studies they name, a phenomenon in cognitive psychology known as "automatic attitude activation."5
Enhanced attention to and recall of studies through the use of acronyms may facilitate the appropriate translation of research findings into clinical practice. If acronyms exert influence independently of normative markers of clinical credibility, however, such influence is not rational scientifically, even if it is understandable psychologically. Consequently, this subtle linguistic tool could undermine evidence-based practice. The observed close association between acronym use and sponsorship by the pharmaceutical industry amplifies this concern.
Matthew B. Stanbrook, M.D., Ph.D.
Peter C. Austin, Ph.D.
Donald A. Redelmeier, M.D.
University of Toronto
Toronto, ON M4N 3M5, Canada
m.stanbrook@utoronto.ca
Supported by a fellowship award from the Canadian Institutes of Health Research and by the Clinician-Scientist Program of the Department of Medicine, University of Toronto (to Dr. Stanbrook); by a new investigator award from the Canadian Institutes of Health Research (to Dr. Austin); and by a Canada Research Chair in Medical Decision Science and a grant from the Canadian Institutes of Health Research (to Dr. Redelmeier).
References
Berkwits M. CAPTURE! SHOCK! EXCITE! Clinical trial acronyms and the "branding" of clinical research. Ann Intern Med 2000;133:755-759.
Orlowski JP, Christensen JA. The potentially coercive nature of some clinical trial research acronyms. Chest 2002;121:2023-2028.
Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks, Calif.: Sage, 2002.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
Bargh JA, Chaiken S, Govender R, Pratto F. The generality of the automatic attitude activation effect. J Pers Soc Psychol 1992;62:893-912.