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BMJ 2010; 340 doi: (Published 16 March 2010) Cite this as: BMJ 2010;340:c1476

Old treatments have a low profile in leading medical journals

Between 2008 and 2009, six leading medical journals published 328 studies evaluating drug treatments for disease. Less than a third (104/328) compared one established treatment with another, or otherwise helped doctors and patients make everyday decisions about which treatment to use, which dose to prescribe, how to avoid side effects, or how long to treat. Researchers trawled through the six journals to try and quantify a much publicised blind spot in biomedical research—comparative effectiveness studies evaluating existing treatments and informing real world choices.

Among the 104 comparative effectiveness studies they found, few compared drug treatments with non-drug treatments such as behaviour change (11/104), and even fewer included a cost effectiveness analysis (2/104). One in six (16/104) compared different dosing strategies, and only one in five (20/104) focused on drug safety.

Nearly all studies relied on non-commercial funding (90/104), because commercial organisations are necessarily more interested in evaluating new drugs against placebos, for the regulators. The US government recently pledged more than $1bn (£0.66bn; €0.73bn) for research dedicated to helping doctors and patients get the most out of existing treatments. This snapshot should help direct the money where it is needed most. Used wisely, the new money has the potential to transform health care in the US, adds one observer (p 985).

Donating a kidney looks safe in a large study from the US

Live kidney donors are one answer to the chronic shortage of kidneys for transplantation. But is it safe to donate a kidney to a relative? The most reassuring data so far come from a large cohort of more than 80 000 adult donors who had a nephrectomy between 1994 and 2009 in the US. Just 25 died within 90 days of surgery—an associated mortality of 3.1 per 10 000 donations, which is substantially lower than the mortality associated with laparoscopic cholecystectomy (18/10 000).

Long term survival was excellent. Donors were …

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