Intended for healthcare professionals

Rapid response to:

Analysis Too Much Medicine

Overdiagnosis of bone fragility in the quest to prevent hip fracture

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2088 (Published 26 May 2015) Cite this as: BMJ 2015;350:h2088

Rapid Response:

Re: Overdiagnosis of bone fragility in the quest to prevent hip fracture

The decision of the BMJ to embrace a theme of over-diagnosis and over-treatment may be built on worthy foundations but the success of such an approach requires the application of the same rigour and standards to submitted articles that would be applied to any research manuscript. Chasing headlines and controversy might bring short term publicity but the strategy is fraught with problems. The line between being a responsible widely-read, scientific journal and one that has a reputation for notoriety and inaccuracy can be precariously thin.

Failing to distinguish between personal opinions, that often fail to stand up to scientific scrutiny, and scientifically founded reviews is one fault, but then headlining these hints at a worrying lowering of editorial standards. The latter is reflected even more worryingly in the concerns raised about the review process prior to publication. The request by Dr Javaid and others for the reviewers’ comments to be shared is an important one to be addressed to maintain the integrity of the journal and its editorial processes. I was pleased to note that the BMJ is seeking permission from the reviewers to enable them to do this and would seek to know when this might occur; personally, I cannot see how these comments could not be published anonymously even if permission is withheld.

There are many topics that deserve discussion and scrutiny within the field of medicine. The integrity of processes within our scientific journals needs to be held in the highest regard. We will all lose if a journalistic theme, no matter how noble, is pursued at the cost of eroding this integrity.

Competing interests: Prof. McCloskey has contributed to the development of the FRAX® tool in collaboration with the World Health Organization. He has been or is in receipt of research funding, speaker fees and/or consultancy fees from the following: ActiveSignal, Amgen, Arthritis Research UK, Consilient Health, GSK, GE Lunar, Hologic, Internis, Lilly, MRC, MSD, NIHR, Novartis, Ono, Pfizer, Roche, Servier, Synexus, Tethys, Unilever and Wyeth.

04 August 2015
Eugene V McCloskey
Professor of Adult Bone Diseases
University of Sheffield
Metabolic Bone Centre, Northern General Hospital, Herries Rd, Sheffield S5 7AU