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  1. Case report should be withdrawn

    Dear Editor

     

    Case report should be withdrawn

    HealthWatch UK is a charity that promotes ‘science and integrity in medicine’, values we might all expect to be shared by the BMJ and all its subsidiary journals. Accordingly, we ask you to think again about the Publishing Executive’s response (1) to the e-letter submitted by our colleague Les Rose (2) regarding a report by Zaidi et al. (3) about curcumin as a treatment for myeloma.

     

    We regard the response as unsatisfactory because:

     

    1. Zaidi et al. had little regard for the extensive published research on the medicinal chemistry of curcumin. Their conclusion made a clear case for the clinical use of curcumin in myeloma, when it would have been far more appropriate to call for rigorous clinical trials. The BMJ was wrong to say the language they used was ‘cautious’.

     

    2. Zaidi et al. have not responded to Rose and their use of citations of research by an investigator whose related research has been retracted was not commented upon (1). This should have been detected both by reviewers and editors and should have been put right.

     

    3. It is poor judgment for BMJ Case Reports to deny responsibility for claims in other media – especially when our complaints to the BBC were rebutted by the justification that this was a peer-reviewed publication. Journal executives must know that such claims will be amplified by the lay media, especially when they are unusual and thus newsworthy. Indeed, journals often issue press releases for this purpose. Editors therefore have an obligation to ensure that peer review is rigorous and claims in published papers are made responsibly.

     

    4. While case reports have a role in medicine, they are no more than a suggestion of where proper research should next be carried out. It is not appropriate even to suggest that a treatment should be prescribed on the basis of anecdote.

    For all these reasons, HealthWatch UK considers that this report should be withdrawn and an editorial should be published explaining the reasons.

       

    Susan Bewley, Professor of Women’s Health, Kings College London, Chair of HealthWatch UK Nick Ross, writer, campaigner and broadcaster Roger Fisken, consultant physician (retired)

     

    On behalf of the Board of Trustees of HealthWatch UK.

       

    References

     

    (1) Thomas J. Association is not Causation. http://casereports.bmj.com/content/2017/bcr-2016-218148.full/reply#casereports_el_4149

    (2) Rose L. Association is not Causation http://casereports.bmj.com/content/2017/bcr-2016-218148.full/reply#casereports_el_4149

    (3) Zaidi A, Lai M, Cavenagh J. Long-term stabilisation of myeloma with curcumin. BMJ Case Reports 2017: published online 16 April 2017, doi:10.1136/bcr-2016-218148 http://casereports.bmj.com/content/2017/bcr-2016-218148.full

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  2. Re:Association is not causation

    BMJ approached the authors for their comments, but did not receive a response. This case was reviewed by two external peer reviewers prior to publication. It uses cautious language throughout and correctly offers no definitive conclusions. BMJ Case Reports is not responsible for claims made in other media.

    Conflict of Interest:

    I am the Publishing Executive for BMJ Case Reports

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  3. Association is not causation

    Zaidi et al conclude that "Dietary supplements, such as curcumin, may be beneficial for some myeloma patients". This is on the basis of their single case report; in other words it is an anecdote. In contrast, the medicinal chemistry of curcumin has been studied in depth for many years. Nelson et al conclude that, despite over 120 clinical trials, no beneficial effect has been observed (1).

    I am wondering about how rigorous was the peer review of this case report. Did the reviewers evaluate what was the more likely explanation, in the light of the published literature?

    I note that Zaidi et al cite a review by Aggarwal et al in 2009 (2). Several papers from this author were withdrawn in or about 2012 as possibly fraudulent (3), casting doubt on his authority. I do not think this oversight reflects well on the authors of the present case report, or on its reviewers.

    This case report has recently attracted substantial attention from the lay media. Exaggerated claims have been made on national radio. Yet there is good evidence that cancer patients who rely on alternative treatments such as plant extracts have worse outcomes (4). Was it really responsible of the BMJ to publish this report in its present form?

    References

    1. Nelson KM, Dahlin J, Bisson J et al. The Essential Medicinal Chemistry of Curcumin. J Med Chem. 2017 Mar 9; 60(5): 1620-1637.

    2. Aggarwal BB, Harikumar KB. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol 2009;41:40-59.

    3. Ackerman T. M.D. Anderson scientist, accused of manipulating data, retires. Houston Chronicle, March 2, 2016 Updated: March 4, 2016. http://bit.ly/2AHTN20 (accessed 8th Jan 2018)

    4. Johnson SB, Park HS, Gross CP et al. Use of Alternative Medicine for Cancer and Its Impact on Survival. Journal of the National Cancer Institute, Volume 110, Issue 1, 1 January 2018

    Conflict of Interest:

    I have had smouldering myeloma for nine years but have not required treatment.

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