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Biomedical subjects

Richard Horton

Publications and source records attributed to Richard Horton.

At least 73 records · Page 4Linked to original sources
PubMed2003

The health of peoples: predicaments facing a reasoned utopia.

How might nations cooperate to improve the health of their most vulnerable peoples? There is, presently, no coherent political, social, or ethical framework to answer this question. What progress there is remains piecemeal. Despite a long-term strategy to 2015 enshrining health as part of the process of human development--the Millennium Development Goals--existing institutions are struggling to meet these challenges. The WHO is underfunded and its work in countries is weak. The World Bank is rich but remains unable to free itself from a neoliberal Washington consensus. New institutions--such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria--distort efforts to build a coordinated international strategy for global health. And major policy initiatives (e.g., the Commission on Macroeconomics and Health) lack political commitment to invest in health. In this article, the author traces the beginnings of an answer to the question of what might constitute a political (specifically, foreign policy) approach to improving the health of peoples. A normative model for defining a just health system is urgently required. The author uses the framework of international relations provided by John Rawls to devise a series of policy principles for the health of peoples.

Delivery of Health Care↗
PubMed2003

An investigation of nitric oxide metabolites during symptomatic myocardial ischaemia in relation to exercise tolerance test.

BACKGROUND: Nitric oxide (NO) plays a pivotal role in the pathophysiology of coronary heart disease (CHD). Low plasma concentrations of NO metabolites (nitrite and nitrate), the stable oxidation products of NO have been reported in patients with CHD but this is controversial. Plasma nitrite and nitrate concentrations during symptomatic myocardial ischaemia and in response to exercise in subjects with CHD have not been studied. We therefore measured plasma nitrite and nitrate concentrations in subjects before and after an exercise tolerance test (ETT). MATERIAL/METHODS: Plasma nitrite and nitrate concentrations were measured before and after an ETT in 24 subjects with symptomatic exercise-induced myocardial ischaemia (positive ETT) and in 27 subjects without exercise-induced myocardial ischaemia (negative ETT). RESULTS: Plasma nitrate concentrations were higher (p<0.002) before and after the ETT in subjects with a positive ETT (31.51+/-21.80 mol/L and 30.86+/-21.42 mol/L respectively) than in the subjects with a negative ETT (14.75+/-6.71 mol/L and 15.64+/-6.50 mol/L respectively). Plasma nitrite concentrations before and after the ETT were similar in both groups. Within each group, plasma nitrite and nitrate concentrations were not altered by exercise. CONCLUSIONS: Subjects with exercise-induced myocardial ischaemia have higher plasma nitrate concentration than subjects without exercise-induced myocardial ischaemia. This is consistent with either a compensatory or an inflammatory response of the vascular endothelium to endothelial damage. Symptomatic exercise-induced ischaemia is not associated with altered plasma NO metabolite concentrations.

Adult↗
PubMed2002

The hidden research paper.

CONTEXT: To determine whether the views expressed in a research paper are accurate representations of contributors' opinions about the research being reported. METHODS: Purposive sampling of 10 research articles published in The Lancet; qualitative analysis of answers to 6 questions about the meaning of the study put to contributors who were listed on the byline of these articles. Fifty-four contributors listed on the bylines of the 10 articles were evaluated, and answers to questions were compared between contributors within research groups and against the published research report. RESULTS: A total of 36 (67%) of 54 contributors replied to this survey. Important weaknesses were often admitted on direct questioning but were not included in the published article. Contributors frequently disagreed about the importance of their findings, implications, and directions for future research. I could find no effort to study systematically past evidence relating to the investigators' own findings in either survey responses or the published article. Overall, the diversity of contributor opinion was commonly excluded from the published report. I found that discussion sections were haphazardly organized and did not deal systematically with important questions about the study. CONCLUSIONS: A research paper rarely represents the opinions of those scientists whose work it reports. The findings described herein reveal evidence of (self-)censored criticism, obscured meanings, confused assessment of implications, and failures to indicate directions for future research. There is now empirical support for the introduction of structured discussion sections in research papers. Editors might also explore ways to recover the plurality of contributors' opinions.

Biomedical Research↗
PubMed2002

Postpublication criticism and the shaping of clinical knowledge.

CONTEXT: Letters to the editor are an important means for ensuring accountability of authors and editors. They form a part of the postpublication peer review process. I studied the critical footprint made in the medical literature by 3 randomized trials (Hypertension Optimal Treatment [HOT], Captopril Prevention Project [CAPPP], and Swedish Trial in Old Patients with Hypertension 2 [STOP-2]) published in The Lancet and investigated the extent to which that footprint was preserved in shaping clinical knowledge. METHODS: Qualitative appraisal of the criticism of each trial, taken from published letters. Agreed weaknesses and unanswered criticisms were identified from the authors' reply. I searched MEDLINE for practice guidelines published after the trial report and sought evidence for incorporation of criticism into these guidelines. RESULTS: From the time of publication to October 2000, HOT was cited in 9 of 36 practice guidelines; CAPPP, in 6 of 36; and STOP-2, not at all. HOT received 14 published criticisms, 5 comments, and 3 questions, of which 15 were responded to. Only 1 criticism, lack of power, was referred to in 1 guideline. CAPPP received 14 criticisms, 9 comments, and 3 questions, of which 8 were responded to. Only 1 criticism, imbalances between groups, was referred to in 1 guideline. STOP-2 received 12 criticisms, 9 comments, and 3 questions, of which only 6 were responded to. CONCLUSIONS: More than half of all criticism made in correspondence went unanswered by authors. Important weaknesses in trials were ignored in subsequently published practice guidelines. Failure to recognize the critical footprint of primary research weakens the validity of guidelines and distorts clinical knowledge.

Clinical Competence↗