Lancet Botches Another One
According to Medecins Sans Frontieres, which judges a malnutrition study in Lancet to be deeply, dangerously flawed in its methodology and conclusions. MSF:
London/New York, January 16, 2008 – A series on maternal and child undernutrition in the current issue of the medical journal The Lancet, correctly puts the spotlight on nutrition as “a desperately neglected aspect of maternal, newborn, and child health.” However, because of weaknesses in analysis and outmoded recommendations the series is undermining efforts to promote urgently needed change.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams are confronted daily with the devastating impact of childhood malnutrition, having treated more than 150,000 children in 99 programs in 2006. The organization’s medical staff sees first-hand how malnutrition weakens children’s resistance and increases the risk of dying from pneumonia, diarrhea, malaria, measles, and AIDS. They have also documented the dramatic impact of nutrient-dense, ready-to-use food (RUF) in treating childhood malnutrition.
A few of the weaknesses in the Lancet series:
By not including, for example, deaths from nutritional oedema, the highly lethal form of severe acute malnutrition which predominates in large parts of central and southern Africa, The Lancet series dramatically underestimates the number of deaths attributable to severe acute malnutrition;
A failure to actively endorse the new WHO, UNICEF, and WFP supported approach of community/home-based management of severe acute malnutrition with RUF;
A focus on hospital-based care in an era when ministries of health, UN agencies, and NGOs are actively moving to a proven strategy of community/home-based care with RUF. Only complicated cases are now treated in hospital;
The authors justify withholding strong support for community-based care on a lack of “randomized trials.” However, they go on to stress the usefulness of hospital-based care based on the results of nine studies, none of which are randomized.
MSF has been treating acute malnutrition with ready-to-use food since 2000 in African and Asian countries, including Afghanistan, Angola, Burundi, Ethiopia, Niger and Sudan. Outpatient/home-based strategies have permitted MSF to treat far more children than would have been possible in the past, when hospital-based treatment was the standard of care. Results have been most closely monitored in MSF’s program in Maradi, Niger, where hundreds of thousands of patients have been treated since 2001. In 2007, over 22,000 severely malnourished children were treated with a cure rate of 84 percent and a mortality rate of less than three percent.Large-scale outpatient treatment of severe acute malnutrition is being successfully implemented by ministries of health, with support from implementing partners, in Malawi, Ethiopia, and Niger. However, despite strong UN recommendations to implement RUF treatment strategies, only about three percent of children with severe acute malnutrition have access to therapeutic RUF today. 1
By failing to strongly endorse and promote community treatment with RUF, the The Lancet authors are undermining the support for this lifesaving intervention.
Perhaps the conservative approach is based on the fact that new, more effective strategies with ready-to-use food will be more expensive, and will require international funding to purchase products (often locally). But considering the exceptional results achieved to date with RUF by MSF and others, and the potential to save lives, donors should fund and support recipient countries to rapidly scale-up this intervention. Implementation of this strategy will mean the difference between life and death for at-risk children under three.
I know zip about this issue and have no opinion. Readers will be familiar with controversy surrounding Lancet’s historical issues with bias and bad metholodogy, however.
Welcome Instapundit, Hotair, Surberistas, etal. Always so good to see you. Come on in, make yourself at home.
Posted by Jules Crittenden at 10:19 am on Friday, January 18, 2008
9 Responses to “Lancet Botches Another One”
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January 18th, 2008 at 10:32 am
Sounds like Lancet is branching out from killing American soldiers to killing children. George Soros must be very proud.
January 18th, 2008 at 10:53 am
The Lancet editor, Dr. Richard Horton, on youtube.
A picture’s worth 1000 words.
http://youtube.com/watch?v=csxvUzpIQ18&feature=related
January 18th, 2008 at 10:53 am
[...] Jules Crittenden fisked [...]
January 18th, 2008 at 11:26 am
New England Journal is no better. The recent attack on anti-depresants was worded to make you think that the drug companies were concealing trial results. the truth was that the material NEJ used was all filed with the FDA, your Federal guardian angel.
January 18th, 2008 at 11:42 am
I think drug companies do conceal trial results.
And have suppressed study results with outcomes that “the FDA” might not look on happily in considering granting approval.
My comment is general and doesn’t relate to the specific situation you refer to.
Which was reported in nytimes yesterday, article titled
“Antidepressant Studies Unpublished”
Ah, but Congress will save us, uh huh.
And last year, Congress passed legislation that expanded the type of trials and the depth of information that must be submitted to clinicaltrials.gov, a public database operated by the National Library of Medicine.
January 18th, 2008 at 2:00 pm
[...] Crittenden points out that, according to Medecins Sans Frontieres (Doctors Without Borders), the Lancet has botched yet [...]
January 18th, 2008 at 3:45 pm
Merriam-Webster’s Medical Dictionary..
Main Entry: lan·cet
Pronunciation: ‘lan(t)-s&t
Function: noun: a sharp-pointed and commonly two-edged surgical instrument used to make small incisions (as in a vein or a boil) called also lance
The Lancet, has become a boil, that needs to be, lanced.
January 19th, 2008 at 8:32 am
Wikipedia has a good piece on the Humanitarian Daily Ration.
The HDR has been used, AFAIK, as far back as the Bosnia situation.
Still, the Lancet’s position has to be considered. You’ll recall the drooling glee with which the libs counted up the dead Iraqi babies due to sanctions.
When we first started on Afghanistan, we were dropping HDRs into the countryside, with flights based out of Ramstein. I talked to a liberal clergyman who said he was against it because it “muddied the water”. Apparently not enough dead Afghans.
So don’t discount a vicious and murderous motivation here.
January 20th, 2008 at 6:59 pm
[...] THE LANCET quickly earning a very bad reputation …. [...]