What does Clinical and Experimental Allergy mean by Trusted Evidence in Allergy'?

Soon after our appointment as joint Editors in Chief of Clinical and Experimental Allergy, we developed a new mission to be the home of ‘Trusted Evidence in Allergy’. In this editorial, we explain what we mean by Trusted Evidence in Allergy and how this mission is informing our approach to commissioning, editing, publishing and disseminating manuscripts. Science has been characterized as being in a ‘crisis of reproducibility’ such that in some fields, the majority of published studies are not confirmed when independent groups attempt to replicate findings.1 While the true extent of the issue of scientific misconduct and questionable research practices is debated, there is clearly increasing concern amongst scientists about reproducibility, and the issue appears to be particularly acute in relation to biomedical sciences such as allergy/immunology.2 In biomedical science, the potential for harm from misleading scientific findings is also high, since findings often impact clinical practice and self-management strategies of people affected by health conditions. Some experts estimate that as many as 20% of published clinical trials contain false data.3 However, the key mediators of reproducibility concerns are less dramatic than falsified data—namely multiplicity of testing and selective reporting (Table 1). Together these can powerfully skew published findings so that the findings become ‘non-reproducible’. Multiplicity and selective reporting are tools which allow researchers to report a desired finding, even if that finding is not supported by the data. While the use of these tools might appear extreme to a non-scientific audience, issues with multiplicity and selective reporting are common in the biomedical science literature and are facilitated when there is low transparency. Transparency is still low in biomedical research - for example, 15 years after ‘mandatory’ clinical trial registration, it is still common for clinical trials to be published without a trial registration record, or with a registration record which fails to clearly state the aims of the trial. The key personal or institutional drivers of poor scientific practice, which uses multiplicity and selective reporting to present data in a biased manner, are academic incentives such as pressure to publish and commercial incentives to maximize profit. When these academic and commercial incentives are combined, whole fields of science can be misleading, dominated by spin and marketing messages with little real scientific progress.4 Unfortunately, there are also specific, intentional marketing practices, which can lead to presentation of marketing messages as scientific findings, in order to effect behaviour change in scientific or healthcare professionals. These go beyond multiplicity and selective reporting, using techniques such as ghost-written articles with respected key opinion leaders as authors; or so-called seeding trials, designed to stimulate regional sales growth.5 The field of allergy, like other biomedical fields with strong commercial potential, struggles to find an independent voice. The major allergy journals, their societies, their conferences and many key opinion leaders are sponsored by companies, which can profit from specific types of scientific findings, often through promoting overdiagnosis or unnecessary treatments. This can lead to a skewed representation of research findings. An obvious example would be highlighting of industry-sponsored guidelines, which serve to expand clinical indications for using industry products at major conferences. More subtle examples would be undue emphasis in conference programmes, journal pages and guideline recommendations on pharmaceutical treatments for allergic conditions, at the expense of natural or self-management approaches. Our aim in being the home of Trusted Evidence in Allergy is to lead the field in transparency and independence from commercial sponsorship. We have taken initial steps in this direction by formally joining CONSORT, prohibiting certain types of commercial advertisement and updating our author guidelines to emphasize the importance of public registration of protocols to reduce the risk of selective reporting. Where commercially sponsored work is published in our journal, which could potentially have a marketing objective, we require authors to state the sponsorship source in the Abstract so that readers can interpret findings in that context. In order to present readers with independent, rigorous summaries of the evidence supporting allergy practice, we have developed a special collection of ‘Cochrane Corners’, summarizing recent Cochrane Reviews relevant to allergy—this collection continues to be added to each month.6 We are also playing an advocacy role, encouraging allergy societies and other health professional organizations to distance themselves from controversial commercial partnerships, which can distort science and harm the public.7 We encourage submissions of work to Clinical and Experimental Allergy which align with our mission to be the home of Trusted Evidence in Allergy, including manuscripts addressing the ‘crisis of reproducibility’, addressing misrepresented or fraudulent science and addressing the needs of those affected by allergy rather than just those who profit from allergy. This month's Cochrane Corner summarizes evidence for phototherapy to treat atopic eczema.8 It is disappointing to see how weak the clinical trial evidence is for phototherapy, given that this treatment has been part of the eczema armamentarium for over 50 years. Figure 1 shows the key patient-centred outcome of interest, with increased probability of a self-reported reduction in itch with narrow-band ultraviolet B treatment compared with no phototherapy. This contrasts with topical treatments, biologics and immunosuppressants, where evidence for efficacy is derived from multiple, larger clinical trials. However, phototherapy is a cheaper alternative to the systemic treatments and further work is clearly needed to establish the place of phototherapy in the growing hierarchy of eczema treatments. Robert J Boyle led development of this manuscript. Mohamed Shamji approved the final version of the manuscript.