Letters to the Editor

we could pursue more donors who are not seeking public recognition, or at least not such prominent public recognition. There are certainly a range of offerings that sit below the level of the medical school name. These range from sponsoring a campus building name, to sponsoring research programs, to sponsoring lecture theaters: The options are manifold. These options would command lower funding streams and require more donors to raise more money, but schools would then be less reliant on a single donor. Another strategy, of course, would be to reduce the need for funding altogether by pursuing low-cost, highvalue forms of medical education to produce low-cost, high-value doctors who would deliver low-cost, high-value care. Then we could name our medical schools after our profession’s own rich heritage—names like Flexner, Osler, Hippocrates, Galen, Lister, Fleming, Imhotep, Sushruta, Asklepios, Celsus, or Rhazes. This is the form of richness that we should pursue. Disclosures: None reported. Kieran Walsh, FRCPI Clinical director, BMJ Learning, the medical education service of the BMJ Group, London, United Kingdom; [email protected].

References 1 Falit BP, Halperin EC, Loeffler JS. Green eggs and ham: Strategies to address the growing phenomenon of selling a medical school’s name. Acad Med. 2014;89:1614–1616. 2 Walsh K, Jaye P. Cost and value in medical education. Educ Prim Care. 2013;24:391–393. 3 Center on Philanthropy at Indiana University. The 2010 Study of High Net Worth Philanthropy: Issues Driving Charitable Activities Amongst Affluent Households. Indianapolis, Ind: Center on Philanthropy; November 2010. http://agb. org/sites/default/files/legacy/u16/BAML%20 HNW%20Final.pdf. Accessed July 30, 2015.

Medical Literature: Don’t Believe Everything You Read To the Editor: Throughout medical school, internship, and residency I encountered a variety of medical papers and studies referenced by attendings, residents, and fellows. Many were from highly obscure journals and lacking sound methodology. The overriding theme was that my fellow residents and even some attendings were not all well

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versed on critical appraisal of study methodology. It became apparent that the understanding of methodology, study design, and clinical applicability was sorely lacking. As I first immersed myself in reviewing the literature in preparation for writing my own papers, I discovered numerous methodological flaws, gross errors in referencing, and, most striking, quotes obviously taken out of context. Recently, I sought more information about a statistic as referenced in a highly regarded journal. Review of the original source uncovered misquoted references and statistics reported incorrectly. Equally alarming is the frequency with which statements are quoted in ways that contradict the overall conclusions of the original source. Now, having submitted manuscripts to various journals, I am struck by the degree of variability in the peer review process and vast differences in submission requirements. There are journals that go to extreme lengths in selection of multiple expert reviewers and journals that consult a single reviewer. The commentary of an expert reviewer truly enhances and completes a manuscript and provides scrutiny for inaccuracies. In recent years, there have also been a large number of manuscript retractions for falsification and misconduct.1,2 Finally, well-regarded journals generally retain statisticians to assess the quality of statistical work, a layer of review that is often not provided by the more obscure journals. Instruction in decrypting the medical literature tends to focus on heavy statistical analysis and may scare away inexperienced readers. However, excellent templates exist for how those of us without research backgrounds can learn to examine and assess the medical literature appropriately and determine the validity of a study.3,4 In an era in which it is possible to conduct literature searches “on the fly” (often using a standard search engine), for the novice reader it is easy to believe everything you read. There must be a push in medical education—from medical students to attendings—to educate ourselves and our trainees about what is reliable evidence to be used in the practice of evidence-based medicine!

Disclosures: None reported. Adam C. Adler, MD, MS Attending physician, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; [email protected].

References 1 Nath SB, Marcus SC, Druss BG. Retractions in the research literature: Misconduct or mistakes? Med J Aust. 2006;185:152–154. 2 Woolley KL, Lew RA, Stretton S, et al. Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for misconduct: A systematic, controlled, retrospective study. Curr Med Res Opin. 2011;27:1175–1182. 3 Young JM, Solomon MJ. How to critically appraise an article. Nat Clin Pract Gastroenterol Hepatol. 2009;6:82–91. 4 Barratt A, Irwig L, Glasziou P, et al. Users’ guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group. JAMA. 1999;281:2029–2034.

The Responsibility of Academic Medicine for Reducing Football Injuries To the Editor: As a result of playing football, high school and college students die of heat prostration, dehydration, and head trauma, others are rendered paraplegic and quadriplegic, and many are sent on a pathway leading to premature dementia and death as a result of recurrent concussions—and we are all supposed to feel sanguine about this because we are reassured that there is a doctor on the sidelines during games. Concussion rates in football practice and competition exceed other sports.1 Repetitive concussions and years of playing football are associated with diminished hippocampal volume and slowed reaction time.2 Academic medicine has a responsibility to be a leader in efforts to reform the game. Academic medicine plays a significant role in facilitating football. Medical school clinical departments provide sideline physicians, do screening physicals, and practice sports medicine for football players. Advertisements link clinical practices to football: “Come see the doctors who take care of the fighting [fill in the name of the mascot] of the University of [fill in the blank].” Some college athletic departments want to be paid by the faculty

Academic Medicine, Vol. 90, No. 11 / November 2015

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Medical literature: don't believe everything you read.

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