The July 2012 issue of The Cochrane Library included an update of a Cochrane Review on deworming drugs for soil-transmitted intestinal worms in children. The review hadn't been updated in four years and although a number of new trials had been found, the update didn't radically change the conclusions -- that there is a lack of high-quality evidence that community-based deworming programmes improve outcomes. The updated review also included summary of findings tables that presented the quality of evidence for each of the main outcomes using the GRADE methodology. Given the global investment in deworming programmes it’s not surprising that there was debate and differing opinion on the conduct of the review and its findings.
Such debate only happens if people know about the review and if someone is motivated to kick-start the discussion. For this review that spark came mostly from a post on PLOS Medicine's Speaking of Medicine blog, presenting the arguments for and against deworming programmes. The blog was the idea of one of the review's authors, and Co-ordinating Editor of the Cochrane Infectious Diseases Group, Professor Paul Garner. One benefit of a blog is that readers can quickly and easily add their comments to the debate (indeed there is sometimes a race to publish the first comment). That immediacy, simplicity and informality is just right for a debate on a controversial and important review. The blog was of course also a springboard for sharing on Twitter, Facebook and other social media, and this prompted responses in other blogs and media. The story of that dissemination can be seen in this 'Storify': http://storify.com/JHeditor/deworming-drugs. As you can see, opinions on the review ranged from "incomplete and misleading" at one end of the spectrum to "reinforces our skepticism about the quality of much of the evidence" at the other. What’s also apparent is the input of infomediary organisations, which have interpreted and summarised the evidence for their target audiences.
The debate continues, and not all the major players have contributed yet, but we hope the arguments and discussions will help to influence policy and guidelines. A challenge facing the review team and the wider Cochrane community is how best to participate in the discussion and how to gather in all the threads. One way in which Cochrane Reviews differ from other biomedical publications is that they are 'living documents' that are amended or updated in response to criticisms or new information. Gathering comments (from wherever they occur) is an important means of improving the quality and relevance of reviews. It is clear that there are now multiple avenues for readers of scientific research to join the conversations around scientific articles. It is also clear that traditional barriers are breaking down in different ways - discussions extending beyond the boundaries of publishing companies as, in this case, the debate moved from a Cochrane Review published by The Cochrane Collaboration and its publisher, John Wiley & Sons, to blogs hosted by the Public Library of Science and the BMJ Group. We invite you to join the debate, wherever it occurs. If you want to submit your comments directly to the Review Group, you can use the 'Submit comments' function in the Article tools menu on The Cochrane Library.
1John Hilton; 2David Tovey
1John Hilton (email@example.com), Editor, Cochrane Editorial Unit, 13 Cavendish Square, London, W1G 0AN, UK; 2David Tovey (firstname.lastname@example.org), Editor-in-Chief, The Cochrane Library, Cochrane Editorial Unit, 13 Cavendish Square, London, W1G 0AN, UK.
How to cite: Hilton J, Tovey D. Debating the evidence for deworming programmes [editorial]. Cochrane Database Syst Rev. 2012 Aug15;8:ED000045. http://www.thecochranelibrary.com/details/editorial/2477681/Debating-the-evidence-for-deworming-programmes.html
1. Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD000371. DOI: 10.1002/14651858.CD000371.pub4
2. PLOS Medicine. Should deworming policies in the developing world be reconsidered? Speaking of Medicine, 18 July 2012 http://blogs.plos.org/speakingofmedicine/2012/07/18/should-deworming-policies-in-the-developing-world-be-reconsidered (accessed 8 August 2012)
Competing interests: The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request) and declares (1) no receipt of payment or support in kind for any aspect of the article; (2) no financial relationships with any entities that have an interest related to the submitted work; (3) that JH is employed as Editor by The Cochrane Collaboration and DT is employed as the Editor in Chief of The Cochrane Library but otherwise the authors/spouses/partners/children have no financial relationships with entities that have an interest in the content of the article; and (4) that there are no other relationships or activities that could be perceived as having influenced, or giving the appearance of potentially influencing, what was written in the submitted work.
Image credit: A Crump, TDR/WHO/Science Photo Library
Feedback on this editorial and proposals for future editorials are welcome.