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WHO jumps the gun?

On 21st August PLoS Medicine published a research article from Kenya that reported a remarkable increase in the number of children sleeping under insecticide-treated mosquito nets, following policy changes that led to greater availability of free nets. A month later the Lancet published further findings from the same study.

Both journals had, however, been taken by surprise, on 16th April, by the release of a lengthy press kit by the World Health Organization, before the articles themselves had been published. The Kenyan research team had shared their data with WHO but on a confidential basis; they too were surprised (indeed shocked) by the early release. But the breaking of a press embargo is not the main issue here. Both research articles included detailed discussion of the results and the study strengths and limitations. The WHO document in contrast made bold unqualified statements and went on to issue new guidance on the use of nets, based on its interpretation of the study data.

An editorial in the Lancet has already registered concern over the behaviour of WHO. There has also been debate on the matter on various listservs, including HR4D-net and HIF-net.

So should WHO be making claims based on research that has not completed expert peer-review and which it has chosen to interpret in its own way? It would be interesting to hear the views of readers of PLoS Medicine on this point. However, it does seem to me that if we journal editors wait until expert review has been completed – and we are confident in the rigour of a study and its conclusions – before we publish, then policy-setting UN organisations must also surely hold their fire before they contact the media and issue new guidance.

Discussion
  1. surely the key issue is not the timing, but rather the misrepresentation of the study findings – which has the effect of promoting use of a strategy at variance with the evidence (e.g. single prong ITN distn via free giveaways via campaign vs multiprogram approach).

    Andrew Oxman et al published a paper in The Lancet in June which documented a less than rigorous focus within WHO to ensuring guidelines represented accurately existing knowledge
    http://www.thelancet.com/journals/lancet/article/PIIS0140673607606758/abstract

    I would take this latest statement as yet another example of the same problem (allow personal preferences and opinions to color presentation of evidence)

  2. Thanks, April, for your comment. I certainly agree that breaking an embargo is not as important as introducing a policy based on an over-interpretation of research findings.

    For my part, I think the new findings on net use in Kenya – as reported in PLoS Medicine and the Lancet – are very exciting. The distribution of free nets does seem to have made a big difference. (I should note a personal bias here, as I have never been overly impressed by social marketing and would have expected free distribution to produce better results!)

    Nevertheless, the researchers interpreted their results with caution and did not over-interpret. WHO seems, here at least, to have behaved less responsibly.

    Paul Chinnock

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