Two grumpy editorials at NEJM

Steve Simon


I don’t have time to follow the journals as closely as I should, but I was shocked to find two very nasty editorials in recent issues of the New England Journal of Medicine. They are sharply critical of open sharing of data and of quality improvement efforts.

The first, an editorial on data sharing, warns us against “data parasites.” These are

“people who had nothing to do with the design and execution of the study but use another group’s data for their own ends, possibly stealing from the research productivity planned by the data gatherers, or even use the data to try to disprove what the original investigators had posited.”

Apparently, in order to avoid being a data parasite, you have to work closely with the original investigators. You can’t work on an “obvious extension” and your work has to acknowledge and offer coauthorship to the group that accumulated the original data.

To that I say, Pshaw! Some research can and should involve close work with the original investigators, but if failure to do so is parasitic, then the whole field of meta-analysis has been condemned.

There’s a quote by Harry Truman that is relevant here.

“It is amazing what you can accomplish if you do not care who gets the credit.”

If you are afraid to share your data because you are worried about someone else getting credit for your hard work, then I say you should get out of the business of medical research. Sure, you should keep your data private until you’ve written up the bulk of your research. But after that, cast your data upon the waters, and see what happens.

The second, an editorial against the standardization of the delivery of medical care,? claims that lean six sigma experts intent on standardizing every aspect of medical care are lurking outside your office with a stopwatch. They invent a term, medical Taylorism, that is a gross mischaracterization of lean six sigma.

Perhaps some bureaucrats have co-opted the quality improvement movement to squeeze a few dollars of profit at the expense of medical care. But anyone familiar with the movement will recognize lean six sigma as a rebellion against Taylorism. Wikipedia has a nice summary of Taylorism, by the way, in an article on scientific management, if you’re unfamiliar with this term. W. Edwards Deming, a pioneer in quality improvement, was a very harsh critic of Taylorism, and most current proponents of quality improvement would probably concur with his assessment. See this blog post, for example.

It’s important to realize that some aspects of medical care cannot and should not be standardized. But if anything, there is too little standardization, and rates of c-sections, for example, show variations far beyond what can be accounted for by individual patient differences.

Both editorials take points (collaborate when you can, don’t standardize everything) that do have some limited validity and take them to extremes. They set up straw men (data parasites, medical Taylorism)? to convince you to embrace their message to keep these bad things from happening.

You can find an earlier version of this page on my blog.