Emerson Gwendolyn B, Warme Winston J, Wolf Fredric M, Heckman James D, Brand Richard A, Leopold Seth S
Department of Orthopaedics, University of Washington, Seattle, 98195-6500, USA.
Arch Intern Med. 2010 Nov 22;170(21):1934-9. doi: 10.1001/archinternmed.2010.406.
If positive-outcome bias exists, it threatens the integrity of evidence-based medicine.
We sought to determine whether positive-outcome bias is present during peer review by testing whether peer reviewers would (1) recommend publication of a "positive" version of a fabricated manuscript over an otherwise identical "no-difference" version, (2) identify more purposefully placed errors in the no-difference version, and (3) rate the "Methods" section in the positive version more highly than the identical "Methods" section in the no-difference version. Two versions of a well-designed randomized controlled trial that differed only in the direction of the finding of the principal study end point were submitted for peer review to 2 journals in 2008-2009. Of 238 reviewers for The Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research randomly allocated to review either a positive or a no-difference version of the manuscript, 210 returned reviews.
Reviewers were more likely to recommend the positive version of the test manuscript for publication than the no-difference version (97.3% vs 80.0%, P < .001). Reviewers detected more errors in the no-difference version than in the positive version (0.85 vs 0.41, P < .001). Reviewers awarded higher methods scores to the positive manuscript than to the no-difference manuscript (8.24 vs 7.53, P = .005), although the "Methods" sections in the 2 versions were identical.
Positive-outcome bias was present during peer review. A fabricated manuscript with a positive outcome was more likely to be recommended for publication than was an otherwise identical no-difference manuscript.
如果存在阳性结果偏倚，那么它会威胁到循证医学的完整性。
我们试图通过测试同行评议者是否会（1）推荐发表一份伪造手稿的“阳性”版本而非一份除结果无差异外完全相同的版本，（2）在无差异版本中识别出更多故意设置的错误，以及（3）对阳性版本中“方法”部分的评分高于无差异版本中相同的“方法”部分，来确定同行评议过程中是否存在阳性结果偏倚。2008 - 2009年，将两份仅在主要研究终点结果方向上存在差异的精心设计的随机对照试验版本提交给两家期刊进行同行评议。《骨与关节外科杂志》和《临床骨科学与相关研究》的238名随机分配去评审手稿阳性或无差异版本的评审者中，210人返回了评审意见。
与无差异版本相比，评审者更有可能推荐测试手稿的阳性版本发表（97.3%对80.0%，P < 0.001）。评审者在无差异版本中检测到的错误比在阳性版本中更多（0.85对0.41，P < 0.001）。尽管两个版本的“方法”部分相同，但评审者给阳性手稿的方法评分高于无差异手稿（8.24对7.53，P = 0.005）。
同行评议过程中存在阳性结果偏倚。一份结果为阳性的伪造手稿比一份除结果无差异外完全相同的手稿更有可能被推荐发表。
