REPLY
Colloid Use in the Critically Ill
Deborah Cook, MD
3 September 2002 | Volume 137 Issue 5 Part 1 | Pages 370-371
IN RESPONSE:
Drs. Wilkes and Navickis raise both ethical and scientific issues. The topic of publication ethics has been featured recently in a partial revision of the document "Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Scientific Publication" (1), which was developed by the International Committee of Medical Journal Editors. Financial relationships such as employment, stock ownership, and honoraria are still considered the most easily recognized potential conflicts of interest and are often not apparent unless they are specifically declared (1). Disclosure of these relationships is crucial for review articles and editorials because bias can be more difficult to detect in these publications than in reports of original research (2). These guidelines also acknowledge that research sponsored by government and other agencies is subject to influence. Contemporary standards of transparent reporting include reporting both consultant relationships and receipt of project funding.
The meta-analysis by Wilkes and Navickis (3) remains unable to "allay concerns regarding the safety of albumin" for many reasons (4). The 95% CI around the pooled relative risk for death associated with albumin includes a substantial increased risk for death, which is both comparable with the Cochrane meta-analysis (4) and a cause for concern. The data underscore ongoing questions about the risk–benefit and cost–benefit ratios of albumin administration. This uncertainty is directly illustrated by the worldwide launch of further randomized trials reevaluating the effect of albumin and other colloids on morbidity and mortality.
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Author and Article Information
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McMaster University; Hamilton, Ontario L8N 4A6, Canada
1. DeAngelis CD, Fontanarosa PB, Flanagin A. Reporting financial conflicts of interest and relationships between investigators and research sponsors [Editorial] JAMA. 2001;286:89-91. [PMID: 11434832].
2. Davidoff F, DeAngelis CD, Drazen JM, Hoey J, Højgaard L, Horton R, et al. Sponsorship, authorship, and accountability [Editorial] JAMA. 2001;286:1232-4. [PMID: 11559271].
3. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials Ann Intern Med. 2001;135:149-64. [PMID: 11487482].
4. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers BMJ. 1998;317:235-40. [PMID: 9677209].
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