POLIO TIPS & TECHNIQUES: Reading and Believing

By Dr. Richard L. Bruno

I’m embarrassed that I was in college before I realized that not everything printed in text books is true. It took more years to realize that not everything printed in those most sanctified of all publications, peer-reviewed medical journals, was true. I just couldn’t understand why journal articles full of flaws were allowed to be published when the articles had been reviewed by an editor and two objective scientist reviewers.

When I became a reviewer and then editor of several journals, I discovered something truly shocking: Most research submitted to journals is crap. In 20 years of reviewing dozens of research articles, I’ve accepted not even a handful for publication. Why? Because no thought went into the experiments’ designs, little care had been taken in collecting the data, the statistical analyses were incorrect and, most importantly, the conclusions were just plain wrong. Yet, the editors of hundreds of medical journals publish thousands of terrible articles each year. The problem isn’t just that the papers are fatally flawed, it’s that their publication leads to patients not only not being helped but being damaged, sometimes fatally.

For example, in a 2006 issue of the obscure Journal of the Peripheral Nervous System, Mayo Clinic researchers published a 15-year follow-up of 38 polio survivors, reporting that 82% reported “progressive muscle weakness,” had an 18% decrease in muscle strength and lost 45% of their remaining motor neurons.

The authors admitted that “a normal age- and gender-matched control group”-which should have been used as a comparison for the polio survivors-”was not included [and therefore] one cannot reliably compare the changes in the polio group with those in a normal again population.” But, the lack of a control group didn’t stop the editors allowing the authors to conclude that polio survivors “did not age any differently than a normal population” because they lost a “normal” number of motor neurons and that “the most likely cause” for “progressive muscle weakness…in our polio survivors is aging alone.”

When the media got hold of the article, the focus was on the advertised “normal” loss of motor neurons and the headlines became, “People who survive polio in childhood will not suffer further effects later in life.”

What the Mayo paper didn’t say was that the 2006 article was the last of three articles written by the same authors. The first paper was published in March 2005 in the respected journal Neurology, which reported the subjective 18% increase in muscle weakness and the 45% loss of motor neurons. But also reported were tests of muscle strength measured objectively by machine, which found that subjects had an overall decrease in muscle strength of 21% in their arms, legs and hands. The authors admitted that they “did not include a normal control group.” But, as opposed to the 2006 article, the March 2005 paper rightly stated, “In the absence of a normal control population, [h]ow the changes identified in our polio [subjects] compare with those of a normal aging population remains unknown,” and that “The syndrome of progressive weakness late after paralytic poliomyelitis was quite common.”

In September 2005, the authors published a second study in Neurology of the same subjects, this time describing “adaptive equipment use.” In 1987, 13% reported using a brace or “gait aid” (cane or crutch), 16% had been forced to change jobs and 13% had modified their homes due to muscle weakness. Fifteen years later, an additional 12% had to modify their homes or move because of weakness and there had been a 100% increase in subjects using a brace, aid or wheelchair. The 2005 studies certainly don’t support the 2006 declaration that polio survivors “will not suffer further effects later in life.” So, why did the authors omit their own findings of muscle weakness and loss of ability from their 2006 paper and change how polio survivors’ bodies “compare with those of a normal aging population remains unknown” to “our polio survivors did not age any differently than a normal population?” The authors twisted, truncated and tortured their findings and the editors and peer-reviewers let them.

What’s important is that we are extremely cautious when medical research is published. For PPS or any medical condition, consumers need to do the hard work of reading the actual research studies to understand what’s really happening to their bodies and to know how to care for them. But, what do you do when authors publish one finding in a journal and then release different results to the media? That’s a question for next column.

Dr. Richard L. Bruno (rbruno@unitedspinal.org) is Director of The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center.