Aprotinin: effect on bleeding during and after surgery

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Research funders, academic institutions, researchers, research ethics committees, and scientific journals are all complicit in unnecessary research.

As we explained previously, and as the first two examples of unnecessary research indicate, new research should not be designed or implemented without first assessing systematically what is known from existing research.

A shocking analysis published in 2005 focused on controlled trials of a drug called aprotinin to reduce bleeding during and after surgery. Aprotinin works. The shocking bit is that, long after strong evidence had accumulated showing that the drug substantially reduces the use of blood transfusion, controlled trials continued to be done. [16]

At the time of the analysis, the reports of 64 trials had been published. Between 1987 and 2002, the proportion of relevant previous reports cited in successive reports of aprotinin trials fell from a high of 33% to only 10% among the most recent reports. Only 7 of 44 subsequent reports referenced the report of the largest trial (which was 28 times larger than the median trial size); and none of the reports referenced systematic reviews of these trials published in 1994 and 1997.

As the authors of the analysis emphasized, science is meant to be cumulative, but many scientists are not accumulating evidence scientifically. Not only are most new studies not designed in the light of systematic reviews of existing evidence but also new evidence is only very rarely reported in the context of updates of those reviews.