The BMJ guide to wickedness

December 18, 2003

Several articles in this week's Christmas issue of the BMJ offer a comprehensive guide for the corrupt and incompetent.

The first study shows how performance targets encourage gaming and "creative accounting" of data. The authors describe how to manipulate hospital waiting times and suggests that position in league tables may also be improved by various gaming strategies to reduce hospital death rates.

On a serious note, this review highlights some dilemmas faced by those under pressure to ensure that healthcare providers conform to performance targets, say the authors.

In a second article, researchers decide to cash in their reputations by setting up a new company, HARLOT plc, that guarantees to maximise the profits of manufacturers of dodgy drugs, devices, and useless screening tests.

They offer to "cook the data" to protect worthless products and provide "an array of aftercare services" for keeping the truth from interfering with sales. "If you faithfully follow our advice, your drug should sell like hot cakes," they promise.

In the final article, researchers examine some of the more dubious techniques that can be used by organisations to make their products seem more attractive when being assessed by the National Institute for Clinical Excellence (NICE).

These include selectively reporting the most favourable evidence and analysing the results in a way that favours the product. Producers and users of health technology assessments need to be aware of these potential biases, they say.


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