WHO non-medical cesarean study under spotlight again

Nigel Hawkes has written an opinion piece in The Independent today, 'Peer-reviewed journals aren't worth the paper they're written on', in which he refers to the WHO's cesarean study that I wrote about back in January.

He writes: "A few months ago, I wrote in this column about a study in The Lancet of which I took a dim view. It claimed that Caesarean operations undertaken without medical cause were nearly three times as likely to cause death or complications to the mother as a normal birth. The evidence fell miles short of proving this claim.

Others shared my view, and one of them, Penny Christensen of Birth Trauma Canada, complained to The Lancet. Rebuffed, she sent them my analysis to support her claim. In reply, an editor wrote to her with the disparaging remark: "We are a scientific journal, and as such prefer to see the scientific debate continued by reference to other academic articles that have been peer-reviewed."

Ms Christensen's complaint has now gone to The Lancet's ombudsman, and we'll see if he shares the attitude that only the peer-reviewed are entitled to have their opinions properly considered."

I have just submitted this comment:

"I have also complained to the Lancet Ombudsman about the cesarean delivery study Nigel mentions above, and together with other references, cited his statistical analysis (and criticism) of it in my letter.

As a journalist, my confidence in the peer review process was knocked after the publication of "Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08, Lumbiganon et al", since I struggled to understand how such inconsistency between actual data gathered and final interpretation drawn could be accepted by reviewers for publication. I wrote about it on my blog in January this year.

I still believe peer review is a good thing, but I agree that criticism and open debate of a particular study or collection of studies should not be stifled by a requirement that all references referred to in any argument be peer reviewed first too."

Pauline McDonagh Hull
Editor, electivecesarean.com