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Independents' Day

Please BMJ, no more studies on the ‘weekend effect’

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Dead babies. An emotive subject at the best of times (as it should be).

That is why I was interested in reading a new study published in the BMJ that reports to show a ‘weekend effect’ in obstetric care.

The paper – published today – reports ‘approximately 770 perinatal deaths and 470 maternal infections per year above what might be expected if performance was consistent across women admitted, and babies born, on different days of the week’.

There could not be a more important subject for research and this particular paper was press-released by the BMJ to all the major media outlets with the headline: ‘Study finds higher risks for babies born at the weekend’.

This has resulted with two national newspapers splashing headlines such as ‘Betrayal of our Babies’ and ‘Risk of having a weekend baby’ across their front pages today.

These are front pages that will cause an enormous amount of upset and concern – I would not be surprised if GPs are faced with mothers terrified about being admitted on a weekend – and it will provide yet more grist to the health secretary’s seven-day working mill.

And I would not have such a problem with all of that if the result was as clear cut as it has been represented. Except, it isn’t.

The authors provide no real explanation at all for their figures, they suggest the weekend effect ‘might be amenable to the provision of healthcare’, but that is about it.

Even worse, the authors chose a midweek reference day of Tuesday for their comparisons, and this did show a significant increase in in-hospital neonatal mortality at weekends. Except if they had used Thursday as the comparator, then they would have shown a decrease.

Yes, you read that right. Neonatal mortality was actually higher on a Thursday compared with Saturday and Sunday.

If you look at puerperal infections then there is a peak on a Saturday, but again, they have chosen to compare it with Tuesday. The lowest point on the graph. And if you squint, then Sunday looks a lot like Friday.

So we are talking about a ‘Thursday-Friday-Saturday-Sunday’ effect? Well perhaps, but that does not make such a good headline. Why are they claiming there is a ‘weekend effect’ at all? I have no idea. In fact, I have no idea quite how this paper got through peer review at all given in the state it is in.

And it would be forgivable if it wasn’t the second paper the BMJ has published showing a ‘weekend effect’ that offered equivocal conclusions. After the previous paper, the editor of the BMJ had to write to the health secretary to tell him to stop using their data to justify his new junior doctor contract.

Hey, I have a radical idea. Perhaps we should ditch publishing this line of research altogether until it can come up with clear answers. It is just making things worse.

Nigel Praities is editor of Pulse

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Readers' comments (11)

  • there's a storm of protest in the BMJ thank goodness..wonder what they will do about it

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  • Harry Longman

    Among the many confounders in this confounded paper, did they look at actual numbers? Births are higher on weekdays... because of elective caesareans.

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  • I believe they controlled for caesareans

  • BMJ has been political for years IMO, and more interested in gobal warming and medicine -anywhere- else in the world than Britain

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  • Dear Nigel,
    You should be a peer reviewer!

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  • And Junior doctors/the BMA/GPs eat babies too...

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  • BMJ is at best kindling for fires.

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  • Chaps,It was an observational study.
    By definition it cannot in any way address causality.

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  • All this does is continue to allow misinformation by the press and twisting of the stats by politicians.

    Ultimately we are not going to lie down and take this as a profession.

    Either we stand together as the junior doctors are bravely doing to try and make a stand to unfair conditions as a result of all this meddling or like GPs one by one retire, emigrate or locum as we have no solidarity.

    Either way we are heading down one path only. The disintegration of the NHS and disillusioned, skilled, and caring doctors. No amount of media or political spin will change the course of what will happen if they continue to batter and bully us! We will not accept this.

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  • Just Your Average Joe

    Dear BMJ

    Please consider this research for publication.

    Jeremy Hunt spouts more b@llsh1t on a weekday than on weekends.

    Whenever you see him interviewed it is always a weekday, perhaps it is that his lazy politician backside is parked on a weekend so the emmisions produced are cleaner. (Unless a certain German car manufacturer has been brought in to clean the emissions data).

    The data clearer suggests he needs a muzzle and should be prevented from any public appearances - certainly if televised to prevent global warming.

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  • Nigel, you have indeed a valid point, but that must not divert us from the fact that the BMJ, under its current editor, has been courageous enough to expose scandalous conflicts of interests of elite GPs, wearing several hats and doing extremely well for themselves.

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