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76%, and 52% 5 years later. ADDITION- MRC Epidemiology Unit, Institute of Metabolic in the hope of nding help for their
Europe might have been too small Science, Cambridge CB2 0QQ, UK (SJG); Department patients.
of Cardiovascular Sciences, University of Leicester,
and too brief, but the most likely Leicester, UK (MJD); Julius Centre for Health Sciences No existing index establishes
explanation for the non-signicant and Primary Care, University Medical Centre Utrecht, whether an article is more useful
17% reduction in risk of cardiovascular Utrecht, Netherlands (GEHMR); and School of Public to physicians involved in everyday
Health, Department of General Practice, University
events was the quality of routine care of rhus, rhus, Denmark (TL)
practice or to those who need to be
and hence the limited dierences in 1 Wareham NJ, Grin SJ. Should we screen for
cited to obtain funding or promotion.
treatment between study groups. This type 2 diabetes? Evaluation against National Thus, an article could be broadly
in turn explains the number needed Screening Committee criteria. BMJ 2001; read, but rarely cited, thereby falling
322: 98688.
to treat (NNT) of 78 screen-detected 2 Eborall HC, Grin SJ, Prevost AT, Kinmonth AL, through the cracks of the validation
patients treated for 53 years to prevent French DP, Sutton S. Psychological impact of mechanism. The total number of
screening for type 2 diabetes: controlled trial
one cardiovascular event. and comparative study embedded in the
articles, total number of citations,
However, it would be wrong to infer ADDITION (Cambridge) randomised controlled citations per article, and number of
from this nding that screening is not trial. BMJ 2007; 335: 48689. highly visible items are currently the
3 Eborall H, Davies R, Kinmonth AL, Grin S,
worthwhile. In assessing the potential Lawton J. Patients experiences of screening most useful parameters in calculating
benets of screening, the NNT should for type 2 diabetes: prospective qualitative the quality of scientic production.
study embedded in the ADDITION
reect changes in treatment before (Cambridge) randomised controlled trial. BMJ
There is no way for authors to obtain
and after diagnosis (as shown above), 2007; 335: 49093. information about the downloading of
the duration of the lead time between 4 Echouo-Tcheugui JB, Sargeant LA, Prevost AT, their articles, unlike what is possible for
et al. How much might cardiovascular disease
detection by screening and clinical risk be reduced by intensive therapy in people citations. Most publishers consider this
diagnosis, the likelihood of treatment with screen-detected diabetes? Diabet Med proprietary information. I suggest that
2008; 25: 143339.
irrespective of a diagnosis of diabetes, publishers should provide a real-time
5 van den Donk M, Sandbaek A, Borch-Johnsen K,
and the eectiveness of treatment. et al. Screening for type 2 diabetes: lessons counter of article downloads and that
Our estimates suggest that around from the ADDITION-Europe study. Diabet Med these data be taken into consideration
2011; 28: 141624.
ten patients with screen-detected in the overall assessment of scientic
diabetes would need to be treated for production. This further element could
10 years to prevent one event.4 be useful for building a fair, honest, up-
We have reduced the uncertainty, Cited or read? to-date, and eective way of working
but whether screening represents an to improve citation metrics.
ecient use of scarce resources remains The need to establish quantitative I declare that I have no conicts of interest.
unclear. Tackling the growing burden of and qualitative indices of scientic
diabetes requires a balanced investment production by a researcher or
Carlo Bellini
carlobellini@ospedale-gaslini.ge.it
in primary prevention, better care for institution is hotly debated. World-
Neonatal Intensive Care Unit, Gaslini Childrens
those with the disorder, and perhaps wide, the impact factor and H-index
Hospital, University of Genoa, Department of
also in some settings earlier detection are regarded as the best available.1,2 Pediatrics, 16147 Genova, Italy
via screening in high-risk groups.5 The advantages and disadvantages 1 Hirsch JE. An index to quantify an individuals
SJG has attended an advisory board for Colgate have been widely discussed.3 However, scientic research output. Proc Natl Acad Sci USA
Corbis