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Publication bias against negative results from clinical trials: three of the seven deadly sins

Nature Clinical Practice Neurology volume 3, pages 590–591 (2007)Cite this article

Strong evidence indicates a publication bias against negative results of clinical trials. Assessment of the number of meeting abstracts that turn into full papers reveals that a trial showing a benefit of a drug or device has a much greater chance of full publication than does a trial showing no benefit.1,2 Further, publications of trials approved by institutional review boards are frequently characterized by selective outcome reporting and high rates of failure to present null or negative results.3,4 The failure to publish negative results leads to an accumulated literature favoring benefits of treatments. This bias distorts systematic reviews and meta-analyses, encourages the use of questionable treatments, and stifles the implementation of a true evidence-based medicine. Who is to blame? Journal editors, commercial sponsors, and investigators (the would-be authors) all stand accused.

Journal editors are often blamed by investigators, and as a former Editor one of us confesses to that bias. In a competitive journal, space mandates that a majority of submitted manuscripts must be rejected, and many good articles including those describing methodologically sound studies with positive and negative results are among them. Editors love articles that capture the interest of readers, that attract mention in The New York Times or Science news pages, and that garner citations. Editors are guilty of pride. Studies have shown, however, that inability to find an editor willing to publish negative results is rarely a problem.5 A study of papers submitted to JAMA showed only a tendency and not a statistically significant editorial bias against negative results.6 The 'knee-jerk' response that the journals are the primary villains in publication bias is incorrect.

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Authors and Affiliations

  1. RT Johnson is University Distinguished Service Professor of Neurology, Microbiology and Neuroscience, and K Dickersin is Professor of Epidemiology and Director of the Center for Clinical Trials, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,

    Richard T Johnson & Kay Dickersin

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  1. Richard T Johnson
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  2. Kay Dickersin
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Correspondence to Richard T Johnson.

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Johnson, R., Dickersin, K. Publication bias against negative results from clinical trials: three of the seven deadly sins. Nat Rev Neurol 3, 590–591 (2007). https://doi.org/10.1038/ncpneuro0618

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