The title of the report of a clinical trial can be indicative (such as “Newbetalol in the treatment of tachycardias”) or informative (“Newbetalol prevents tachycardias”).1 Rosner believes informative titles are “improper and imprudent” and a symptom of “science as product.”2 Weiss objected to an “overly optimistic” title beginning “Improved survival . . .” from a pilot study using historical controls.3 According to the popperian model, hypotheses cannot be proved but only supported or rejected, and then only to an arbitrary level of statistical significance. This makes an informative title incorrect, but rejected hypotheses live on in such titles.
I tested the validity of informative titles in clinical reports and their prevalence.
Methods and results
To see whether informative titles are valid, I searched Medline (Paperchase) for clinical trial reports published in 1996 whose titles contained the word “prevents.” I searched Medline at five year intervals from 1970 to 1995, and for 1997 as the last full year, for titles containing some active verbs as markers for informative titles. Although limiting, this method of identification is more efficient than, say, examining titles at random. I grouped them as absolute verbs (“prevents,” “abolishes,” and “eliminates”), relative verbs (“prolongs,” “reduces,” “improves,” “predicts,” “lessens,” and “weakens”), and “nounal” verbs (“increases,” “decreases,” and “causes”), although a quick scan of retrieved titles showed that most occurrences in the nounal group were as verbs not nouns.
I found 24 reports in 1996 with “prevents” in their title. All were of the effect of a clinical intervention. Their abstracts showed that in at least eight of the reports the intervention did not “prevent”—for example, 14 infections in the intervention group compared with 44 in the other, and 15 fractures of the spine in the intervention group compared with 21 in the other. The concluding sentences of the retrieved abstracts were often more honest: “significantly reduces the rate of . . . infections,” “reduces the incidence of spine fractures.” Six of the 24 studies were explicitly pilot studies or preliminary presentations. So researchers were indeed “overly optimistic,” at least in their interpretation of “prevents.”
No clinical trial title from 1970 contained any of the 12 verbs I searched for, but their prevalence increased over time more rapidly in the titles of clinical trials than in other types of paper (table). My search was not exhaustive, but the consistency of the findings across the three types of verb suggests a general trend. The percentage of clinical and non-clinical titles containing active verbs (all 12 verbs and the three groups of verb separately) was correlated with year. For clinical titles, occurrences of the verbs correlated with the square of the year (with 1970 as year zero): (0.0028×(year)2)−(0.01×year)−0.0037. The second order term of the equation is significant (P<0.001, r2=0.999). If this relation continues, 4.4% (95% confidence interval 3.8% to 5.8%) of all clinical papers in 2010 will have one of these 12 verbs in the title. By 2070, 27.6% (23.5% to 36.1%) will do so.
Comment
I do not know why informative titles are becoming more popular. It may be unconscious mimicking, or maybe researchers, sponsors of trials, or journal editors prefer them. We live in a “soundbite” society, and there is evidence that doctors sometimes make clinical decisions from the titles of journal articles.4
There may be arguments for reviews and editorials carrying informative titles, but what Rosner termed “assertive sentence titles”2 have little place in the reporting of research. They are indeed “improper and imprudent,” and too often plain wrong. Readers should have to look beyond the title for the conclusion of a clinical trial.
Summary
An indicative title gives the purpose of a study; an informative title gives the conclusion. Informative titles usually contain an active verb. Titles including the active verb “prevents” are often not an accurate description of the findings of clinical studies. A Medline search on 12 active verbs in titles showed that informative titles are becoming more common. There was a post hoc relation between occurrence of searched active verbs and year: the percentage is increasing with the square of the year, such that 4.5% (95%CI: 3.8%-5.8%) of all titles of clinical reports published in the year 2010 will contain one. There may be arguments for reviews and editorials carrying informative titles, but they are too often wrong to have any place in the reporting of research. Journals should ask for indicative titles, or alter investigators' informative titles during sub-editing.
Table.
Results of Medline search for 12 active verbs in titles of clinical trials and other papers. Verbs grouped as absolute, relative, or nounal (see text for details)
| Year of publication | Total No of papers | No (%) of papers that are clinical trials | No (%) of clinical trials with active verb in title
|
No (%) of non-clinical trials with active verb in title | |||
|---|---|---|---|---|---|---|---|
| Absolute verb | Relative verb | Nounal verb | All verbs | ||||
| 1970 | 216 457 | 2 033 (0.94) | 0 | 0 | 0 | 0.00 | 311 (0.15) |
| 1975 | 265 040 | 3 701 (1.40) | 0 | 1 (0.03) | 0 | 1 (0.03) | 410 (0.16) |
| 1980 | 308 314 | 4 251 (1.38) | 0 | 3 (0.07) | 5 (0.12) | 8 (0.19) | 771 (0.25) |
| 1985 | 318 473 | 6 740 (2.12) | 3 (0.04) | 22 (0.33) | 11 (0.16) | 36 (0.53) | 1173 (0.38) |
| 1990 | 399 121 | 11 983 (3.00) | 18 (0.15) | 56 (0.47) | 42 (0.35) | 116 (0.97) | 2188 (0.57) |
| 1995 | 427 616 | 20 632 (4.82) | 23 (0.11) | 172 (0.83) | 116 (0.56) | 311 (1.51) | 3153 (0.77) |
| 1997 | 426 014 | 20 381 (4.78) | 26 (0.13) | 225 (1.10) | 125 (0.61) | 376 (1.84) | 3645 (0.90) |
Footnotes
Competing interests: None declared.
References
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