The international authorship listed on the masthead of the HORIZON paper includes some of the leading clinical investigators in the osteoporosis field (along with employees of the sponsoring pharmaceutical firm, Novartis) who most probably are aware of these issues in data interpretation.
The editors of the august New England Journal of Medicine and the authors' "peers" responsible for reviewing the paper prior to acceptance for publication, are also probably aware of the data interpretation issues.
So, why is the paper published in a format that engenders the hype I am decrying? Could it be that there is more at stake than would be served by reporting a marginal effect on hip fractures?
Certainly, there is much at stake for all those involved with the trial itself. Novartis has invested a fortune in the development of this drug, and another fortune supporting the trial, participating in the data analysis and the preparation of the manuscript. All the masthead authors declare financial arrangements with pharmaceutical firms, most with multiple firms and nearly all with Novartis.
Then, again, there are some elderly folks for whom osteoporosis is the bane of their sunset years. I applaud the goal of trying to spare them such a fate.
However, pursuing that goal demands as much rigor in reporting the science as in performing the science. If the science demonstrates a tenuous, small effect, then no one should be led to think otherwise.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist for University of North Carolina Hospitals.