Correspondence
76%, and 52% 5 years later. ADDITION- MRC Epidemiology Unit, Institute of Metabolic
Europe might have been too small
and too brief, but the most likely
explanation for the non-signicant
17% reduction in risk of cardiovascular
events was the quality of routine care
and hence the limited dierences in
treatment between study groups. This
in turn explains the number needed
to treat (NNT) of 78 screen-detected
patients treated for 53 years to prevent
one cardiovascular event.
However, it would be wrong to infer
from this nding that screening is not
worthwhile. In assessing the potential
benets of screening, the NNT should
reect changes in treatment before
and after diagnosis (as shown above),
the duration of the lead time between
detection by screening and clinical
diagnosis, the likelihood of treatment
irrespective of a diagnosis of diabetes,
and the eectiveness of treatment.
Our estimates suggest that around
ten patients with screen-detected
diabetes would need to be treated for
10 years to prevent one event.4
We have reduced the uncertainty,
but whether screening represents an
ecient use of scarce resources remains
unclear. Tackling the growing burden of
diabetes requires a balanced investment
in primary prevention, better care for
those with the disorder, and perhaps
also in some settings earlier detection
via screening in high-risk groups.5
SJG has attended an advisory board for Colgate
Corbis
Palmolive, has received honoraria for speaking from
Unilever, Eli Lilly, GlaxoSmithKline, MSD, and Novo
Nordisk, and has received travel expenses from Eli
Lilly; MJD has served on advisory boards for Novo
Nordisk, Eli Lilly, MSD, Bristol-Myers Squibb, and
Roche, and has received honoraria for speaking from
Novo Nordisk, Eli Lilly, Sano-Aventis, Novartis, and
MSD; GEHMR has served as a consultant and
participated in advisory boards for Novo Nordisk and
MSD, and has received honoraria for speaking from
Novo Nordisk; TL has received research funding from
Novo Nordisk, AstraZeneca, Pzer, GlaxoSmithKline,
Servier, and HemoCue, has received honoraria for
speaking from various pharmaceutical companies,
and holds stock in Novo Nordisk.
*Simon J Grin, Melanie J Davies,
Guy E H M Rutten, Torsten Lauritzen,
on behalf of the ADDITION-Europe
investigators
simon.grin@mrc-epid.cam.ac.uk
314
in the hope of nding help for their
Science, Cambridge CB2 0QQ, UK (SJG); Department
of Cardiovascular Sciences, University of Leicester,
Leicester, UK (MJD); Julius Centre for Health Sciences
and Primary Care, University Medical Centre Utrecht,
Utrecht, Netherlands (GEHMR); and School of Public
Health, Department of General Practice, University
of rhus, rhus, Denmark (TL)
1 Wareham NJ, Grin SJ. Should we screen for
type 2 diabetes? Evaluation against National
Screening Committee criteria. BMJ 2001;
322: 98688.
2 Eborall HC, Grin SJ, Prevost AT, Kinmonth AL,
French DP, Sutton S. Psychological impact of
screening for type 2 diabetes: controlled trial
and comparative study embedded in the
ADDITION (Cambridge) randomised controlled
trial. BMJ 2007; 335: 48689.
3 Eborall H, Davies R, Kinmonth AL, Grin S,
Lawton J. Patients experiences of screening
for type 2 diabetes: prospective qualitative
study embedded in the ADDITION
(Cambridge) randomised controlled trial. BMJ
2007; 335: 49093.
4 Echouo-Tcheugui JB, Sargeant LA, Prevost AT,
et al. How much might cardiovascular disease
risk be reduced by intensive therapy in people
with screen-detected diabetes? Diabet Med
2008; 25: 143339.
5 van den Donk M, Sandbaek A, Borch-Johnsen K,
et al. Screening for type 2 diabetes: lessons
from the ADDITION-Europe study. Diabet Med
2011; 28: 141624.
Cited or read?
The need to establish quantitative
and qualitative indices of scientic
production by a researcher or
institution is hotly debated. World-
wide, the impact factor and H-index
are regarded as the best available.1,2
The advantages and disadvantages
have been widely discussed.3 However,
the question might arise: is an article
written to be cited or to be read?
In 2009, I published an article in the
American Journal of Medical Genetics
on non-immune hydrops fetalis.4
The journal has an impact factor
of 2505 and, as of June, 2011, the
article had been cited seven times
(two self-citations), according to ISI
Web of Science. However, between
publication and June, 2011, the article
was downloaded 3167 times from
the journals website (data from
the publisher)the highest number
of any article during that period. I
assume that many colleagues dealing
with hydrops fetalis read the article
patients.
No existing index establishes
whether an article is more useful
to physicians involved in everyday
practice or to those who need to be
cited to obtain funding or promotion.
Thus, an article could be broadly
read, but rarely cited, thereby falling
through the cracks of the validation
mechanism. The total number of
articles, total number of citations,
citations per article, and number of
highly visible items are currently the
most useful parameters in calculating
the quality of scientic production.
There is no way for authors to obtain
information about the downloading of
their articles, unlike what is possible for
citations. Most publishers consider this
proprietary information. I suggest that
publishers should provide a real-time
counter of article downloads and that
these data be taken into consideration
in the overall assessment of scientic
production. This further element could
be useful for building a fair, honest, up-
to-date, and eective way of working
to improve citation metrics.
I declare that I have no conicts of interest.
Carlo Bellini
carlobellini@ospedale-gaslini.ge.it
Neonatal Intensive Care Unit, Gaslini Childrens
Hospital, University of Genoa, Department of
Pediatrics, 16147 Genova, Italy
1 Hirsch JE. An index to quantify an individuals
scientic research output. Proc Natl Acad Sci USA
2005; 102: 1656972.
2 Poynard T, Thabut D, Munteanu M, et al.
Hirsch index and truth survival in clinical
research. PLoS One 2010; 5: e12044.
3 Saleem T. The Hirsch indexa play on numbers
or a true appraisal of academic output?
Int Arch Med 2011; 7: 25.
4 Bellini C, Hennekam RC, Fulcheri E, et al. Etiology
of nonimmune hydrops fetalis: a systematic
review. Am J Med Genet 2009; 149A: 84451.
Department of Error
Williams HC, Dellavalle RP, Garner S. Acne vulgaris.
Lancet 2012; 379: 36172In this Seminar
(Jan 28), an aliation was missing for Sarah
Garner. The aliation should be The
Commonwealth Fund, New York, NY, USA. This
correction has been made to the online version
as of Jan 27, 2012, and to the printed Seminar.
www.thelancet.com Vol 379 January 28, 2012