![\"An](\"\/\/media.nature.com\/w800\/magazine-assets\/d41586-019-01751-0\/d41586-019-01751-0_16767060.jpg\")
<\/div>\n<\/div>Anaesthesia has been linked to delirium and death in older patients.<\/span>Credit: BSIP\/UIG via Getty<\/p>\n<\/figcaption><\/figure>\n <\/p>\n <\/p>\n How deeply an anaesthetist should sedate an elderly person when they have surgery is a controversial issue, because some studies link stronger doses of anaesthetic with earlier deaths. So it should reassure clinicians to see a study1<\/a><\/sup>\u00a0in the\u00a0British Journal of Anaesthesia\u00a0<\/i>that investigates and rules out such a link \u2014 the published paper\u2019s discussion section says so explicitly: \u201cThese results are reassuring.\u201d<\/p>\n Or are they? Another paper2<\/a><\/sup>\u00a0in the journal analyses the same results and reaches a different conclusion about death rates. It says the trial didn\u2019t include enough patients to reach that conclusion \u2014 or any conclusion \u2014 on mortality.<\/p>\n The opposing takes on the mortality link \u2014 a secondary conclusion of the study \u2014 are the result of an unusual peer-review experiment at the journal to tackle reproducibility of results in the field. In recent years, uncertainties over the reliability of studies have plagued anaesthetics research, fuelled by high-profile cases of fraud. That\u2019s a problem, because such studies influence clinical practice and can have serious and immediate implications for patients.<\/p>\n So, for some papers, the\u00a0British Journal of Anaesthesia<\/i>\u00a0is now asking an independent expert to write their own discussion of the study2<\/a><\/sup>. Unlike conventional peer reviewers, they look only at the methods and results sections and are blinded to the paper\u2019s conclusions3<\/a><\/sup>. The two discussions sections are published together, with similarities and differences highlighted.<\/p>\n It\u2019s an approach that some reproducibility experts welcome and say other fields should copy. Efforts to improve reproducibility have so far focused on methods and results, and need to extend to inferences and conclusions, says John Ioannidis, one of the authors of the independent discussion and a long-standing advocate for better reproducibility in science, based at Stanford University in Palo Alto, California. \u201cOut of very similar results with very similar methods people can make inferences or create narratives or tell stories that are very different,\u201d he says. Independent discussion authors are free of \u201cany allegiance bias, conflicts or any reason to favour one result or one interpretation\u201d.<\/p>\n <\/p>\n Spin and bias<\/strong><\/p>\n The move is intended to address the \u201cover-interpretation, spin and subjective bias\u201d that often plague the discussion sections of academic papers, says Hugh Hemmings, editor of the\u00a0British Journal of Anaesthesia<\/i>and a neuropharmacologist at Weill Cornell Medical College in New York City.<\/p>\n \u201cThe power of this approach will be when there is disagreement and it\u2019s not clear who is right.\u201d The treatment is reserved for studies in contentious or high-profile and policy-relevant areas, says Hemmings, because those studies are influential in the literature and can see their conclusions repeated and quoted.<\/p>\n At present, critiques of papers in the journal can appear weeks or months after publication, as guest editorials for example. By publishing the independent discussion at the same time as the peer-reviewed original, the journal hopes to accelerate the self-correcting nature of the literature. \u201cIf independent discussion authors find a fatal flaw, then we\u2019ll have a bit of a problem. But it won\u2019t be the first time,\u201d says Hemmings.<\/p>\n The original paper\u2019s lead author praises the approach. \u201cI think it\u2019s brilliant,\u201d says Frederick Sieber, a researcher in anaesthesiology and critical-care medicine at Johns Hopkins Bayview Medical Center in Baltimore. \u201cWe\u2019re all biased and this gives a second pair of eyes.\u201d<\/p>\n <\/p>\n In agreement<\/strong><\/p>\n Having seen the independent discussion, Sieber agrees that the study was not big enough to robustly measure the link to mortality. \u201cEverything they said is valid.\u201d The original paper\u2019s main conclusions still stand, he says, because its main goal was to report the impact of the depth of sedation on delirium, not death. The independent discussion agrees that the delirium data and conclusions are valid, because the number of patients required to test the link is smaller.<\/p>\n Not everyone sees value in the additional step. In an editorial published in the journal4<\/a><\/sup>, Robert Sneyd, dean of the Plymouth University Peninsula Schools of Medicine and Dentistry, UK, warns that independent discussion sections will inevitably draw on the same people who are already asked to review papers. It risks \u201cflogging the same pool of reviewers harder or (implausibly) recruiting fresh blood,\u201d he writes. A better solution is to enforce existing rules, such as guidelines to authors, he says \u2014 for example to make clear a study\u2019s possible weaknesses and to avoid speculation.<\/p>\n Hemmings says that his journal has at least one more independent discussion lined up, and that he will continue with the idea as long as people find it useful. \u201cIt may generate so much controversy that I can\u2019t continue to do it.\u201d<\/p>\n <\/p>\n <\/p>\n<\/div>\n Nature<\/span>\u00a0570<\/strong>, 16 (2019)<\/p>\n <\/p>\n <\/p>\n