Concerns Regarding Ultrasound-guided Regional Anesthesia

In Reply:—I thank Dr. Barasch for his insightful comments and for this opportunity to clarify my statement regarding the priority for confirmatory research. Actually, we agree that both laboratory and clinical research findings are strengthened, challenged, or refuted by further studies, and that subtle effects or those which are heavily dependent on the exact conditions of the experiment absolutely require confirmation. In my own field of interest, I note that it took very few studies to establish that the analgesic potency of epidural morphine greatly exceeded that of systemic delivery, but dozens of studies to establish that potency of epidural fentanyl differed little from that of systemic delivery. At this point, it would be very unlikely that yet another study comparing epidural to systemic morphine or fentanyl would meaningfully add to our understanding of analgesic potency, although other factors which were not previously examined in depth, such as opioid-induced immune modulation, might justify such a comparison. My point in the editorial was not that confirmatory research was not wanted in this journal, but rather that we would consider articles addressing the study topics of the retracted papers as being entirely novel rather than confirmatory. I also thank Dr. Barasch for the suggestion regarding electronic publication of selected articles, and we will discuss the advantages and disadvantages of creating this second class of article within our Editorial Board. As I have quickly observed, this journal, like others in medical science, must continuously and critically review its processes and products to better serve the research and clinical practice communities.