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* [BMJ Journals](http://journals.bmj.com/) ## You are here * [Home](https://ebm.bmj.com/) * [Archive](https://ebm.bmj.com/content/by/year) * [Volume 27,Issue 4](https://ebm.bmj.com/content/27/4) * Transparency of COVID-19 vaccine trials: decisions without data [Email alerts](https://myaccount.bmj.com/myaccount/signup.html?regService=etoc-alerts&corpusCode=ebmed&fwdUrl=https://ebm.bmj.com/) [](https://ebm.bmj.com/content/early/2021/08/08/bmjebm-2021-111735) Article Text [Article menu](https://ebm.bmj.com/content/early/2021/08/08/bmjebm-2021-111735#block-system-main) * [Article Text](https://ebm.bmj.com/content/27/4/199)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_art/node:146756/1) * [Article info](https://ebm.bmj.com/content/27/4/199.info)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_art_info/node:146756/1) * [Citation Tools](https://ebm.bmj.com/content/27/4/199.citation-tools)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_cite_tool/node:146756/1) * [Share](https://ebm.bmj.com/content/27/4/199.share)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_share/node:146756/1) * [Rapid Responses](https://ebm.bmj.com/content/27/4/199.responses)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_elets/node:146756/1) * [Article metrics](https://ebm.bmj.com/content/27/4/199.altmetrics)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_altmetrics/node:146756/1) * [Alerts](https://ebm.bmj.com/content/27/4/199.alerts)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_art_alert/node:146756/1) * [Article Text](https://ebm.bmj.com/content/27/4/199)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_art/node:146756/1) * [Article info](https://ebm.bmj.com/content/27/4/199.info)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_art_info/node:146756/1) * [Citation Tools](https://ebm.bmj.com/content/27/4/199.citation-tools)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_cite_tool/node:146756/1) * [Share](https://ebm.bmj.com/content/27/4/199.share)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_share/node:146756/1) * [Rapid Responses](https://ebm.bmj.com/content/27/4/199.responses)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_elets/node:146756/1) * [Article metrics](https://ebm.bmj.com/content/27/4/199.altmetrics)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_tab_altmetrics/node:146756/1) * [Alerts](https://ebm.bmj.com/content/27/4/199.alerts)[](https://ebm.bmj.com/panels_ajax_tab/jnl_template_bmjj_art_alert/node:146756/1) [](https://ebm.bmj.com/content/early/2021/08/08/bmjebm-2021-111735)[![Image 3: Download PDF](https://ebm.bmj.com/sites/default/themes/bmjj/img/icon-pdf.png)**PDF**](https://ebm.bmj.com/content/early/2021/08/08/bmjebm-2021-111735#) EBM analysis General medicine Transparency of COVID-19 vaccine trials: decisions without data ![Image 4: Loading](https://ebm.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif) 1. [http://orcid.org/0000-0002-6408-9855](http://orcid.org/0000-0002-6408-9855)Sarah Tanveer 1, 2. [http://orcid.org/0000-0003-3637-2423](http://orcid.org/0000-0003-3637-2423)Anisa Rowhani-Farid 1, 3. Kyungwan Hong 1, 4. [http://orcid.org/0000-0002-4778-2949](http://orcid.org/0000-0002-4778-2949)Tom Jefferson 2, 5. [http://orcid.org/0000-0002-7804-4113](http://orcid.org/0000-0002-7804-4113)Peter Doshi 1 1. 1 Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland, USA 2. 2 Department for Continuing Education, University of Oxford, Oxford, UK 1. Correspondence to Dr Peter Doshi, Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; [pdoshi@rx.umaryland.edu](mailto:pdoshi@rx.umaryland.edu) [https://doi.org/10.1136/bmjebm-2021-111735](https://doi.org/10.1136/bmjebm-2021-111735) ## Statistics from Altmetric.com [![Image 5: Article has an altmetric score of 570](https://badges.altmetric.com/?size=240&score=570&types=mbrtttfd)](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686) [See more details](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686) [Picked up by **9** news outlets](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=news) [Blogged by **1**](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=blogs) [Referenced in **2** policy sources](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=policy-documents) [Posted by **703** X users](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=twitter) [On **2** Facebook pages](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=facebook) [Reddited by **17**](https://www.altmetric.com/details.php?domain=ebm.bmj.com&citation_id=111543686&tab=reddit) **65** readers on Mendeley ## Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. [Request permissions](https://s100.copyright.com/AppDispatchServlet?publisherName=BMJ&publication=ebmed&title=Transparency%20of%20COVID-19%20vaccine%20trials%3A%20decisions%20without%20data&publicationDate=2022-08-01&author=Sarah%20Tanveer%2CAnisa%20Rowhani-Farid%2CKyungwan%20Hong%2CTom%20Jefferson%2CPeter%20Doshi&contentID=10.1136/bmjebm-2021-111735&volumeNum=27&issueNum=4&startPage=199&endPage=205&numPages=7©right=BMJ%20Publishing%20Group%20Ltd.%20All%20rights%2C%20including%20for%20text%20and%20data%20mining%2C%20AI%20training%2C%20and%20similar%20technologies%2C%20are%20reserved.&orderBeanReset=true) * [COVID-19](https://ebm.bmj.com/keyword/covid-19) * [policy](https://ebm.bmj.com/keyword/policy) * [public health](https://ebm.bmj.com/keyword/public-health) ### Summary box * Data transparency has become a well-established norm in biomedical research, and is especially important for broadly used public health interventions like COVID-19 vaccines. * Tax payers helped fund COVID-19 vaccine trials and should have the right to access the results. * There is inadequate availability of COVID-19 vaccine trial documents and data; individual participant data will not be available for months, perhaps years, for most vaccines. * Widespread use of interventions without full data transparency raises concerns over the rational use of COVID-19 vaccines. * Trial transparency must start early and be continuous. Trial protocols should be released once finalised, before trial results are reported, and should be accompanied with the release of trial documents and data before clinicians and the public make decisions regarding product use. ## Transparency in clinical trials: an established norm across sectors Access to data for drugs and vaccines has historically been fairly limited to journal article publications and hard-to-access and difficult to read regulatory reports.1 But the past decade has witnessed strides in clinical trial data transparency. A wide range of institutions, from pharmaceutical companies, government agencies, trade organisations, journals and not-for-profit organisations, have all acknowledged the importance of data sharing, including the release of deidentified individual participant data. Many policies, regulations and platforms now exist to facilitate data access, including landmark transparency policies from the European Medicines Agency (EMA)2 3 and Health Canada.4 Both regulators now post on their websites, sections of the licensure dossier received by the industry (https://clinicaldata.ema.europa.eu/ and https://clinical-information.canada.ca/). There are also industry and academic platforms to facilitate third-party access to trial data and documents, including ClinicalStudyDataRequest.com, Yale University Open Data Access (YODA) Project and Vivli.5 In 2013, the US and European industry trade organisations endorsed a joint statement on clinical trial data sharing, making a series of commitments that ‘recognise the importance of sharing clinical trial data in the … [View Full Text](https://ebm.bmj.com/content/27/4/199.full) ## Footnotes * Twitter @AnisaFarid, @RIATinitiative * Contributors ST and PD conceptualised the article and ST wrote the first draft. AR-F and KH led the data extraction and analysis. All authors (ST, AR-F, KH, TJ, PD) were involved in reviewing and editing the final manuscript. * Funding The Laura and John Arnold Foundation funds the RIAT Support Center, which supports the salaries of ST, AR-F, KH, TJ and PD. * Disclaimer The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, FDA/HHS, The University of Maryland, or the US Government. * Competing interests KH was supported by the Food and Drug Administration (FDA) of the US Department of Health and Human Services (HHS) as part of a financial assistance award U01FD005946, unrelated to this manuscript, totaling US$5000 with 100% funded by FDA/HHS. PD has received travel funds from the European Respiratory Society (2012) and Uppsala Monitoring Center (2018); grants from the FDA (through University of Maryland M-CERSI; 2020), Laura and John Arnold Foundation (2017–2022), American Association of Colleges of Pharmacy (2015), Patient-Centered Outcomes Research Institute (2014–2016), Cochrane Methods Innovations Fund (2016-2018) and UK National Institute for Health Research (2011–2014); was an unpaid IMEDS steering committee member at the Reagan-Udall Foundation for the FDA (2016–2020), and is an editor at The BMJ. The Laura and John Arnold Foundation funds the RIAT Support Center, which supports the salaries of ST, ARF, KH, TJ, and PD. TJ’s competing interests are online ([https://restoringtrials.org/competing-interests-tom-jefferson/](https://restoringtrials.org/competing-interests-tom-jefferson/)). * Provenance and peer review Commissioned; externally peer reviewed. ## Read the full text or download the PDF: [Buy this article ($64)](https://ebm.bmj.com/highwire/foxycart/add/146756) [Subscribe](https://ebm.bmj.com/subscribe) Log in [Log in via Institution](https://ebm.bmj.com/login/shibboleth?subcode=bmjjournals&env=prod&uri=https%3A//ebm.bmj.com/accallback/content%25252F27%25252F4%25252F199) [Log in via OpenAthens](https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&hw-shib-return-uri=https%3A//ebm.bmj.com/accallback/content%25252F27%25252F4%25252F199&subcode=bmjjournals) ### Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * [Forgot your log in details?](https://ebm.bmj.com/user/password)[Register a new account?](https://ebm.bmj.com/user/register?destination=node/146756) [Forgot](https://ebm.bmj.com/user/password) your user name or password? ## Read the full text or download the PDF: [Buy this article ($64)](https://ebm.bmj.com/highwire/foxycart/add/146756) [Subscribe](https://ebm.bmj.com/subscribe) Log in [Log in via Institution](https://ebm.bmj.com/login/shibboleth?subcode=bmjjournals&env=prod&uri=https%3A//ebm.bmj.com/accallback/content%25252F27%25252F4%25252F199) [Log in via OpenAthens](https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&hw-shib-return-uri=https%3A//ebm.bmj.com/accallback/content%25252F27%25252F4%25252F199&subcode=bmjjournals) ### Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * [Forgot your log in details?](https://ebm.bmj.com/user/password)[Register a new account?](https://ebm.bmj.com/user/register?destination=node/146756) [Forgot](https://ebm.bmj.com/user/password) your user name or password? 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Keren, J Med Ethics, 2020 * [Public acceptance of COVID-19 vaccines: cross-national evidence on levels and individual-level predictors using observational data](https://rev.trendmd.com/open/RKGOfFsdrdxyaaeEItdIcvqAu5HvboWrX3l_TwG8vw_tqOahIxZ7nSeWABW-6OYjZkyXaoVEkgZoIzQMmhyHASGhrsrxujpHbCaVD2gda0dO-CPxlenqlfDDRYoI3escKEtZ0zmTbhxr6lEntI2TxbOByPATczhesIBuc3ANmG35q0QXpw5knQfK5oEwQtNbVv2K3GGI96pqPcvODnxuC3yy_tfo9Z_dJ0kDmrsQ9UY32gQZBYHueX7qKxh3nVRSdSwBLdbNwAXfuQ2rMijltwGo_jKgbYTJoAqbR_GzMDdL3YxvG-ttJOZI02O1QGjFg6IjO1P74zdSPZLryP3U6nouej5XasU9a88xZEG_YoZC33rFGWCzijjyWmb0Pb19MPhNfzPzVvlEW2qLF0g7uzrteAXnejYzn6BMrcbhbmW5MM6xxzN5-dnE-6qm1RlUVOBWPkukdI2P2eFqbQYhke8YBfVAiROfnllEGTkCFbOls0gI6oxXn3o5I45FHMHePhoHSpgVS4oCQ9eXE4Lv5nWiWzZK6TyAxgHdVW_N5JxQgYypYtrt4ojqSiJ-bHW-p3vm7dCc3-a3ekmVGRC_PcGxhuckkwmgobr-bQ9n2tXcfC37lWBn4kihmOVl4EP3rdFPm3DThcR9Iuae8abdmxeThaQdUm8LAyrkeE85RsU1DMoefIUq3Y-N1_RSerNaOJv923YCBdgbYXXaD1rVsblDyt_CMIK-vByjmbGujbYCUbxzA1Kq3dkXoa7zVR7Ab0-WEZKMpWFQ8f0YmOgYQTefiyE0_D_MUrmJd9LetRPkV-1zssSW32X9EuGVUnPvClpJ9eVYIGaIzmcfn0xiBpzndjNJpVynyFin4WkdNwFJxsgJ1odYecisNWvDs9tjT5y-pKEapCn5juqHg0jyjBwG9p7d2-HBeGk8lh84aV7wXVW3M6BWaAiGWwAP9xgpwnKykn2OcEi4gzg_HAoGxfaBFyofzEgnnyR7zwOTjFxJrLHhnSOnwU3vdLYbWmm1We52hR9AG8RWAXpeh6ZYtPOTK4d8h15f1w5OcbMEbg4T-kSMcKPf_UUTNZQor03R1nNScuLX3JCOcJfg_DV-QLz_2WAKQ9Etthfat31sjthhkPHiMpDiW1_J6AkiGOgLMnANLi0PDYWcBU-We84bgn9AqvUyV_16LHnS3U1PPWwvDRee5SEeHyG1LS639iGbJXU2aToF9IoRTaIyWS83AcgBq_C_Z8wzQhfFMyoHsSjSlPIznfMsMBODNGUFwamFKj-y9lJHTC_M3jkwWbWLFMRlzEZZpzJVw8LRxPSG5r1NCxYrtW1GYzpmjax0FucL3ZpQlSKEW3vx0lxVWNsTb16AntLniRnjlFhxqxeGtfxASss9s4sT_AD6qik1lsqHeG5P1oLG89Pqlan2Rsg6KDTButHvxnWks0DHepIAK34BhL9nHuqpdzN4L9roVIKdT7o_0w)Marie Fly Lindholt, BMJ Open, 2021 * [Evolution of the data and methods in real-world COVID-19 vaccine effectiveness studies on mortality: a scoping review protocol](https://rev.trendmd.com/open/DoITR_pB45zPqIFE_RpgHDqutqRttiYVlehsuB960f1Wjb-LymIYdVI9msDL7hMAymOjlknFo3E7AYHdKQXwkWj3xZTAitHVG8b6n53uCvvK4kwVaylo69UcDIpsN7jyufHb_CZJEmE7DYjTyGGthazThdQtAJ0DQ68886180Ku1SkyDxXmCuXQqfbHG57knA0BLHJTtPuQfxnDZcsJCAwvmon-chB-_qRAGkdMnT0PtHqbfVVfMBXbYldHV2eJJ0iuT-WTgdHJCSm4gea1dOq2QlFxb66Nyg9iEqD3JS7yavewzUzjzj5n2l5TWySBvdbVgaI7RKh355-OxXRs06YRQGokJNGHExuCSXyp_jQ-DzHdhBj1DQHHr-z4zPyMfmM1Z1kwo6wnIzUIKX0IDgFiXJmkWaRyOfeJU_SRwazOVBdzYLfJQSi8D_epWguJ4RbTDtP7rlmSw4EmLd4BzEKEm81zJKNWstsao-TL4pjTLEdZor4yVzcn845aV4jUQ4IVVNcr8Ag3AARsh_iPZ4vKrTSpPHcf6c4s6dMuNrkBmIK9cRXx6yuNGRpXttUcrk4qNikLZP6OQViIPSbahR1YMm4wAsA_LsOVkaHWG2YUqAUrxvouv80J5i7zDA5Gbd7NJG1qHlSQgL4gucywX7RMicGe4tUd-NEneGUSQUYi1JaaXrK_AgpgfzLq2KMQcLbNaGfvY4hbSV4_LUsl4XHvtAiHbDvd9qLHT0Hs5SwzZ_N3y-GjWFrP_S6Uez7CTW8QXjvKYHzi2R9kqiCRUO3YByBouc89lZGGes5RsnW1qfAILA1SlB3TpteCAsAp_Hv82aU1B4bnV2qKciaBQQDARxM32kRSH9MBGIBb2l7OrsXtwGyCCw_UP82OqhP3Wza2YnWTexTgebhVfR78gx7BEeYje7FKJ66pvBQ0IG_WHro0cg1yh-JN3cbnJn-Qs8b2EBGhYsMCJiPeF2B2Piho4JVJ-FpVYB2SXsN82FhNKRyzTQuYHRzljtDVeFMc2xBP9QL0FdNRb3uAfOMg26WvAHMCqSK68wfMLoxmSOvzE7_QpGj00ToQXhPDnFxz3_QAUQImZWm1kS_7s7jq-vADK9usk7k-zXV9eJ4sP9Z-Xdmjyi3_8BxvzcBHpFA36qHd6dGpuAdFxHRFLotZjI5f5havOAZezXXb-BlmKL5SSwCvC0iUIeNyKcLV70ugvtVFZ0n7aHsWl3DLDsjwhLKXOexW4BncspqhMkXa5ABE8HgUIixwFPCfqrFKVPrUY3pKvN35p3-od-W74DNh6hpCwn9tFp2MYi7rVEhlpeLQVIr8ip3HiISqHGKxcOPt7Eh8jOSLdCPWmE-ZdT7xnzE2JfCbnaNozakuEs-4UuL674SnGlmbW_VvH3RIZyzhjuZoK4IO8ZcvmTHI9wtdTKenirkmW5iYk8e9vsFPJv5wumUrdXJqIr4yQeDpWMC5IujrKzA)Paulina 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Open blog, 2021 * [Factors influencing estimated effectiveness of COVID-19 vaccines in non-randomised 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P A Ioannidis, BMJ Evidence-Based Medicine, 2022 * [Dupilumab sustains efficacy despite LABA and ICS withdrawal in patients with asthma: a post hoc analysis](https://rev.trendmd.com/open/joHqUqQpBLZMvt5oahVTBs4RIqlhqKmKMTMe2gGKMYP1gEa0wEURdaL6qzyUfRPXkObb-cd1dPVFizmT3B6nvhlBuSV2yZfyibUDRwSlwvtQwfQtOsQmRU21qy48s3-olntMIBttQ1ruP82yqQZVc5cHHJg0ySpMdDBJgnkK1VfFj4C0tbBXTErFJ5udZrzVGb4OGBVPHVa3EtifiAY0rpM6dn1IS6Nw8v5QcL52OYlGQ7fRo0GFJVHePn53VYczJFnTRMPYEPKooIS762LZCuNdORhsi6QzQpcR0LpIaM43-6r_rxG4vey34habWezo3XH5QEgGcc8tpO9Dv3zcGu_QKRIOZ6nlRwd6BAS5YAUDKz9OlGLq4umkW1yz51rhcc9s9l0nDKJXbMPnEjUnmxRCZeq9uuZU7bvE05H4MQOi55Ll1f98qxGuMrIbC3BE2C2Jg-pGrhSZ3_cMqBDcuZ1x-aMw8LoL2W-a9IGe2NFwLJ0ox7YCztaCO7Cubo3-xB6l6mqDG_BCZYT7BfvXGi_jQ9epUCSRPZZhRcfDImU7M-1MzSYt8e89uOdNZWhozvp7O8Qn6PSCNYBIDnqiheNU0cq6lrhevjd-7EzP-3YNxRk3tDhVisIG4UAiP0vvqs7DP6FeHqhq6G0UQ0JeeaXgsho-DJ_Wpi7WAs96B8CtMF6ZHK1BxD4irbdNJ4Y13lZUaGRX0sFodImTH6PCmsSGewvHNkEHCJqTU_Vv1812IOHUmZCe7rM_vSJMs4wgv5JXkf9EjaJZzr0Qgc2KeqvjLZM3JlscHvDAqL_7A16MUge1UquaBOX6W-WhVkgixccagtdPssVNISuLUDgQvkv7nCMvxe2RnP8vadoSjJUK5L2y15FSeuHtKViY03cd7Nnk-nES0e9H1UjEXspOweNu1HpfgBY3xC5mZ21ew8kEK_tXqpN-R1sk-o7Xt53FtH6scp8gP7DCvvcPplIDsoN4o4n8AE2QJEm_YKgyMDMifYWWRDfarT3kF43Qg4Kf31KnpvzE6u4GDdkRBC6qYBisAVivCZ_FK81wyctJmrg2DiJmKYVdxGgoywd5pHBsQKDDwAyxUeVp1STvbnWZZhNRlghIG29EFj1opX_TIhSdUFFXdyh99wmcbDbJj_QhcbXiGB6Dpi8XwbQ-CaJohXl7-VObGACUNZvp-7YRz7igoHeTx35_MlsWw2foDlKemEJABLaDwMQ6yInlo9YiIuOyE1LRZAsiXNBsA25TB4ZaXc7iNPKco1zxw6DBNG8Tu_1Q62cuQmrdJr2IzkWFmA99SVDLYkxsOYmgWJLPZLC_xP2IcMMuKBXQ2Ci0KQeXVK25YDjcHTBisLp7XZY3Ds3HSYUoKAtUqLMGyqyn0JSg-_X_1ZpjMRanAsWfnkyj0V9yPRkcItDM4NGA3zVnN4X5peWg8XJHklJAL1FUaPRn0GL6h46Z46ZjD67XT93hXdr8Hu_KcxaZPs1hBb5gHHZkQgkkwO_iXLJVbfWLFqzzTrkhoSPlTck7OLvP8QGXkowvESNBvNO39-CA-OT5GhQcRoi1xinEPGBqvzwEDTNIuolPk3NHYX9fo9BGHO1sAejQQSvXkJPzHj7itk8G-gceqMNmEDhz_c8Ot8vghSDiH0nf)Michael E. Wechsler, MD, et al., JACI: In Practice, 2026 * [Dupilumab in Patients With Chronic Spontaneous Urticaria Phase 3 LIBERTY-CSU CUPID Randomized Clinical Trials](https://rev.trendmd.com/open/4_qZavU5RUt9p-PVIvEqAi5Dg8MXm-KmgtKKphFbzLXZVjKHldbAj3zX5ANKuZIvET82lugjO9Yfv6jtEIutlSxbNaJpWchM4Hlw5OwrL14NIZiwWMLbl39JuIqOSIsnPwxYMk2KP-1cOkirYIp-PMpyEPI-tcMnApwOl2AdmH3LxJy5hnzMmlisgDpoh61Snc3ijdyrStmHJTXcgbsPTKhDZ1m86JGWRW13auB-pGlUeYnm30K1j6akwqkugPtlwqZBBeQdziaLdrFNraDeE6Nfeuxfh7R0rOPUvhr8nOF9y_vIlZV3WI55uohqIfR6RScFHqDlIJcJcLORwfpRuTHrgacnXduEYPkKSUt0Pj0LUiGh5s9OqXi4B3LxKTNuCwCyBBlNeurxHLm-PPvsuJzfJ7eRtx3Pp4A4wo0fBR9qO82zvMvcsBwisPBeDqfqcBDNzLlOTqMHPUIhTXKsg09D9ZgH4YTeq_qQlpv__XtZnpVVmsdX2AsvoW6NjZReY8dQG95rdHRwHzwMZ2kHHBAhV2ghgPU2kxtDnfEGlf3uoH1QG0-U8Ywl6_LBdNv-4-PEQJz_mmXiVVpSqfj14SkuuhiDG_ygdrWUCY2vyDEP9csdeBrjzw1bDYBRoZSpijYFZ12uD1ff6tV_sCGmBDvg_H_MpQc16_0Anws4rmFsIFswcqT18hCtaDlQBa_IH5OEw8glyJnLRl4ZA_y4C6jP9_SFmvNh27jlzXsgPPwjsZ8fsHsdCWqXlKBaLRX_jRayujzk_ylINRms_sCZcpV2zfNJAiM1SpZyUZH3cf7XYJCdDsu5sLyApbURC5j626E-kpCxoDUJiafUQ-Lcoz5dX5ZqedIiYz0IjspNSk6JdFodPes4enx0r-MYhusUHMCHgHFsh676CzVF12UEsSlUi2guI2fdIu0IP1cGB9MrZo07mVkcfnvddmQMaAjIQbMwIaXfImkyLBH35ujuJxBExlc5PZEVRwLjgMyVlkf4rMW9KSSwNH5LWw71NI0-J-_0qXr1rRiYSXcq2MxkU4TXQDTUddbNMtBUhaBUm3qlslLw6ASlcdKyWv3dujMQH6-rdZrO3JVLKA9edJAtQELMdCCRcfvb8XX8EdvhHQDgGldOicrumyKhvVgZzWZrnRWDC3LNHYhd7zVwoGJPKnBai7csZJ3gYeM_zwlgRQn-uGIN4BnoqS3AmQjThdPtq_2s7VtmURNEX4m-vTIVzCDAUDfs6pQGo52XEvpk5bcZpQkuX6rUn3VxXX-sl3ySsT4VwlblNhQukMl2eQRrz1cx9Vm48cyhjFnYExaM07Vay-U2OjOKuJR1jivP6wW5fl1WxuUWCYV2iGcnt62Q0xF9PX_Nw0GcuM1qTgaYxg2qfVP7DY89Di55TeXFrtfXPTolcpq266jnS91G7wVWdJUupdFz_-Zb1wnVB33qLab0JEqHz6ozS1M7915M6XohVMR3exL8IyeGkZPEJpnSZfQcxF1TKnZs0h5xFIo0vqc31C4a3jv4JrqRGxNdxGGp2uTFNGrP2A2DmgIm-DpOBJugYHI25KITfnTxE5xTq32-GqPXs_alhg7nPgjOKMYZDYms7FQkx_RdEGMHH_a9l6EbdTeKJMlktZOHdVY38-BvLg)Thomas B. Casale, MD, et al., Jama Dermatology, 2026 [Powered by](https://www.trendmd.com/how-it-works-readers) * [Do not sell my personal information](https://www.trendmd.com/personaldata) * [Content](https://ebm.bmj.com/) * [Latest content](https://ebm.bmj.com/content/early/recent) * [Current issue](https://ebm.bmj.com/content/current) * [Archive](https://ebm.bmj.com/content/by/year) * [Top cited articles](http://ebm.bmj.com/pages/most-read-articles/) * [Most read articles](http://ebm.bmj.com/pages/most-read-articles/) * [Responses](http://ebm.bmj.com/eletters) * [Journal](https://ebm.bmj.com/) * [About](http://ebm.bmj.com/pages/about/) * [Editorial board](http://ebm.bmj.com/pages/editorial-board/) * [Sign up for email alerts](https://myaccount.bmj.com/myaccount/signup.html?regService=etoc-alerts&corpusCode=ebmed&fwdUrl=https://ebm.bmj.com/) * [Thank you to our reviewers](http://ebm.bmj.com/pages/thank-you-to-our-reviewers/) * [Subscribe](http://ebm.bmj.com/pages/subscribe/) * [Authors](https://ebm.bmj.com/) * [Instructions for authors](http://ebm.bmj.com/pages/authors/) * [Submit an article](https://mc.manuscriptcentral.com/bmjebm) * [Editorial policies](http://authors.bmj.com/policies/) * [Open Access at BMJ](http://openaccess.bmj.com/) * [BMJ Author Hub](http://authors.bmj.com/) * [Help](https://ebm.bmj.com/) * [Contact us](http://ebm.bmj.com/pages/contact-us/) * [Reprints](http://journals.bmj.com/cgi/reprintform) * [Permissions](http://www.bmj.com/company/products-services/rights-and-licensing/permissions) * [Advertising](https://www.bmj.com/company/for-advertisers-and-sponsor/) * [Feedback form](http://myaccount.bmj.com/myaccount/customerservice/salesforce-form.html) * [Accessibility](https://journals.bmj.com/our-journals/accessibility-old-platform/) * [RSS](http://ebm.bmj.com/pages/rss-feeds) * [Twitter](http://twitter.com/BMJ_EBM) * [Facebook](http://www.facebook.com/BMJ.Evidence.Based.Medicine) * [Blog](http://blogs.bmj.com/bmjebmspotlight) [](http://www.bmj.com/company) * [Website Terms & Conditions](http://www.bmj.com/company/legal-information/) * [Privacy & Cookies](http://www.bmj.com/company/your-privacy/) * [Contact BMJ](http://www.bmj.com/company/contact-us/) Cookie settings Online ISSN: 2515-4478 Print ISSN: 2515-446X Copyright © 2026 BMJ Publishing Group Ltd. 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