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Evidence 2010-Transforming healthcare. Afternoon thoughts

Ami Banerjee
Last edited 1st November 2010

After a hearty lunch, I attended the breakout session about the role of medical journals in raising awareness of evidence. Bill Summerskill, Executive Editor of the Lancet, helpfully described “research” as the roots, “evidence” as the tree and “evidence-based practice” as the fruits which take much more time and effort to produce. He described the measures that the Lancet currently uses to publish the right research with the maximal effect. The problem of plagiarism, setting the research agenda and the importance of targeting readers were just some of the issues raised. We often think of the publication of research in journals as the starting point for media articles, but one of the listeners tackled was the possibility of journals moving in the other direction and taking responsibility for publishing research in the face of media hype.

Sir Ian Chalmers, founder of the Cochrane Collaboration and coordinator of the James Lind Initiative, eloquently described the mismatch between research funding and disease burden. He quoted the “profit motive” (money is in diseases and problems which are different to the major burden of disease), “reductionist snobbery” (the medical community perversely rewards study of clinically small problems) and “criteria for academic recognition” (problems in current culture in research institutions) as major reasons for this mismatch. Amazingly, 60% of research findings presented in conferences never get published, often because they are never submitted to journals. And this is even though so much research funding comes from public sources. Chalmers gave the example of use of steroids after traumatic brain injury as a common medical practice which was totally discredited by proper systematic review, but is sadly, still going on. He concluded that there are many good ethical reasons for getting rid of waste in research funding at the question-forming stage, the design stage, the publication stage and the report stage because research is to improve outcomes for patients at the end of the day.

After an awards ceremony for the best evidence poster, a panel discussion about the future of medical publication ensued. The panel consisted of Carl Heneghan, Director of the CEBM, Fiona Godlee, BMJ editor, David Tovey, Editor in Chief of The Cochrane Library, and Bill Summerskill, Lancet Executive Editor. Carl spoke of the roles of individuals in pushing forward the quality and relevance of research, and conflict of interest remained a significant hurdle. Fiona Godlee spoke of the “broken state” of medical publishing of evidence, which needed a “great deal of scrutiny”. She acknowledged vested interests and conflicts of interests throughout the whole research structure which required total openness. Greater transparency, open access and improvement of patient outcomes have to be primary aims of medical publications. Bill Summerskill said the mechanism of production of the Lancet and other journals has changed beyond recognition in the last 30 years, but the overall aim of quality and peer review remains the same. He believes that technology and globalisation to be major drivers, with Asia, and China in particular, leading in the generation of research evidence. The public will be interested in “social value” rather than impact factor of journals, and so the journal “Nothing is more tarnished than yesterday’s vision of today.” David Tovey had “grounds for cautious optimism”, even though he was sure the paper copy and medical journals in their current form were dead.

Tom Jefferson, of the Cochrane Collaboration, posed the question "What can journals do to improve the reporting of trials?" Bill Summerskill felt that trial registration is only one part of the solution of finding all available data about drugs and interventions. Carl agreed and went further, saying that there had to be more mandatory reporting of trials within a given timeframe; registering trials is not enough. The challenges of EBM in the US and of evidence informing policy dominated the discussion, with calls for research to be put in online databases rather in journals and greater collaboration. The second day will hopefully talk as much about the potential solutions as the problems facing medical evidence.

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