From The Guardian, 24 June 1998, 5

British Medical Journal editor says most published research is inadequate and of no use to doctors

Medical studies 'rubbish'

Sarah Boseley
Health Correspondent
"The editor of one of Britain's leading medical journals yesterday castigated the quality of scientific papers he and his colleagues receive, saying that only 5 per cent of published articles reached minimum standards of scientific soundness and clinical relevance. Richard Smith, editor of the British Medical Journal and a professor of medical journalism, told a conference yesterday that the studies reported in the 20,000 medical journals around the world were not of sufficient calibre nor sufficiently wide in their scope to serve as the foundation stone of the 'evidence-based medicine that the Government was trying hard to promote across the NHS.

 Only 5 per cent of scientific papers came up to scratch, according to Professor Smith. "In most journals it's less than 1 per cent. Many trials are often too small to be relevant, and many of the studies that are published are the positive ones - there is a lot of negative evidence that never sees the light of day."

The Government wants doctors to read and digest all the evidence produced from books and those peer-reviewed studies so as to work out the most effective way of treating patients - evidence-based medicine, as it has come to be known.

But, apart from the inadequacies of the research, says Prof Smith, 'what works on a particular population of people has little or no impact on the patient sitting in front of the doctor'. Speaking at the annual conference of the Royal College of Psychiatrists, Prof Smith said that too many scientific papers contradicted each other, the good ones were almost impossible to find and doctors were not trained to assess which were the most effective treatments for patients. The medical profession and the Government were fully behind the idea of evidence-based medicines, but the delivery of a system was almost impossible, he said.

Few doctors visited medical libraries, he added. Medical books and journals were 'very primitive information tools' and of little use during a consultation when a patient might ask questions the doctor was unable to answer.

'The Internet open up possibilities and most doctors are hoping someone will devise a means of accessing the answers to such questions instantly on the Internet. Where evidence-based medicine is being practiced at the moment it's usually down to an enthusiastic individual."

Prof Smith was critical even of the peer review system which is used to vet every paper put forward for his own journal - the BMJ- and the Lancet. Papers were given rigorous study by scientists chosen because they were specialists in that field. But the system, he said, was 'slow, expensive, prone to bias and abuse, with little evidence of any real benefit". Earlier this month, Prof Smith and Michael Farthing, professor of gastroenterology at St Bartholomew's/London School of Medicine and Dentistry and also editor of Gut, highlighted the problems editors faced when sent fraudulent research.

In one year, their committee on publication ethics came across 27 dubious studies sent to just 10 journals. Prof Smith commented that this was 'the tip of the iceberg'.

The way towards greater clinical effectiveness, he said yesterday, was to involve the patients in their treatment. 'Evidence-based medicine is a waste of time if patients feel they are not getting better.' "

Boseley S: Medical studies 'rubbish', The Guardian, 24 June 1998, 5


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