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Phooey on peer review. See what this former editor of a medical journal says on this and other practices in journal publishing:
Health Tue, Sep 19, 06 Add a pinch of salt to medical findings
Good debate: Don't believe all you read in a medical journal, a former editor tells Claire O'Connell
Every day, doctors thumb through medical journals looking for the latest information on treatments. Meanwhile, journalists relate the findings of published studies to millions of people.
And the underlying belief is that if it is in a prestigious medical journal, then it must be true. Right?
Not always, according to Dr Richard Smith, whose book, The Trouble with Medical Journals, is published today.
Smith, a medical doctor and editor with the BMJ (British Medical Journal) for more than 20 years, lifts the lid on shady ethical practices in large medical journals.
These include dodgy courtships with the mass media leading to public scares, as well as unsavoury links with the pharmaceutical industry, which he claims uses medical journals to promote its drugs.
He also recommends ditching the time-honoured practice of expert peers reviewing papers before they are published.
But why should we care about how medical journals work?
"The ways that medical journals behave have an important influence on people," Smith says.
"They can create a lot of havoc," he adds, citing examples where studies in medical journals sparked media-fuelled scares about emotive issues such as vaccination, alternative treatments for cancer and the contraceptive pill.
His book raises the awkward question of whether journals, in their passion for publicity, might be tempted to publish weak but controversial studies to grab media headlines on "things that are likely to appeal to the public's interest [ quite a different thing from the public interest]."
For example, a dubious study published in The Lancet in 1998 sparked media hype that led to public fears about links between the MMR vaccine and autism.
The study was later withdrawn, its author was discredited and numerous larger and more rigorous studies have since shown no link between the MMR jab and autism.
But the mud stuck, and uptake of the triple vaccine was substantially reduced.
"All medical journals publish rubbish, and quite a lot of it," says Smith, who openly admits transgressions by his own journal. "But luckily, most of it doesn't have the kind of impact that the MMR paper did."
However, medical journals have more worrying bedfellows than the media, according to Smith, who left the BMJ in 2004.
Top of his list of gripes is how "medical journals have become an extension of the marketing arm of the pharmaceutical industry".
Pharmaceutical companies sponsor most of the large clinical drug trials that are published in major medical journals, and the outcomes of such studies are generally good for the sponsor, he says.
"When you look at how often those trials come up with anything that's really bad news for the drug companies, the answer is almost never," says Smith.
"It's not because the drug companies are fiddling the results, it's just that they are rather clever at the kinds of questions that they ask and the way they analyse the data. So they very rarely come up with anything that's bad news," he says.
A favourable clinical trial published in a prestigious journal can have a major impact on drug sales, says Smith.
And there is also a pay-off for the journal: if the pharmaceutical company orders reprints of the paper to send to prospective clients, the journal can make hundreds of thousands of dollars in profit, he adds.
Such cosy arrangements benefit neither the doctor nor the patient, and Smith believes a more open and accountable approach would be to publish full details of trials on regulated websites and have journals critique them.
Smith also dismisses peer review, a vetting system where journal editors choose experts in a particular field (peers) to review submitted papers and recommend whether or not to publish them.
Getting a study into a peer-reviewed journal is generally seen as a mark of quality, but Smith disagrees.
"I think it would be good for the world at large to realise just what a dodgy process peer review is," he says.
"It just doesn't work very well and it's a bit of a lottery."
Instead, he believes that new studies should be published online where everyone can access them and spark a public discourse.
"I'm all for sticking it up on the web with a big sign saying don't believe this just because it's here, wait and see what response there is."
In fact, Smith believes that printed medical journals are generally not the place for original research data, because they offer little of value for doctors.
He suggests that journals instead convey the important information in print and put the full research reports on the web for those who are interested.
"The whole model of sending a lot of original research to ordinary doctors is bonkers," says Smith.
"Most of the scientific articles [in medical journals] are not relevant to the average doctor.
"He or she hasn't got time to read them anyway. And most doctors are not equipped to critically appraise the evidence, so there's a tendency to say 'it's in the New England Journal of Medicine so it must be true'."
The extensive list of ills in Smith's book, which he wrote during a two-month stay in Venice, came as something of a surprise, even to himself.
"I had no idea the book was going to turn out like that - I've become a grumpy old man," he says.
"But probably the closer you get to any institution, the more you see the human defects," he adds.
Dr Richard Smith will give a public interview hosted by Dick Ahlstrom, science editor of The Irish Times, on Thursday, September 21st at 6pm in the Royal Irish Academy, 19 Dawson Street, Dublin 2.
The event is co-organised by the British Council. Places are free but must be reserved in advance by phoning Laura on 01 6090635 or Maura on 01 6090633 (10am-5pm).
� The Irish Times
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