Product Description

It is a turbulent time for STM publishing. With moves towards open access to scientific literature, the future of medical journals is uncertain and unpredictable. It is the only book of its kind to address this problematic issue. Richard Smith, a previous editor of the "British Medical Journal" for twenty five years and one of the most influential people within medical journals and medicine, depicts a compelling picture of medical publishing. Drawn from the author's own extensive and unrivalled experience in medical publishing, Smith provides a refreshingly honest analysis of current and future trends in journal publishing including peer review, and the risk that money can cloud objectivity in publishing. The controversial and highly topical nature of this book will make uncomfortable reading for publishers, researchers, funding bodies and pharmaceutical companies alike making this useful resource essential reading for anyone with an interest in medicine or medical journals.

Product Details

• Amazon Sales Rank: #348588 in Books
• Published on: 2006-09-15
• Original language: English
• Number of items: 1
• Binding: Paperback
• 292 pages

Review
Lively, full of anecdote and he [Smith] is brutally honest British Journal of Hospital MedicineThis is a unique offering by the former BMJ editor- challenging, comprehensive and controversial. This must be the most controversial medical book of the 21st Century John Illman, MJA News

From the Author
Beware medical journals
Can you trust medical journals? You might hope that you could--not least
because they are one of the main conduits between new research and doctors.
News from the journals also features regularly in the mass media,
influencing public and political thinking on health, sickness, birth, and
death--pretty important things, I'm sure you'll agree. My conclusion after
25 years working for a medical journal, 13 of them as the editor, is that
you should be suspicious of journals. Maybe if you're smart you're
suspicious of everything.

One problem with medical journals is that much of what they contain is
plain wrong. And much of what's not wrong simply doesn't matter. Canadian
researchers have for years been combing medical journals to find research
articles that matter to patients and are "true" in that their conclusions
are supported by their methods and data: they find that it's less than 5%
of the article and for most journals less than 1%.

More troublesome is the bias in the research. The highest form of
evidence in medicine is the randomised controlled trial, and about two
thirds of the trials in major journals are funded by the pharmaceutical
industry. Unfortunately--and stupidly I never realised this until I
retreated to a 15th century palazzo in Venice to write a book on medical
journals--those trials almost always come up with results favourable to the
company. It's not that they fiddle the results, but they are clever with
the questions they ask and the methods they use. They are so clever that
every study funded by the drug industry of whether newer contraceptive
pills caused more blood clots found that they didn't, whereas every study
funded with public money found they did. I was led to the reluctant
conclusion that medical journals are in some ways extensions of the
marketing arm of drug companies.

(You might have spotted by now that this blog is partly a promotion of
my book "The trouble with medical journals." Evidently such things are
acceptable in the blogosphere. It isn't much of a book, but it might be
worth a glance.)

One reason that journals publish so much rubbish is because their
method of assuring quality--peer review--is hopeless. Broadly peer review
the process whereby one or more peers of the authors of a study pass a
judgement on the study, usually anonymously. It lies at the heart of
science and determines which research get funded, which studies are
published, who is promoted, and who wins a Nobel prize. Despite being
central to science it had never until 20 years ago been studied, a paradox
for a way of studying the world that depends on experimentation and data.
When the studies began they showed that peer review was slow, expensive,
largely a lottery, ineffective at detecting error, prone to bias, easily
abused, and entirely useless for picking up fraud. In one study of peer
review the researchers inserted eight errors in a 600 word article and sent
it to 400 reviewers: the median numbers of errors that the reviewers
spotted was two; nobody spotted more than five; and a fifth of the
reviewers didn't spot any. As the now famous saying goes: "If peer review
was a drug it wouldn't be allowed on the market." Yet it continues to be a
sacred belief for an intellectual discipline that scorns faith and demands
evidence.

In my book I explore many other defects in medical journals, but
perhaps the most disturbing is the publication of fraudulent studies.
Nobody knows how many studies are fraudulent, but we now have a series of
cases stretching back 50 years. We were shocked by the first cases and
assumed that they must be rare and due to mental problems among
researchers. This was naïve. All human activity is associated with fraud,
and in science it is easy to commit fraud because the system depends on
trust. If authors say that they studied 200 patients they are believed:
nobody asks for pictures, signatures, or medical records.
As an editor I came across many instances of fraud--and particularly
disturbing were three cases where authors had probably published dozens of
fraudulent studies in prominent journals but where nobody has investigated
the studies. We are left not knowing whether they are fraudulent or
not--and so whether to use or discard them. The major scandal is not that
fraud happens but that science does not have adequate methods of preventing
and managing the problem.
I grow boring and "old mannish," and maybe my book is boring. But it is, I
contend, important for us all to understand the many problems with medical
journals--otherwise, our debates on health, sickness, birth, and death may
be corrupted from the beginning.

Customer Reviews

Medical Journals
Richard Smith, who worked for the British Medical Journal for many years and was editor from 1991 to 2004, has written an immensely well-informed, amusing, and comprehensive account of the murky world of medical research and medical publication. In a series of stories, some of which make your hair stand on end, he exposes the prevalence of medical publications which are poorly designed, poorly reviewed, or downright fraudlent. No one as far as I know has written anything on medical research which is so extensive and well written.

A new classic
This book is a must read for anyone who practices medicine or conducts, peer reviews or publishes research. While the subject matter is extremely serious, with profound and unavoidable lessons for doctors, researchers, editors, reviewers and publishers, it is also highly entertaining thanks to Smith's story telling which makes each chapter a joy to read. The book has a broader remit than its title would suggest. It is as much about the state of medical research as a whole and its consequences for medicine, as it is about publishing. A new classic - highly recommended.

This book is important the the general reader - because:
Why review a book about medical journals? Richard Smith is the former editor of the British Medical Journal (and, incidentally, brother of Arthur Smith, the comedian) and he has written a punchy book that deserves to be read. Medical journals are how doctors speak to each other, and how researchers speak to doctors. Thus, if we are to benefit from new treatments, or to be spared from useless and dangerous treatments, medical journals are everybody's business. Discourses around health and disease are as important as the discourses around politics, business and the arts, and this book is written for any reader and not just the medical in-group.

The book makes a dozen major points, all illustrated by good stories. Here's one.
One of the holy grails of gynaecology is to salvage an ectopic pregnancy by moving the fetus to the womb, where it can continue to develop. In 1994, Malcolm Pearce, a gynaecologist at St George's Hospital, published, along with his professor, a paper that said he had done just that. The professor was president of the Royal College of Obstetrics and Gynaecology and editor of the British Journal of Obstetrics and Gynaecology, where the report was published.
The paper was fraudulent. The patietn didn't exist.
The book tells how it happened and alcohol plays a major role in the story. Towards the end of a boozy dinner at the Royal College of Obstetrics and Gynaecology, Pearce told a colleague that he had successfully reimplanted the embryo. The colleague told the media, who contacted Pearce regularly for news, adding to the pressure on him. Over a drink to celebrate the editor's birthday, Pearce told the editorial team about his success, adding that he would like to send a report to the BMJ or Lancet. The editorial team wanted the report for their own journal and told Pearce they could publish the report in the next issue if he wrote it immediately. Pearce added the professor's name and the study was rushed into the journal without the usual process of peer review.
It is astonishing that the professor never asked to see the case notes, let alone meet the patient. A whistle-blower at the hospital reported that the patient never existed. Pearce was disgraced, and the professor resigned his post, his editorship, his headship of the Royal College, and his chances of a knighthood.

There are other examples of fraud, and probably a lot of minor fraud is never unmasked. All human life is in this book, which makes plenty of pertinent points. In medicine there are plagiarists, and there are people in the pay of drug companies. Medical journals are difficult to fund, and should they be paid for by authors or by readers or advertisers? Is the process of peer reviewing papers necessary or foolproof (the answer is yes and no) Why is it, for example, that virtually all research on arthritis drugs show that the product under test is as good as or better than rival products?

Richard Smith was asked to write this book by Sandy McCall Smith, professor of medical law in Edinburgh and author of the No 1 Ladies Detective Agency books. Cambridge University Press wanted him to take the stories out and make it more academic. He refused. The Royal Society of Medicine Press published it as it stood. It is a gripping read, a real page-turner, and I recommend it.