JOURNALS AND PUBLICATIONS

"The relationship between doctors and patients is undergoing a profound change, which is reflected in medical journals," Richard Smith, former editor of the BMJ writes. Patients are ceasing to be "human guinea pigs" and are becoming participants in their own health care. In this chapter from "The Trouble With Medical Journals," Smith discusses the shift toward informed consent and patient participation in medical research and explains why there's still a long way to go.

Richard Smith, former editor of the BMJ: "Editors must balance the demands of many different groups, from readers to owners, and must be accountable. Perhaps because of the power of the myth of editorial freedom editors are often much less accountable than other professionals, and there are many examples of editors abusing their positions without any retribution. But at the same time, if editors are slaves to the political commands of their owners then the journals they edit will never be respected. How can the right balance be achieved?"

According to former BMJ editor Richard Smith, research has shown, "far from conflict of interest being unimportant in the objective and pure world of science ... it is the main factor determining the result of studies." Smith claims "the best response to conflicts of interest seems to be disclosure rather than attempted eradication" and argues more studies are required to understand how to mitigate bias in research and patient care.

Because academics “gain credit from publishing” and quantity is more important than quality, many publish closely related papers that add redundancy to medical research. This problem is compounded by pharmaceutical companies commissioning repeat publication of favorable studies. Though many think such practices are harmless, Richard Smith argues they lead to bias in the evidence doctors use to inform their treatment decisions. Treatments “may seem more effective than they are," which leads Smith to conclude redundant publication "pollutes medical evidence."

Richard Smith, former editor of the BMJ, examines the advantages and disadvantages of various authorship models for the publication of scientific research. He advocates for a model based on contributorship rather than authorship. He claims such a model would "reflect the diversity of views of contributors ... [and] help to move us beyond the illusion of a scientific paper as an objective artefact to a living, human and therefore imperfect document."

Richard Smith, former editor of the BMJ, discusses the problems that complicate and sometimes undermine scientists' ability to perform or interpret clinical studies, even the highly prized randomized controlled trial.

Richard Smith, former editor of the BMJ, discusses how medical journals negotiate conflicting values and lists which values he thinks all journals should hold in the highest regard.

"Can journals reform? Can they lead? Are medical journals important for leadership in medicine? Or is this grandiosity on the part of editors? Aren't journals there to follow, reflect and comment rather than to lead? These are the questions I want to explore in this brief chapter," writes Richard Smith, former editor of the BMJ.

“Scientific journals exist primarily to disseminate and record science, but many medical journals ... have been about more,” writes Richard Smith, former editor of the BMJ, in this chapter of his book, The Trouble With Medical Journals.

Richard Smith, former editor of the BMJ, discusses the nature of medical journals and why a broader audience than doctors and other medical professionals should care about what they publish. "What journals publish and the ethical issues that arise in making those decisions can have a broad impact on peoples' lives," he argues.