Reinvention starts here

doi:10.1136/bmj.327.7422.0-g

BMJ 2003;327 (1 November), doi:10.1136/bmj.327.7422.0-g

Editor's choice

Reinvention starts here

If anyone doubts that academic medicine needs all the supportit can get then articles in this week's journal should convincethem. The centrepiece is a report from the Academy of MedicalSciences on the woeful state of clinical research in the UnitedKingdom (p 1041).

Some of the problems relate to funding. But what's more corrosivethan lack of money is the apparent abandonment of the beliefin the value of academic medicine. The full explanation of thisfall from grace is unclear, but Jocalyn Clark and Richard Smithprovide some clues in their editorial (p 1001). This may bethe right time to ascertain what the world wants from academicmedicine and then set about finding the best ways to deliverit. Firstly, however, the world will need to be reminded ofthe benefits that academic medicine has already delivered.

In a paper providing support for the academy's assertions IainChalmers and colleagues chart the falling numbers of randomisedcontrolled trials funded by the United Kingdom's major non-commercialfunding agencies, most notably the NHS research and developmentprogramme (p 1017). In his editorial on how to improve clinicalresearch, Paul Stewart argues that the first step should bea critical assessment of this programme. The NHS was meant tospend 1.5% of its turnover on clinical research but has yetto achieve this target (p 999).

Elsewhere in the journal there are numerous indications of theproblems that may arise when assessments of new clinical interventionsare left entirely in the hands of their manufacturers. Industrysponsored clinical studies are twice as likely to have positivequalitative conclusions about costs than studies sponsored bynon-profit organisations (p 1006). Last week the Lancet's editor,Richard Horton, provoked howls of protest from AstraZeneca whenhe criticised the clinical trials of its new statin for "weakdata," "adventurous statistics," and "blatant marketing dressedup as research" (p 1005).

And as we went to press the Cochrane Collaboration was decidingwhether it should accept industry funding of its reviews. Atits meeting, participants shared stories of being offered cashfor good reviews by drug companies (p 1005).

Good deeds in a naughty world are rare this week, but LéonSchwartzenberg's life was full of them, as his obituary shows(p 1052). "Servant of social justice" he may have been; fullypaid up member of the awkward squad (or whatever the Frenchequivalent is) he certainly was.

Our recent theme issue on "What is a good death?" sparked offa flurry of responses, from which we publish a selection thisweek. Akheel A Syed's description heads the list: "A good deathis like the final chapter of a good book: it wraps up the storyof `life' with panache; is physically, emotionally, and spirituallysatisfying to the author (the deceased) and the readers (kithand kin); and leaves no loose ends to be explained in a sequel"(p 1047).

Tony Delamothe, web editor

(tdelamothe{at}bmj.com)

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