Editor's Choice

Reinvention starts here

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7422.0-g (Published 30 October 2003) Cite this as: BMJ 2003;327:0-g
  1. Tony Delamothe, web editor (tdelamothe{at}bmj.com)

    If anyone doubts that academic medicine needs all the support it can get then articles in this week's journal should convince them. The centrepiece is a report from the Academy of Medical Sciences on the woeful state of clinical research in the United Kingdom (p 1041).

    Some of the problems relate to funding. But what's more corrosive than lack of money is the apparent abandonment of the belief in the value of academic medicine. The full explanation of this fall from grace is unclear, but Jocalyn Clark and Richard Smith provide some clues in their editorial (p 1001). This may be the right time to ascertain what the world wants from academic medicine and then set about finding the best ways to deliver it. Firstly, however, the world will need to be reminded of the benefits that academic medicine has already delivered.

    In a paper providing support for the academy's assertions Iain Chalmers and colleagues chart the falling numbers of randomised controlled trials funded by the United Kingdom's major non-commercial funding agencies, most notably the NHS research and development programme (p 1017). In his editorial on how to improve clinical research, Paul Stewart argues that the first step should be a critical assessment of this programme. The NHS was meant to spend 1.5% of its turnover on clinical research but has yet to achieve this target (p 999).

    Elsewhere in the journal there are numerous indications of the problems that may arise when assessments of new clinical interventions are left entirely in the hands of their manufacturers. Industry sponsored clinical studies are twice as likely to have positive qualitative conclusions about costs than studies sponsored by non-profit organisations (p 1006). Last week the Lancet's editor, Richard Horton, provoked howls of protest from AstraZeneca when he criticised the clinical trials of its new statin for “weak data,” “adventurous statistics,” and “blatant marketing dressed up as research” (p 1005).

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

    Good deeds in a naughty world are rare this week, but Léon Schwartzenberg's life was full of them, as his obituary shows (p 1052). “Servant of social justice” he may have been; fully paid up member of the awkward squad (or whatever the French equivalent is) he certainly was.

    Our recent theme issue on “What is a good death?” sparked off a flurry of responses, from which we publish a selection this week. Akheel A Syed's description heads the list: “A good death is like the final chapter of a good book: it wraps up the story of ‘life’ with panache; is physically, emotionally, and spiritually satisfying to the author (the deceased) and the readers (kith and kin); and leaves no loose ends to be explained in a sequel” (p 1047).

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