Elsevier

The Lancet

Volume 374, Issue 9683, 4–10 July 2009, Pages 86-89
The Lancet

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Avoidable waste in the production and reporting of research evidence

https://doi.org/10.1016/S0140-6736(09)60329-9Get rights and content

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Choosing the wrong questions for research

An efficient system of research should address health problems of importance to populations and the interventions and outcomes considered important by patients and clinicians. However, public funding of research is correlated only modestly with disease burden, if at all.6, 7, 8 Within specific health problems there is little research on the extent to which questions addressed by researchers match questions of relevance to patients and clinicians. In an analysis of 334 studies, only nine

Doing studies that are unnecessary, or poorly designed

New research should not be done unless, at the time it is initiated, the questions it proposes to address cannot be answered satisfactorily with existing evidence. Many researchers do not do this—for example, Cooper and colleagues13 found that only 11 of 24 responding authors of trial reports that had been added to existing systematic reviews were even aware of the relevant reviews when they designed their new studies. About 2500 systematic reviews of research are now being published every

Failure to publish relevant research promptly, or at all

Biased under-publication and over-publication of research are forms of unscientific and unethical misconduct about which the public has become increasingly aware, particularly because of several exposés of suppressed evidence about serious adverse effects of treatments.18 More generally, studies with results that are disappointing are less likely to be published promptly,19 more likely to be published in grey literature, and less likely to proceed from abstracts to full reports.2 The problem of

Biased or unusable reports of research

Although their quality has improved, reports of research remain much less useful than they should be. Sometimes this is because of frankly biased reporting—eg, adverse effects of treatments are suppressed, the choice of primary outcomes is changed between trial protocol and trial reports,21 and the way data are presented does not allow comparisons with other, related studies. But even when trial reports are free of such biases, there are many respects in which reports could be made more useful

Conclusions and recommendations

Although some waste in the production and reporting of research evidence is inevitable and bearable, we were surprised by the levels of waste suggested in the evidence we have pieced together. Since research must pass through all four stages shown in the figure, the waste is cumulative. If the losses estimated in the figure apply more generally, then the roughly 50% loss at stages 2, 3, and 4 would lead to a greater than 85% loss, which implies that the dividends from tens of billions of

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