Being Ben Goldacre

Ben Goldacre

I had the privilege this week (2 August 2016) of hearing Dr Ben Goldacre when he addressed INANE (International Academy of Nursing Editors) 2016 at the headquarters of the Royal College of Nursing of the United Kingdom in London, UK. Goldacre is the author of two seminal books: Bad Science (don't forget to Google 'The doctor will sue you now' for the missing chapter) and Bad Pharma which have made his name as someone who sees through the 'bullshit' around many medical and scientifc claims and who is not afraid to speak out about what he sees. To that he has added I Think You'll Find It's a Bit More Complicated Than That which he signed for me after the lecture.

The experience of listeing to Goldacre must be what it was like taking a machine gun nest in the Second World War: a spray of words and ideas delivered at high speed with the occasional grenade tossed in. He clearly keeps a single massive PowerPoint for these occasions into which he delves, fast forwards and then focuses on whatever point he wants to make that day. Inevitably (and I imagine always) he runs out of time. He will have had to be more disciplined for his TED talk Battling bad science as these require rehearsal and precision in front of TED advisors according to Ted Talks: the Official TED Guide to Public Speaking.

Goldacre's crowning achievement and the mission he now preaches about is the All Trials Campaign which is a significant effort to force clinical triallists - especially those involved with pharmaceutical companies - to present all their data according to the original protocol and to publish the trials which were in favour of the control group. Most reputable journals are signed up to this.

However, this is not the place to rehearse all that Ben Goldacre has said in any of his books or blogs; instead - what callenged me this week? Goldacre asked how many of us were full-time editors and I think there was only one feeble effort to raise a hand.  His point was to ask how many of us carried out the vital task of scrutinising research, some of it using RCTs, when we had so many competing demands as academics and clinicians. On the other hand, he asked what we were being paid for (albiet that some of us are not paid*), if we did not scrutinise the science we publish - especially RCTs on which major purchasing and prescribing decisions are made. It is obvious that many trials are not publshed according to protocol, i.e. they report secondary outcomes without declaration, and even when they do report trials accurately on offical websites such as ClincalTrials.gov that they then do not publish them accurately (honestly?) in journals. It also seems, from a study that Goldcare has conducted, that some leading medical journals (he praised the BMJ, was lukewarm about The Lancet and less enthisiastic about JAMA and NEJM and AIM) are less than willing to have the extent to which they are complying with the highest standards or reporting RCTs pointed out and to publish related correspondence.

Richard Gray

Professor Richard Gray of the Hamad Medical Coporation and Associate Editor of Journal of Psychiatric and Mental Health Nursing said what many of us were thinking when he raised whether or not journals were the place to publish RCTs and should this not simply be left to online repositories. Goldacre more or less agreed and certainly pointed to the economy of information required in, for example, ClincalTrials.gov - essentially just the results with little room for discussion.

I don't think that there will be a massive movement away from publishing RCTs - after all, who would go first and risk the loss of good articles, citations and the contribution to journal impact factor while others persisted? But I do think most of the editors present will now be considering how we can publish RCTs better and also audit that we are doing it better.

* I wish to declare that I am supported financially by Wiley for my work with Journal of Advanced Nursing and Nursing Open

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