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Book reviews |
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Richard Smith worked for the British Medical Journal for 25 years and became well known as a spiky and controversial editor and chief executive from 1991 to 2004. One's image of him as a liberal and possibly left-wing radical took a major knock when he resigned to become chief executive of a large American healthcare company setting up business in the UK. Had he sold his soul to Mammon, one asked oneself? This book suggests not. It is still the same old controversial, radical and stimulating Richard Smith who comes through the 266 pages (not including the 418 references).
It is written in a very personal style with many, often humorous, anecdotes to leaven the otherwise serious challenges he offers to those with a traditional view of what medical journals should be about. The traditional pattern, whereby authors freely contribute reports of expensive research (paid for by themselves, charities or state funded bodies) to publishers, who then distribute them at considerable profit to themselves and their shareholders, is being severely challenged by the model of open publishing made possible by the internet. Paper journals are rapidly being transformed into magazines with racy accounts of the latest breakthroughs, while the serious science is left online to be retrieved by the equally serious researchers who need to study the detail.
Smith starts his book by questioning whether medical journals are really needed at all. Much to my relief, he concludes that they probably are but that they have plenty of things about them that need to be put right. He discusses peer review, a flawed process at the heart of science and its journals. He documents the growing problem of research fraud and that other by-product of the internet, easy and all too convenient plagiarism.
He highlights the difficulty of separating the truth from the spin imparted by researchers anxious to get another grant, by pharmaceutical companies anxious to promote their products and editors anxious to improve their impact factor. He throws into stark relief the growing problem of science becoming a money generating industry rather than an intellectual activity generating new insights by challenging the paradigm.
Are we, he asks, failing the developing world by concentrating on high-tech molecular biology aimed at rare diseases rather than practical improvements to basic medical care that could benefit millions? When malaria, the world's greatest killer, attracts only 4% of total world research spending, one has to admit that he has a point. He ends by discussing the future and concludes that the status quo is not an option.
He finds it odd that large institutions such as the National Health Service spend very little money educating and updating their employees, relying instead upon the commercially biased output of publishers and pharmaceutical companies. The scenario whereby doctors continue to rely on free handouts (from companies such as Microsoft, GlaxoSmithKline, Google, Wikipedia and Tesco) for their information is not one that attracts him. He prefers to see a future where employers accept responsibility for providing doctors and other health workers with high-quality, impartial and evidence-based learning materials, possibly even decision support systems. However, the slowness with which the NHS has invested in electronic guidelines and their reluctance to make readily available reliable sources of information, such as PubMed and the Cochrane Collaboration, do not suggest that his dream will come true. Let us all hope that we do not instead get his nightmare where profit is all and truth becomes a casualty in need of resuscitation.
Philip J Steer, BSc MD FRCOG, Editor-in-Chief, BJOG1
1. Honorary Consultant to the Chelsea and Westminster Hospital
Royal Society of Medicine Press, 2006
ISBN 9781853156731
Paperback, 266 pages, £19.95
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