Richard Smith: A variation on the theme of the importance of publishing

Richard SmithI fully support the Alltrials campaign to see all clinical trials published, and I’m a signature to the letter of people who have participated in trials and are horrified that their trial might not have been published. The results of my trial were published, but signing the letter caused me to remember projects that I’d give time to that were not published, much to my frustration and annoyance.

The first time was when I was part of a group of “inside outsiders” set up by George Alberti to review the Royal College of Physicians. (We were “inside outsiders” in that most of us were fellows of the college, but had little to do with it.) It was a fascinating experience, and I learnt a lot. I learnt, for example, that the college had four chief executives and that the only one of them who clearly wasn’t the chief executive was the one who was called the chief executive: he was more of a head butler. I also learnt that the BMA, which I though was an antiquated organisation, was Google compared with the college of physicians.

Our chairman, Oliver James, wrote an excellent report full of words like pathetic, out of date, ridiculous, and adamantine. I can’t actually remember the words, and I doubt that it included adamantine, although it should have done. What I do remember is that the report was bluntly critical of the college. I’d assumed that the report would be published, and it was circulated to the council—and perhaps even to the fellows. Many old timers objected, and the report was buried: it wasn’t published in the sense that I could find it in a library today. It should have been published.

Demonstrating my foolishness, I then made the same mistake again. I was one of a group set up by the Royal College of Obstetricians and Gynaecologists to investigate the circumstances surrounding the publication of two fraudulent papers in one issue of the British Journal of Obstetrics and Gynaecology, which is owned by the college. Again it was a most interesting experience, including a long meeting with Malcolm Pearce, the main author of the fraudulent papers. He was struck off by the GMC, but never appeared before it. He gave us a very long, complicated, and wholly unbelievable account of how the papers were not fraudulent.

Again I’d assumed that the report would be properly published, but it wasn’t: it was simply sent to fellows. This was a great pity as the report was both compelling and important. It was very well written (not by me) and read like a detective story, a classy whodunit. The report was important because it argued that the days of amateurs editing specialist journals needed to end. Stephen Lock, my predecessor as editor of the BMJ, did have access to the report and wrote a strong editorial in the BMJ drawing out the need to end amateurishness. But you won’t be able to find the report in a library.

My conclusion is that just as participants in trials should decline to enter the trial without a written commitment that the results will be published, so anybody asked to be part of a review should join only with a written guarantee of publication.

Competing interest: RS wasn’t paid for either of the reviews described here but gave up a lot of time. He was expelled from the Royal College of Physicians for not paying his subscription. He wrote a blog on his expulsion. He’s still a fellow of the Royal College of Physicians of Edinburgh as it’s cheaper and more fun.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.