The BMJ Today: Is medicine marching towards an era of greater openness?

Tiago_VillanuevaIn the latest Endgames picture quiz, a 41 year old man presents to the emergency department with a two week history of worsening shortness of breath, productive cough, intermittent fever, night sweats, and non-pleuritic pain in the right side of the chest wall. He was diagnosed with a pulmonary abcess secondary to community acquired pneumonia. There are no published guidelines regarding the management of pulmonary abscess, which includes antibiotics that are in part chosen according to clinical judgment rather than a sound evidence base.

Doctors are well aware that practising medicine often means making decisions under conditions of great uncertainty. Fortunately, the evidence base of treatments is constantly evolving, and we need it to evolve in order to keep improving patient care. But doctors may be mislead if, due to lack of disclosure, they don’t have access to the complete evidence base for most drugs in current use. Both patients and doctors may have reason to smile this week, as the BMJ has reported that the members of the European Parliament have just voted in favour of adopting legislation aimed at increasing the transparency of clinical trials. In 2016, among other measures, all trials are expected to be registered in a publicly available EU clinical trials register before starting. BMJ deputy editor Trish Groves has said that the medical community and trial participants in particular should prepare for an “era of much greater openness.”

Many of the trials that will have to be registered involve the allocation of participants to a study arm by simple random allocation, also known as random allocation or randomisation. However, some trials will use block randomisation in order to ensure that there are similar numbers of participants in the different study arms. A recent Endgames statistical question explains the finer nuances of using block randomisation in clinical trials.

Openness is definitely a trait that BMJ Confidential interviewees must have. Trisha Greenhalgh, who is featured this week, admits that the worst mistake of her career was working in neurosurgery for six months even though she was not good at it. She also discloses that Wagner is her guiltiest pleasure, that she often continues to ride to work on a Condor bike she used to compete for Great Britain in the 1986 European Ironman Championships, and that she still has a personal ambition to get the BMJ editorial staff to acknowledge “a wider range of paradigms” and break out of a “rationalist experimentalist rut.”

Finally, the next time you consider submitting a paper to the BMJ, don’t forget that the BMJ operates a system of open peer review whereby authors and reviewers are aware of each other’s identities. Is open peer review the fairest system or not? Trish Groves and Karim Khan present their perspectives over on the BMJ Open blog.

Tiago Villanueva is the editorial registrar, BMJ.