Richard Smith: Stephen Lock, one of the best BMJ editors, is 90

richard_smith_2014“Editors of The BMJ are alternating fools and bastards,” said Stephen Lock, my predecessor as editor of The BMJ, who has a gift for memorable axioms. Stephen, who will be 90 on 8 April, is, we think, the first editor of The BMJ to make it to such an age. He is as sharp as ever, which can at times be painfully sharp, still works, and swims regularly; he has even recently attended the Glastonbury Festival and chatted with Eric Clapton at a London concert. (I’ll leave you to guess how that could be, but it’s not his love of pop music).

Stephen is clear that his predecessor Martin Ware, an old Etonian, was a fool; indeed, Stephen thinks that old Etonians are the source of many of Britain’s problems, a sentiment that seems exactly right looking at their role in the Brexit farrago. Ware’s predecessor, Hugh Clegg, was proud of being a bastard and frightened even Stephen. (The story I tell, which may be inflated, is that Stephen had to kiss the dead Clegg, who had a Russian orthodox funeral because he was married to the Estonian niece of the Baroness Budberg, mistress of both Maxim Gorky and H G Wells; Stephen would, I’m sure, have found it harder to kiss Clegg alive.) I’ve declared myself to be a fool, along the lines romantically of Lear’s fool, but the axiom breaks down with Fiona Godlee, the present editor: I see no evidence that Fiona is either a bastard or a fool. Stephen has no doubt that he is a bastard.

But he is a lovable bastard, and may even these days be an ex-bastard. He was very good to me. He was my mentor, teaching me to write and to be an editor; but also teaching me about the world, recommending me wonderful books (I’ve now read the 12 volumes of The Dance to the Music of Time twice and am about to start on a third round and my enthusiasm for Anthony Trollope comes directly from Stephen), and going to great lengths to arrange for me to go the Stanford Business School in the hope that the education might prepare me to help with the business side of the BMJ.

Stephen also taught me about research fraud. He became concerned about it in the 80s when most scientific authorities thought it unimportant—because it hardly ever happened, never harmed anybody, and didn’t matter because science is self-correcting (all of which are wrong). He managed to convince the Royal College of Physicians to produce a report on the subject, which he wrote. He didn’t succeed in getting the scientific authorities to take the problem seriously, and everybody, including me, thought him a little crazy and obsessed. But it was us who were badly wrong. Stephen wasn’t surprised that the authorities were so lethargic, pointing out that the Royal Society still had slaves ten years after slavery was abolished.

Another subject where Stephen was way ahead of others was research into editorial processes—or “journalology,” as he christened it. Scientists who should demand evidence for all that they do abandoned the concept when it came to the processes of publishing science. Peer review, which is central to science and still, I argue, faith rather than evidence based, was largely unexamined until Stephen began to research it. He discovered, for example, that most of the 90% or so studies rejected by The BMJ were published elsewhere usually unchanged in response to the reviewers’ comments. His book A Difficult Balance: Editorial Peer Review in Medicine is one of the best things written on peer review.

Stephen raised the scientific standards of The BMJ, particularly by introducing statistical review, which was unusual at the time, and “the hanging committee” a group of researchers and clinicians who together with editors reviewed the science and judged what would interest readers. (The committee was named by Stephen after the committee of the Royal Academy that decided which pictures submitted for the annual show should be hung). But Stephen also recognised that many readers of The BMJ were not much interested in the research and so he introduced features like ABCs and Minerva, which made the journal much more useful and accessible to doctors.

The BMJ should,” Stephen insisted, “be readable to the man in Patagonia.” (I still think often of that man, perched on a rock in the turbulent Southern oceans, reading The BMJ with the journal in one hand and a Spanish-English journal in the other.) The journal should be written in plain English not the “decorated municipal gothic” of usual academic writing. With friends Stephen taught writing around the world, which brought him among other honours The White Rose of Finland. Magne Nylenna from Norway describes how Stephen helped him: “When I became editor of the Norwegian Medical Journal in the 80s Stephen became my mentor. He invited me over to London and taught me all the basics. I remember his red, green, and blue pens and his questions: Is it new? Is it true? Is it important? Later, after he retired, he came to Norway for many years to run writing courses for PhD students with me.”

Stephen was always internationally minded, helping many journals, including the National Medical Journal of India and the Medical Journal of Australia, which he kept afloat when the Australian Medical Association had one its repeated bouts of bloodletting and fired its editor. Together with Ed Huth, the editor of the Annals of Internal Medicine, he founded the International Committee of Medical Journal Editors and was adept at stopping the giant and conflicting egos of the editors of the New England Journal of Medicine and JAMA from destroying the group. He recognised that it was impossible for the group to have a single leader, and he and Ed unostentatiously created a way of the working that has allowed the group to continue for 30 years, and, almost despite itself, make important achievements

Stephen had no pretensions about editing, which he describes as “taking in other peoples’ washing”; and he recognised that much of what we published had “all the impact of a doughnut in the North Sea.” He would dismiss some articles as “a word salad,” a criticism I’ve found useful and commonly applicable. At the same time he wrote pieces that had great impact. Probably his most famous editorial was published in 1989 in the midst of Margaret Thatcher’s reform of the NHS that centred on introducing an internal market and separating purchasers and providers. Stephen wrote:

“All ages have their fashions and in crime today’s is “steaming”: a gang runs amok through a crowded train or carnival demanding money at knifepoint. The aim is achieved through bewilderment and fear, much as in Clausewitz’s description of total war. The government has used a comparable strategy as one of the two prongs in imposing its plans for the fourth reorganisation of the health service.” (Stephen assumed a good education of his readers, and if you don’t know of Clausewitz, look him up.)

Many doctors would date that fourth reform as the beginning of a decay in the soul of the NHS. In his editorial Stephen asked the medical profession to work more closely together, a call that has been repeatedly made in a profession where “no kingdom is too small for a doctor to be king of,” causing a continual splitting.

With his passions for history and opera, Stephen now works in the Benjamin Britten archives and does tours of the art in the Red House, including in the tour the bedroom where Britten and Peter Pears illegally shared a bed, pointing out that no policeman in Britain would arrest friends of the Queen Mother. He describes himself as the “Last Victorian,” by which I think he means high principled, concerned with standards, suspicious of emotion, and somewhat stiff. But despite that he popped up recently on television describing the electric excitement caused by the first night of Peter Grimes in 1945.

Stephen would probably select Ernest Hart, a 19th century editor, as the greatest of The BMJ editors, but Stephen is among the best—and is certainly the longest lived. Happy Birthday.

Richard Smith was the editor of The BMJ until 2004.

Photo credit: NICK SINCLAIR