The BMJ: Transparency and trust in medical science - Kamran Abbasi

Thank you so much. It's quite jazzy in here. I've got an old school presentation, but let's see how we go. I'm going to talk about transparency and trust in medical science. I'm delighted to be here. What you do matters deeply to us at the BMJ. I've got a lot of slides; it's going to be a whistle-stop tour. This is what we're about: creating a better world that prioritizes health and well-being for people and the planet above economy and GDP. Science and what you're doing is central to that. The BMJ has been around since 1840; during the pandemic everything became contentious, and being more transparent and open is clearly the answer. But we also need to remember we're at the center of improving health through housing, transport, education, environment—everything matters. Science is changing again; the hierarchy of methodology is shifting. Ben described our journey: we were at the forefront of improving reporting of randomized controlled trials, and we need to be at the forefront of what's happening now with large datasets, real-world evidence, and AI. We can't just stick to old ways; we have to embrace the new. The BMJ is unique—we have journalism, research, comment, education. We often lead but others don't follow, but we think it's the right thing. We publish about 2% of papers; it's a highly selective process. Our values are evidence-based, open, transparent, trusted, patient-centered, courageous, and independent. Dave Sackett created modern evidence-based medicine; it's not rigid but informs practice. Doug Altman wrote in 1994: 'We need less research, better research, and research done for the right reasons.' Those words are still apt. We have a problem—too much information, like the Rime of the Ancient Mariner: water everywhere but none to drink. We're overwhelmed but can't find what we need. In 2004, as acting editor, I wrote about transparency and trust—our whole enterprise relies on these. We can't scrutinize everything; we trust authors. How we fix that is a problem, but perhaps you've fixed it. We led on registering clinical trials to fix publication bias. My predecessor Fiona Godlee launched the open data campaign, reanalyzing trials and finding different results. Even in 2016, Ben wrote asking all BMJ research papers to share analytic code. Honestly, we didn't understand code—we spoke to statisticians and got pushback: it's complicated, hard to do. So it got parked, but Ben kept at it. He and Nick wrote an editorial in 2019, which got lost in the pandemic. But my philosophy is if you know the right thing, just do it. Don't be held back. When the pandemic ended, we revisited. There were good ideas like tagging papers as open research. We had conversations with Ben and Nick. And we saw how unsuccessful data and code sharing were: a meta-analysis of 105 studies found less than 10% of authors shared data, even fewer for code. Only 8% of medical articles from 2016–2021 reported data publicly available, and 2% actually shared data; for code, declared sharing was 3%, actual 0.1%. Voluntary schemes don't work. So we decided to act. We wrote an editorial with input from Ben and Nick and announced our policy earlier this year. It caused internal problems, but here it is: for all clinical trials, you must share data before we publish; for all studies, you must share code. We're already publishing papers true to this—large datasets analyzed transparently, answering real questions quickly. It's a very important resource. The value is clear. But journals face many challenges: AI, fraud, open-access business models. There's a firestorm. That's why holding transparency and trust dear is more important than ever. I won't go into slides about Hindawi retracting 8,000 articles in one year; this year will be worse—big publishers planning to retract 16,000–20,000 papers. Predatory journals are being exposed. There are 10 areas of focus; one is real-world data, trusted research environments. For journals, three principles: quality (peer review plus), diversity (of ideas and methodologies), and integrity. Trusted research environments deliver all three—data sharing with mandated code sharing, solving the problem of routinely collected observational data. They let you work with large datasets, fulfilling transparency and trust. I want to thank everyone involved—you're doing what we should be doing for patients and the public. And it gets you published in the BMJ: six papers in the BMJ from open safety, plus others in BMJ Medicine, BMJ Mental Health, BMJ Open. George Bernard Shaw said if you have an apple and I have an apple, exchanging apples leaves each with one; but if you have an idea and I have an idea, exchanging ideas leaves each with two. That's what open safety and trusted research environments do—share ideas to increase knowledge. We all have to act. My favorite quote from Michelle Obama: 'If we start feeling tired, if we start feeling dread creeping back in, because it does when you're pioneering, trying to change things, and people don't follow—you have to keep going if you believe it's the right thing. Pick ourselves up, throw water on our faces, and do something.' Remember: a better world prioritizes health and well-being. That's what you're all helping to deliver. Thank you for listening.