Over the last 100 or so years, medical research has exploded with developments and advancement, with new treatments being established, life expectancies constantly increased, and new disease mechanisms posited, explored, and revised. Alongside treatments, new methods to conduct research are also constantly changing, taking advantage of novel technologies, allowing researchers to answer more complex questions, more quickly, than ever before[1,2].

Yet, despite all this advancement, the way we write and report the findings from our research hasn’t really changed all that much in this same 100-year time frame. The ‘IMRAD’ model (Introduction, Methods, Results and Discussion) of writing academic papers appeared in the mid 20^th century, and still forms the backbone of how we write papers today[3].

Take, for example, this article by Raistrick et al. (1948) on streptomycine[4]. Aim, Methods, Results, Conclusion are all present. The research might now be considered out of date; the methods might appear quaint compared to current techniques, but the paper’s structure is unmistakeably similar to what we have now. The results are presented in tables, with a limited amount of narrative either side that explain why the results are there, where they’ve come from, and what this means. The exact analysis is only described at a high level. There’s a lot of data processing and analysis that has been hidden from view, and only the polished parts form the results section.

When the analysis is relatively straightforward, then this isn’t a problem – the papers will contain pretty much everything we need to understand how those results came about. But analyses nowadays are increasingly complicated, multi-stage affairs which might have several data preparation algorithms even before the analysis is considered. If some observations are missing, for example, clever multiple imputation methods might have been used to correct for potential biases. Interesting algorithms that process free-text records into bite-sized quantifiable datapoints might have been used. Do any of the inner workings of these data processing steps end up in the paper? Not often, particularly if the journal has a word limit: there simply isn’t the space.

Is that transparent?

Can we be confident we can reproduce these results with only this information?

Compounding this issue is the shift in how we use these papers. There is an increasing focus on amalgamating and reusing datasets – meta-analyses, for example – or reanalysing datasets in the light of new methods. Without the datasets and the code, and enough detail on what was actually done with respect to the analysis, we’re forced to badger corresponding authors with emails, hoping for a response.

Is this efficient?

Or is there another way to write papers that gives us the detail we need for transparent, reproducible research?

At EBMLive I’ll be discussing ‘Literate Programming’, an approach which interweaves text and code, melding analysis and writing to generate manuscripts with the code embedded inside. If you’d like to hear more, it’d be great to see you there.

References

[1]      World Health Organisation. From MDGs to SDGs: General Introduction. Heal. 2015 from MDGs to SDGs, 2015.

[2]      British Medical Association. The Changing Face of Medicine and the Role of Doctors in the Future 2017:1–23.

[3]      Sollaci LB, Pereira MG. The introduction, methods, results, and discussion (IMRAD) structure: a fifty-year survey. J Med Libr Assoc 2004;92:364–7.

[4]      Medical Research Council. Streptomycin Treatment of Pulmonary Tuberculosis: A Medical Research Council Investigation. BMJ 1948;2:769–82. doi:10.1136/bmj.2.4582.769.

[5]      Chalmers I. Why the 1948 MRC trial of streptomycin used treatment allocation based on random numbers. J R Soc Med 2011. doi:10.1258/jrsm.2011.11k023.

[6]      Crofton J. The MRC randomized trial of streptomycin and its legacy: A view from the clinical front line. J R Soc Med 2006. doi:10.1258/jrsm.99.10.531.

Conflict(s) of interest

None.

Biography

Matt Parkes is a 2019 Doug Altman Scholarship recipient and a research statistician at the University of Manchester, in the ROAM (Research in Osteoarthritis Manchester) unit, a group specialising in conducting late phase clinical trials of nonpharmacological interventions for osteoarthritis. His research interests include chronic disease clinical trials methods, outcome research, and digital epidemiology. He is particularly keen to explore ways of improving transparency, reproducibility, and collaboration in research.

Why? How? What (needs improving)?

Systematic reviews are a key tool in the practice of evidence based medicine. Their findings and conclusions aim to support decision-making in health care practice and policy, but are also a valuable basis for future research. Systematic reviews synthesise and critically appraise all relevant evidence available regarding a specific research question using systematic methods (hence the name).

But how to make the methods systematic?

The answer is simple: By prospectively specifying them. Not only does this provide a roadmap for the review team, it also reduces the risk that the methods are being modified during the systematic review process depending on the results, thus introducing bias. For example, if I decided to report only certain outcomes and analyses because they have significant results, I would bias my systematic review’s results and conclusions.

Two transparent ways of prospectively specifying one’s methods are to publish a systematic review protocol as a peer-reviewed article and/or to register the systematic review in PROSPERO, the international prospective register of systematic reviews (1).

Publishing a systematic review protocol as a peer-reviewed article has the advantage that independent reviewers will critically appraise the proposed methods. While publishing protocols has long been the standard for Cochrane reviews, protocols for most other systematic reviews have only regularly been published from 2012 onwards. Nowadays several systematic review protocols are published each day, e.g. in the journals Systematic Reviews or BMJ Open.

PROSPERO records have the advantage that they can be updated throughout the review process to report important changes and to reflect the current status of the review (ongoing, completed, published or discontinued). Prospective registration of systematic reviews is possible since February 2011, when PROSPERO was launched. Since then, over 50,000 reviews have been registered (as of July 1, 2019)*.

These numbers demonstrate the success of past efforts, which also include the publication of a reporting guideline for systematic review protocols, the PRISMA-P checklist (2). Nevertheless, there are still various issues surrounding systematic review protocols and registration, some of which I have investigated in my research:

1. The time between submission of a manuscript for a systematic review protocol and its publication has increased over time (3). In recent years, it was disproportionately high, with no improvement in sight. This might discourage authors from publishing protocols as peer-reviewed articles.
2. Systematic reviews often differed from their protocols in one or more aspects of the methods, but the changes were seldom reported and explained by the authors (4). Changing pre-specified methods is not bad per se – it might even be a good idea. However, the process must be made transparent for protocols to fulfil their purpose.
3. Few systematic reviews updated their PROSPERO records’ status following publication. Most were still marked as ongoing (more details on that at EBMLive 2019). So, if someone was to search PROSPERO for published reviews on a specific research question, they would not find what they are looking for. In turn, we don’t know if systematic reviews whose status is ongoing are actually ongoing, or whether they have been published or discontinued.

Therefore, I believe that we need further innovation in the field of systematic review protocols and registration. We should discuss alternative models of peer review for systematic review protocols, agree on guidance on the reporting of discrepancies between review and protocol, and find new ways to keep PROSPERO up-to-date. I am looking forward to discussing my ideas with you at EBMLive 2019!

Short bio

Tanja Rombey is a 2019 Doug Altman Scholarship recipient and a doctoral student (Theoretical Medicine) at Witten/Herdecke University, Germany. She has a Master’s degree in Public Health from the University of Sheffield and a Bachelor’s degree in Health Economics from the University of Cologne. Tanja has a keen interest in systematic reviews and their methods as a part of evidence based medicine. She currently works on a systematic review and non-linear dose-response meta-analysis. Tanja has no conflicts of interest to declare.

 References

1. Booth A, Clarke M, Ghersi D, Moher D, Petticrew M, Stewart L. An international registry of systematic-review protocols. Lancet (London, England). 2011;377(9760):108-9.
2. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews. 2015;4:1.
3. Rombey T, Allers K, Mathes T, Hoffmann F, Pieper D. A descriptive analysis of the characteristics and the peer review process of systematic review protocols published in an open peer review journal from 2012 to 2017. BMC Med Res Methodol. 2019;19(1):57.
4. Koensgen N, Rombey T, Allers K, Mathes T, Hoffmann F, Pieper D. Comparison of non-Cochrane systematic reviews and their published protocols: differences occurred frequently but were seldom explained. Journal of clinical epidemiology. 2019;110:34-41.

If you are active in research you will no doubt have an inbox full of unsolicited emails from journals asking for your papers.

Here’s an example from my inbox:

‘It’s our immerse [sic] pleasure to invite Authors for Contribute their manuscripts for ‘X Journal of Infectious Diseases’ with an impact factor of 2’

Emails like this, often written in broken English and a fawning manner, are a growing problem in science, a problem known as ‘predator publishing.’ Why does this happen? Who’s writing these emails and why? Interested, I decided to collect all the emails like this I received.

The first thing to note is that I received a lot of them, in fact, I received over 100 emails in just four months. That’s almost one a day. I also received 20 speaking requests and 5 editorial invitations, not bad for an MSc student!

I began to analyse them, extracting details from the publisher’s websites. As I investigated I noticed that almost all of the journals were produced by the same few companies. All of the journals I received emails from charged article-processing fees with an average cost of $1690. Many had titles that struck me as being designed to be deceptively similar to more reputable journals. From my brief study, it seems like a small business model has grown up which seeks to make money from researchers who are willing to publish their work, for a price, in deceptively named journals.

I explored a bit further and began to compare the journals, looking for markers of quality. I found that of the emails I received, only 4 of them were from registered on ‘Medline’ and only 44 had SSNs. Very few of the journals clearly described their editorial process and 50 accepted email submissions.

There are widely available databases that list ‘good quality’ open access journals. Such references include the Berlin Institute of Health Whitelist[i]. Only 2 of the journals I studied had made it onto the whitelist. Conversely, some databases collate ‘predatory’ journals, including ‘Beall’s list[ii].’ 58 of the journals I analysed featured on Beall’s list. Extracting this information from these journals did not take me long, even a basic scan would make one hesitant to trust them. So why do they exist?

The obvious answer is that supply exists to meet demand, targeting a willingness amongst researchers to publish without going through peer review. Traditionally these repositories of unfiltered science have been known as ‘predator publications.’ But to me, this title implies a passivity, as if naïve researchers were being taken for fools. Perhaps we should acknowledge that these journals only exist because there is a small subset of unscrupulous researchers willing to publish in them, perhaps we should rename the phenomenon as ‘fake science.’

How do we deal with this plethora of ‘fake science?’ Well, a first step would be to acknowledge that this is a problem created by the research community itself. We should accept that it is bad practice and reproach those who publish in this way. But we also ought to quantify, work out how many fake science journals there are already and how we stop them. At EBMLive this year I’ll be talking more about ‘Fake Science,’ I hope you can join us at the conference!

[i] https://www.bihealth.org/en/research/quest-center/service/whitelist-englisch/

[ii] https://beallslist.weebly.com/

Biography: Drew Dagens is a 2019 Doug Altman Scholarship recipient and an MSc student at the Centre for Evidence Based medicine at the University of Oxford. Drew studies alongside his duties as a medical officer for the Royal Air Force. No conflicts of interest to declare.

A bright future for distance-learning? Challenges and potential solutions

The late advances in communication allowed distance barriers to dramatically become less important when it refers to continuing education. At the same time, the great amount of “scientific” information currently available demands from each individual proper training in order to distinguish poor from reliable science. In this regard, many believe the best alternative to address the growing escalade of poor science is to implement strategies fostering broad education programs in evidence-based medicine (EBM). This would allow not only readers to better assess the available evidence but also researchers to produce science on better standards.

The idea is that these concepts should be widely available and introduced gradually so that most citizens could understand its basic terms. To address this challenge, distance-learning training programs are being developed in several locations around the world. However, in spite of the possibility of face to face interactions, there are still several pedagogical challenges in order to allow students to develop critical thinking skills in clinical research. Although our experience confirms that most of our challenges are common to any educational program, such as student motivation and engagement, several issues are exclusive to online programs. In the study entitled the “An international web-based clinical research-training program” [1], we describe some of the challenges and successes of a global distance-learning clinical research-training program.

Challenges faced in distance-learning courses

1. Student engagement and motivation
2. Impact of heterogenous audience on learning
3. Learning in large groups
4. Enhancing group learning and social presence
5. Dropouts
6. Quality control
7. Course management

Possible solutions

• Promote more interaction between students to decrease cultural barriers, creating a space to communicate on topics not directly related to the course content.
• Identify individual factors through an initial course survey which could encourage networking and collaborative research partnerships.
• Avoid cognitive overload and ensure to develop a strategy to understand the main motivation of students to take the course.
• Provide easy and constant technical support, defining clear roles and responsibilities for every course staff member.

Distance-learning is an important and accessible method for developing critical thinking skills in research-methodology programs.

References

[1] Suemoto et al., 2015, ‘Five-year review of an international clinical research-training program’, Adv Med Educ Pract. 6: 249-257.

Conflict of interest statement: None to declare.

Biography: Augusto Cesar Soares dos Santos Jr is a 2019 Building Capacity Bursary recipient to attend EBMLive. He is a Nephrologist with a PhD in Health Sciences, currently based at the Hospital das Clínicas Ebserh, Universidade Federal de Minas Gerais, Brazil. His research involves the use of “real-world” and big-data for Health Technology Assessment (HTA), disinvestment from low-value health technologies, patient involvement with HTA and artificial intelligence in the process of decision making under “uncertainty”.

“If physicians are to represent their patients’ interests in the new medical marketplace, they should have no economic conflict of interest and therefore no pecuniary association with the medical-industrial complex.”¹
Arnold S. Relman, MD

There is an extant belief in the biomedical research community that financial relationships with for-profit pharmaceutical companies are to be encouraged, since such relationships represent “confluences” of interest². That is to say, close financial relationships with industry are in the best interest of patients, since the exchange of medical knowledge for financial compensation advances patient care.

One can imagine ways that a physician may work closely with industry while maintaining ideological integrity. However, several data points suggest that true “confluences” of interest — cases where financial relationships with industry exist, but patient care is not affected —  are rare. First, regarding the published literature, several systematic reviews have demonstrated that industry sponsorship of medical studies and pro-industry conclusions are strongly associated^3,4. One common critique of these findings is that industry sponsors are known to selectively publish studies on the basis of statistical significance⁵, begging the question of why physician-authors would consent to provide expert medical knowledge to companies who do not publish in the best interest of patients. Second, regarding individual prescribing practices, it is now well known that receipt of industry payments^6–9 results in the prescription of the sponsor’s drugs, many of which are costly with uncertain benefit or known harms. Even relationships as seemingly trivial as meals¹⁰ have been shown to increase prescription of brand-name drugs.

Therefore, it is my hope to impart my personal charge to other evidence-based scientists who recognize that “confluences” of interest are largely based in fiction. I have charged myself, as a prospective physician-researcher, to reject personal industry payments and continue advocating for representation of conflict-free physicians on guideline panels, clinical trials, and editorial boards. The presence of for-profit companies in biomedical research is unlikely to fade, but physicians that serve only one master — patients — may continue to rise.

References

1. Relman AS. The New Medical-Industrial Complex. New England Journal of Medicine. 1980;303(17):963-970. doi:10.1056/nejm198010233031703
2. Cappola AR, FitzGerald GA. Confluence, Not Conflict of Interest: Name Change Necessary. JAMA. 2015;314(17):1791-1792.
3. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2017;2:MR000033.
4. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA. 2003;289(4):454-465.
5. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008;358(3):252-260.
6. Singh P, Forman H, Adamson AS, et al. Impact of Industry Payments on Prescribing Patterns for Tumor Necrosis Factor Inhibitors Among Medicare Beneficiaries. J Gen Intern Med. 2019;34(2):176-178.
7. Sharma M, Vadhariya A, Johnson ML, Marcum ZA, Holmes HM. Association between industry payments and prescribing costly medications: an observational study using open payments and medicare part D data. BMC Health Serv Res. 2018;18(1):236.
8. Mitchell AP, Winn AN, Dusetzina SB. Pharmaceutical Industry Payments and Oncologists’ Selection of Targeted Cancer Therapies in Medicare Beneficiaries. JAMA Intern Med. April 2018. doi:10.1001/jamainternmed.2018.0776
9. Fleischman W, Agrawal S, Gross CP, Ross JS. Association of Pharmaceutical Manufacturer Payments to Physicians and Prescribing Dosage of Opioids. J Gen Intern Med. April 2019. doi:10.1007/s11606-019-04897-9
10. DeJong C, Aguilar T, Tseng C-W, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. 2016;176(8):1114-1122.

Conflict of interest statement: Mr. Wayant has no conflicts of interest.

Biography: Mr. Wayant is a 2019 Doug Altman Scholarship recipient and a dual-degree DO/PhD student at Oklahoma State University Center for Health Sciences in Tulsa, Oklahoma, USA.  His research explores how bias, poor methods, and poor reporting may affect study medical research conclusions, interpretations, and applications. Clinically, Mr. Wayant is interested in hematology/oncology.

Increase the systematic use of existing evidence

Chairs: Kamal R. Mahtani and Tom Jefferson

Systematic reviews play a vital role in supporting healthcare decision making as well as reducing research waste.  This view is increasingly being recognised by those that benefit from the outputs of this type of research. However, despite all these opportunities, there are systemic failings with the publishing, reporting, and interpretation of much of the evidence base, which undermines the findings of systematic reviews. Furthermore, complex clinical and policy questions often require the use of multiple data sources, viewed through different lenses and incorporating more advanced evidence synthesis methodology.

At EBMLive 2019, we will review some of the benefits, challenges and future perspectives to support the increased and systematic use of existing evidence. Day 1 of the programme will include talks from global leaders in the field, including Andrea Tricco, Gerald Gartlehner and Ruth Garside.

Day 1 will also include several workshops including one led by Jon Brassey, Director of the Trip Database. Jon will provide the audience with his perspectives on finding better evidence in the digital world. Other workshops include “Stakeholder Engagement in Systematic Reviews”; “Refining the E in EBM: developing better evidence” and “Improving the Reporting and Assessment of Harms”.

The event will be essential to anyone interested in ensuring evidence users have systematic access to the best available evidence.
Day Rates are available

Adding capacity, for future leaders in EBM is core to the mission of EBMLive. In 2016, we started by giving the top five trainee submissions free admission and publishing their articles in the Student BMJ. We also hosted a Future Leader’s Showcase and a networking session to create a formalised network of future leaders in EBM. After much reflection, brainstorming, research and with the publication of the EBM Manifesto for Better Healthcare, we refreshed our initiative to support the next generation. This initiative is strengthening scholarship opportunities and events for future leaders at EBMLive.    

The 2019 conference marks the inaugural launch of the Doug Altman Scholarship, honouring the legacy of Doug, a world-leading authority on the execution and reporting of health research, a tireless advocate of EBM and a great supporter of the EBMLive conference (check out the video below). Eight early-mid career researchers are receiving support to travel across the world to attend and present at EBMLive in July.

Adding capacity globally is a core commitment of EBMLive and the Manifesto for Better Healthcare. This year we launch the first Building Capacity Bursaries to eight individuals from low- and middle-income countries. Sir Iain Chalmers, founder of the Cochrane Collaboration, Honorary Fellow of the CEBM, and a staunch advocate of evidence in healthcare will be a mentor to awardees during EBMLive.

We’ve revamped the programme to appeal to students, junior doctors and early-mid career researchers. Beyond participating in the launch of the Doug Altman Scholarship, networking with other early-mid career researchers, and leaders in EBM, there are now several additional events focused on future leaders:

1. Evidence in the Pub. This ice-breaker event is on the eve of EBMLive 2019 (Sunday, 14 July). Organised in a quintessential Oxford pub, this event allows conference attendees and future leaders to network, and stimulate discussion before the big programme of all things EBM begins.
2. Breakfast session on leadership. Associate Professor Kamal Mantani, who has written extensively on mentorship, is developing a session tailored to early-mid career researchers on leadership and mentorship (Tuesday, 16 July).
3. Breakfast session on career journeys. We are continuing our popular and engaging session where academics present “One paper that changed my career” to reflect on important studies that influenced their career (Wednesday, 17 July).
4. Doug Altman Scholarship presentations. During the first two days (15-16 July), we will hear from the eight Doug Altman Scholarship recipients. They will propose creative, innovative and unique ideas to address an issue of research quality and integrity set out in the EBM manifesto.
5. Rapid fire and poster sessions from the Building Capacity Bursary recipients. Each of the eight Building Capacity Bursary recipients from low- or middle-income countries will similarly propose how to address the themes of research quality and integrity through a poster or rapid fire session during the conference.

Beyond the jam-packed academic sessions and networking opportunities, there are multiple reasons to visit Oxford, including the conference Dinner at a historic Oxford College, Keble.

Students, junior doctors and early-mid career researchers can sign up at the discounted rate here.

For those who can’t be there in person, join us on Twitter (#EBMLive2019), listen out for the podcasts and coverage in the BMJ Evidence-Based Medicine journal.

We hope to see you in Oxford in July!

Authored by

Georgia Richards is a Doctor of Philosophy (DPhil/PhD) student in the Centre for Evidence-Based Medicine at the University of Oxford. GR is funded by the National Institute for Health Research School for Primary Care Research Doctoral Studentship, the Naji Foundation and the Rotary Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GR is on the 2019 EBMLive steering committee.

Peter Gill is a staff pediatrician at the Hospital for Sick Children at the University of Toronto, Honorary Fellow at the Centre of Evidence-Based Medicine. He is on the CMAJ Editorial Advisory Board and on the Institute Advisory Board for the CIHR Institute of Human Development, Child and Youth Health (IHDCYH) where he has expenses reimbursed to attend meetings. He is on the editorial board of BMJ Evidence-Based Medicine and the 2019 EBMLive steering committee.

The early-mid career representatives of the 2019 EBMLive Organising Committee.
Follow us on Twitter –  @Richards_G_C and @peterjgill

In February 2019, we announced the creation of a Doug Altman Scholarship to commemorate Doug Altman’s contributions to medical research and to support aspiring leaders of evidence-based medicine (EBM).

The call for submissions was highly competitive, with entries from 26 countries around the globe, and we were overwhelmed by the quality of submissions received.

Through the generous support of the McCall McBain Foundation and due to the high quality of submissions,  it is with great pleasure that the EBMLive Organising Committee can reveal that 16 awards will be issued to early-mid career researchers to attend EBMLive in 2019. Eight Doug Altman Scholarships have been awarded to the top eight submissions to support travel, accommodation and registrations fees. And, a further eight applicants have been awarded our inaugural Building Capacity Bursary to support travel, accommodation and registration for students, early-mid career researchers and clinicians from low and middle-income countries. This is an exciting new initiative that contributes to our aim of adding capacity to EBM globally.

The inaugural Doug Altman Award will be announced on the final afternoon of EBMLive. The award will be presented to one of the eight shortlisted Doug Altman Scholars that demonstrate a strong potential for leadership in EBM, and who actively engages and contributes throughout the conference.

Stay tuned for more news on the dedicated social events and sessions for students, early-mid career researchers and clinicians in the 2019 EBMLive programme.

Authored by Georgia Richards and Peter Gill – the early-mid career representatives of the 2019 EBMLive Organising Committee.

What should we do about the conflicts of interest in medicine? Innovation has meant an open door to conflicted clinicians invested in the development of drugs, devices and technologies. The fragmentation and commercialisation of healthcare systems have accompanied conflicted commissioning decisions, distorted guidelines and created perverse incentives with poor or absent testing. The rush of drugs and devices to the market has created an evidence void and consequently not protected patients.

In 2005, the House of Commons Health Committee recommended that registers of conflicts of interests should be held by professional regulators and updated by registrants. This has not happened.  We now practice in a lax liberal environment with confusing, multiple partial or complete declarations of interest on temporary websites, and no clear definition of what a conflict of interest is, leading some to deny they exist and others to disagree that they do. The current state of conflicted affairs in medicine cannot persist.

Some breakthroughs have occurred: Great Ormond Street Hospital, for instance, now excludes those with a “significant” investment in a product from being in charge of its evaluation. John Hopkins University prohibits researchers with equity or IP from being the trial investigator in their technologies unless the research cannot progress without them.  The US Sunshine Act ensures payments over $5000 to US doctors are disclosed

These breakthroughs in transparency and disclosure are, however, few: in many cases, attempts to reduce conflicts have been inadequate, poorly policed and not delivered benefits beyond providing academics with adequate cover to hide them from the real truth.

Not all conflicts are avoidable and not all bad: intellectual conflicts are hard to avoid, and technological discoveries can create individuals and institutions with academic and commercial conflicts that do benefit patients and society.

There are multiple questions about how to improve practice: should doctors with commercial interests lead research on their products? Should we forget the term ‘conflict’ and start discussing ‘declarations of interest’ instead?  Who should hold and maintain conflicts of interest registers for doctors? Should practicing doctors work with the pharma industry as well as serve on guideline committees? Should researchers with extensive financial interests be disqualified from studies of their own products?

At EBMLive 2019, we will review the history of a conflict of interest; discuss how to reduce Questionable Research Practices, Bias, and Conflicts of Interests and Develop a conflict of interest statement in research

Prior to EBMLive, we want your help in providing a road map for a conflict of interest statement in research

Tell us your thoughts on the EBMLIVE COI questionnaire

During EBMLive we’d like you to participate in the debate to reduce conflicts – or declarations – of interest and develop a conflict of interest statement in research.

After EBMLive we’d like you to help in disseminating the statement in research and resolve the conflicts in medicine for better healthcare for all.

Carl Heneghan  has received expenses and fees for his media work (including payments from BBC Radio 4 Inside Health). He has received expenses from the WHO, FDA, and holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR BRC Oxford and the WHO. He has received financial remuneration from an asbestos case and given free legal advice on mesh cases. On occasion, he receives expenses for teaching EBM and is also paid for his GP work in NHS out of hours.  He is Director of CEBM, which jointly runs the EvidenceLive Conference with the BMJ and the Overdiagnosis Conference with international partners, based on a  non-profit making model. He is Editor in Chief of BMJ EBM and an NIHR Senior Investigator.

Margaret McCartney is a GP partner and senior Fellow for Evidence and Values at the RCGP. She is an author, freelance writer and broadcaster for the lay and medical press and the BBC. She is an honorary Fellow at the CEBM. She gives a small amount of money regularly to Keep Our NHS Public. She has had travel and occasionally locum expenses paid to give talks to healthcare professionals and the public but has never been hosted by a technology/pharmaceutical/PR company. Her DOI is at whopaysthisdoctor.org.uk

The practice of evidence based medicine (EBM) involves the judicious use of the best available evidence to inform decisions that lead to better care. By seeking, synthesising and summarising all available studies on a given topic, systematic reviews play a vital part in contributing to this process.

Systematic reviews can also reduce waste. By ensuring that new research should not be undertaken before a systematic assessment of what is already known or being researched. Unnecessary research not only wastes resources but, more importantly, could harm patients.

Many governments and international organisations recognise the influence that systematic reviews can have on informing healthcare decision making. The UK government, for example, provides core funding, via the National Institute for Health Research (NIHR), to a dedicated, systematic reviews programme. In the USA, the Agency for Healthcare Research and Quality (AHRQ) have a dedicated programme to produce systematically derived  evidence based reports. While the World Health Organisation (WHO) have a dedicated guide on how evidence synthesis can be used to support global health policy.

However, despite all these opportunities, there are systemic failings with the publishing, reporting, and interpretation of much of the evidence base, which undermines the findings of systematic reviews. Furthermore, complex clinical and policy questions often require the use of multiple data sources, viewed through different lenses and incorporating more advanced evidence synthesis methodology.

At EBMLive 2019, we will review some of the benefits, challenges and future perspectives to support the increased and systematic use of existing evidence. Day 1 of the programme will begin with talks from three global leaders in the field starting with Andrea Tricco who is the Director of the Knowledge Synthesis Team Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Canada. You will also hear from Gerald Gartlehner head of the Department for Evidence-based Medicine and Clinical Epidemiology at Danube University, Krems, Austria. And from Ruth Garside who has been supporting evidence synthesis for national and international policymaking for over a decade.

Day 1 will also include a workshop led by Jon Brassey, Director of the Trip Database. Trip is the internet’s leading tool for finding evidence fast. It’s free, has a global following and has been searched over 100 million times. Jon will provide the audience with his perspectives on finding better evidence in the digital world.

Many parallel workshops will also be part of Day 1 including “Stakeholder Engagement in Systematic Reviews”; “Refining the E in EBM: developing better evidence” and “Improving the Reporting and Assessment of Harms”.

There is more. But rather than tell you about it, why don’t you come and join us at EBMLive19? If you have an interest and passion for better health care, you won’t regret it.

Kamal R Mahtani is a GP and Deputy Director of the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. He is also an Associate Editor at the BMJ Evidence-Based Medicine journal and Director of The Evidence-based Healthcare MSc in Systematic Reviews. You can follow him on Twitter @krmahtani

Competing interests: KM receives funding from the NHS NIHR SPCR Evidence Synthesis Working Group and the NIHR Health Technology Assessment programme.