Well, thank you very much for coming in tonight. We have a treat.
We have one of the treasures of Britain, the treasure.
Something that's hard to got me, who is editor in chief of the BMJ.
I think it's actually pretty correct.
I first met Fiona 25 years ago for years.
But one of the characters who was there was the headline, The Fierce Criticism of the Richest Man,
one of the most charismatic, interesting people that you could ever meet.
And we were in a in a consensus of people looking at peer review, and it was called Loch Ness.
And that's where I met people. They got interested in their view. Within a few things together.
And ever since then, she has just grown and grown and grown.
And I think that the most important thing that she has done to fund my personal opinion as editor
in chief of the BMJ open and and follows in the footsteps of one of the great predecessors,
Hugh Clegg, who grocery Hugh Clegg once said if something is in the public interest, it should be in the public domain and it should be kept there.
And that's exactly what Fiona has done. So Lindsey Graham on the ongoing.
Thank you very much. Good luck saying that Tom has been an enormous influence on my life.
This is quirky. You had a small room. And so I can as have other people in this room and all of us in our careers.
You don't necessarily know where you're heading. And certainly I didn't.
And a lot of the directions you take are down to the people you meet and people
you learn to admire and the people who who welcome you into their world.
And Ian is one of the many people around the world, and Tom will certainly be one of those and who has taken us,
I think, to the edge of our own sanity and our own ability to respond to the demands of the work involved.
And Tom has been a real a real exemplar of of devotion to this important cause.
So I'm very honoured to be with you today. I thought it might be useful to let you know the BMJ very well.
Just to give you a quick discussion, overview about the BMJ has been around for a long time.
It's changed a lot in the last nearly 200 years, 118 90 years.
We have a mission as anyone would expect. We want to be the world's most influential medical journal.
We may not be the biggest or the most the highest impact factor,
but we do want to change things and we want to be the change we want to see in the world.
And we believe in integrity, independence, partnership with patients evidence base, answering questions and questioning answers.
So this is the kind of sceptical core within the BMJ team.
We want to challenge the status quo and we have begun increasingly to campaign and our aim is to do that in the public interest.
So although we are owned by a medical doctors organisation, we do not speak for doctors, we speak in the public interest.
We have a number of tools at our disposal,
so we have at our disposal a number of tools to try to do what we aim to do in a lot of top your research education using these campaigns.
And just on the research front, our research is open access, open peer reviewed,
and we try and increase it in comment opinion and also increasingly individual summaries.
And this is one of the ones particularly proud of. We've got metastatic capital.
Will Star Timmins who does these infographics. It's it's a complex issue called a graphical user evidence reviews.
And the idea is that one would eventually be able to slot in data information from individual trials and participant characteristics,
study quality, study findings.
So it's a kind of way of displaying complex data which you might like to look at that could go for graphical and evidence reviews.
So on the research front, we still think there's a way to go to improve the presentation.
But on the campaign front, we have become, as I said, a campaigning journal and the sort of permission,
if you like, historically for us to do this stems back to the editor in the Victorian age, Ernest Hart,
who in the in those days babies were being it is different babies were being farmed out to so-called foster parents who were being
paid for taking on board these babies that in fact were just leaving them out in the cold and killing them or letting them die.
And it was a big issue in Victorian England and that is half of the editor of the BMJ thought that it was something the BMJ should have a view on,
and he advertised in some newspapers as a pretend father of an illegitimate child in
order to attract these foster parents and to identify what was going on with it.
And as Tom says, that permission to campaign continues through into the forties and fifties and sixties, through through Hugh Clegg,
who is the grandfather of Nick Clegg, who said this a subject that needs reform to be kept before the public until it demands reform.
So this is our in our DNA, we feel and it gives us permission to do things that other journals may not want,
people may not feel they have permission to do. I mentioned the campaigns.
You'll see at the top that a glance, better evidence is the one I'm going to be talking about in relation to the what you are all doing.
So why do we need better evidence?
Well, Doug Altman, in a really iconic editorial back in 1994, talked about the scandal of poor medical research.
And in it he said, what should we think about a doctor who uses the wrong treatment,
either wilfully or through ignorance, or he uses the right treatment wrongly?
Most people would agree that such behaviour is unprofessional, arguably unethical and certainly unacceptable.
What then should we think about researchers who use the wrong techniques, either wilfully or they don't use the right techniques wrongly,
misinterpret the results, report their results selectively, cite the literature selectively, and draw conclusions, unjustified conclusions.
We should be appalled. And it was.
We need better evidence that the evidence and evidence for the right reason to research or best research and research for the right reasons.
And these were some of the problems with the evidence that Doug identified and some others have identified,
adding to those asking the wrong questions, not involving patients from techniques, wrong analysis, misinterpretation of results,
manipulation to get the desired answer, overstating the conclusions.
Selective reporting of benefits and harms. Poor Quality Peer Review.
These are additional to some of the things that dog identified.
Lack of engagement with Post-publication peer review is an issue that we as editors fret about.
So once you published your work, do you engage with the reader if they criticise you?
Hidden data. I'll talk more about that. Financial and academic vested interests, positive publication, bias, fabrication,
falsification and plagiarism, which is the standard definition of fraud and regulatory failure.
And the reason these are worry is because they cause research, waste and clinical harm.
And in and Glasgow Publishing in The Lancet in 2009 and subsequently have looked at the for and possibly more before
in this article stages of research and the result of these different types of waste leads in their estimates.
85% of research effort wasted over a billion hundred billion dollars of research funding per year or research effort per year.
So this is a major problem with this research being done that is not achieving what we would all wish it could achieve.
And just to talk about hidden data, this is a again,
what I would consider an iconic piece of work published in the BMJ in 2010
about the drug war boxer team and these authors who basically quit in Germany,
which is the the German equivalent of Nice, were asked whether they should fund or provide insurance.
In Germany, the drug were boxed on the public purse and they felt sure that there was data that they were not being shown.
So they asked the manufacturer for the data. And Pfizer, who produced this drug, which is an antidepressant, it was being used as such,
said that they had provided all the data and they said, well, you clearly haven't.
We've got we're aware that you haven't.
And eventually they persuaded Pfizer by saying that if you don't give us your data, we won't allow your drug to be made available on health insurance.
So Pfizer presented them with the data and it turned out that three quarters of it had never been published before.
And when these authors did the review of the effect of combining the public and the unpublished data, you can see the results.
So in each case we've got remission published unpublished total, published unpublished total.
And then here the reverse is the withdrawal of adverse effects.
So published a nice result,
but boxing better unpublished no result total no effect response same again and then withdrew the reverse to the adverse effects.
So no difference in the published data but with the unpublished data and because the combined drug is only ineffective but also harmful.
So this is, I think, an example beautifully illustrated of of a problem that we know to be pretty endemic throughout clinical trials,
but also specifically in industry funded trials.
So the idea of simply doing a meta analysis based on the published results is obviously long gone as something we should accept.
But I think often there's much more hidden data.
Even if you start trying to look, we don't really take this out a great deal.
I was very fascinated about this case because it turned out when it was published that this
drug had been used in animal studies because it was thought to be so effective in humans.
It was used as animal studies for the animal model for antidepressants.
So the way they test it is whether the rat struggles or whether it swims a swim test in a struggle test if you hold the rat by its tail.
And when these data come out, the animal models have had to change the drug that they use because in reverse,
you mean it's not really transferable to humans? So now for the story that most changed my mind or mind,
the way my brain worked or majorly increased my scepticism about the value of published evidence is the story of Tamiflu.
And this goes back to 2008, 2009, when there was suddenly a huge fear that we were going to be overwhelmed by swine flu,
and governments around the world were being encouraged to stockpile as well.
Time of Tamiflu.
And the UK Government asked the Cochrane Collaboration to update its review on Tamiflu to see if it was still there was any new evidence to include.
I'm sitting here with Tom Hager, with my parents, the.
My version of events may be slightly different. You have the time, but as I understand it,
the Japanese paediatricians contacted the Cochrane Group to say understanding they were about to review and renew their update,
their review to ask them if they had been really appreciative of the fact that
of the ten trials that had been used in that earlier review of the data,
all of them had been funded or performed by Roche employees and only two of them had ever been published in a journal.
The other eight had been in abstracts only. So this prompted Tom and his colleagues to think, goodness, we ought to look a bit more at this.
So the first step was to speak to the systematic review who had reviewed these trials to ask him if he had the data.
He said he didn't. So they then went to the individual trials. Did they have the data?
They didn't. They said that Tom and his colleagues would have to go to Rush to get the data.
The drug company had the data. So Tom started the long journey of trying to get the data from the manufacturer.
And at some point in this proceedings early on, I think he asked if we might help and it seemed an important thing to do.
So the BMJ joined forces with Cochrane to try to get hold of the data and so ensued a lengthy, very, very exciting, interesting.
But certainly for Tom, a huge amount of work for us, a very exciting journey to try and find the truth about Tamiflu.
And on the way we described what we were doing.
So this is an article by Deborah Cohen, who is then our investigations editor,
about the Cochrane's attempt to reproduce an analysis underpinning the use of virtual cannabis.
So the Lancet review published prior to this had concluded that Tamiflu did reduce your
risk of complications and ending up in hospital if you had an influenza like illness.
And the Cochrane really were looking to confirm that.
But at some point in the in the process they set themselves a deadline and said if we don't have the data by that date,
we will publish an updated review which basically says we do not know, we cannot tell.
Having said that, we knew we now know that we don't know and we're not going to make any conclusions.
So this was the story of that approach and an excellent article by Tom's collaborator, Peter Doshi, who's now an associate editor on the BMJ,
looking at the story behind this this Cochrane Review that had concluded that we could not say and what's rather marvellous to have got to see it.
But inside that article obviously is this box with these two columns about whether
or not the drug works for complications to prevent complications of influenza.
And these are the people who say it does work and these are the people who say it doesn't work.
So in this column you've got on the good work side, you've got Kaiser, you've got who's the systematic review,
you've got the European medicines, you've got CDC in America, you've got Australia.
And on the side that it doesn't work.
You've got the US FDA disagreeing with the CDC, you've got Japan and Canada, but at the very top you've got good.
I thought you'll see that both of these top Roche.
So Roche on the one hand says it does recommendations and on the other hand it says it doesn't work complications.
And if you go to this website, it says this website is intended only for Americans.
So you've got an extraordinary situation. I mean, this is awful.
But this this is this is where things stood.
And I guess this is where things stand for quite a few drugs. If only we were to look.
So at the time we wrote an editorial in the Journal saying it is a legitimate scientific concern that data used to support important
public health policy decisions held only by commercial companies and have not been subject to independent external scrutiny.
And we started what became our third campaign with Tamiflu as our poster child and started doing things like writing open letters to Roche.
This one in particular is to John Bell, based in Oxford, which I had a great deal of help writing.
I can't promise I went to work, but I did sign it.
And it's really saying you, John Bell, as a member of Roche's commercial board, not the scientific advisory board, but he's on that commercial board.
I don't know if he still is.
He's he's one of the top doctors in the country, the regents professor of medicine at Oxford, and he's on Russia's commercial board.
So, I mean, in itself is pretty shocking. But the fact that he's on Russia's border and Russia's behaving like this seems doubly shocking.
And we wrote this letter presenting him with the fact that if he were whether or not he replied, we would publish it.
We would prefer to publish it with his reply. He wrote me a very brief email in response, saying, Is this really what we've got to do?
Which I. I didn't know whether I said that. John Bell has responded, saying that he has referred the letter to Roche.
So we did get the reply, but nothing publicly.
This was one of many open letters and also on our website a whole trail of correspondence that Tom and Peter Doshi managed between them and the CDC,
W.H.O., the FDA, a whole host of regulatory and other bodies asking them and of course, Roche asking them to release the data.
They did release the data and this is just a sign that we did get quite enough news coverage and there should be a picture here of Tom.
But I don't know if you can kind of. Kim Kardashian.
But this has been documented and we got very good wide coverage of the final result, which was that when the data arrived,
eventually just on some disks, having been told it was an enormous confidentiality and all sorts of reasons why they couldn't share the data.
And Tom and his team analysed the data, found that there was very little evidence of benefit that it had never been compared with placebo,
saw it with paracetamol, the alternative influenza perhaps, and also that there were harms that had not been previously reported.
So what did the Tamiflu saga do?
We found that a vast amount of money had been spent. Poland was only countries that didn't stockpile the drug.
I think they took a look at the evidence and thought it wasn't very sound.
But in the UK, I'm going to get this figure right, 500 million if I got that right pound, which is half of a percent of the NHS.
Total annual budget was spent on Tamiflu and they then renewed that with 50 million subsequent to that.
So and stockpiling of the drugs sitting in, in warehouses properly used at various points,
we, I mean it was a number of different pieces to this investigation.
And I suppose the question we have to ask ourselves and Tom would be the best
is to tell us this is have we really achieved is it really achieve anything,
concrete things? Tamiflu came off the essential drug, the subject of central drug list.
I think I think governments around the world did get a certain message.
It was a great backlash from Roche. There was a whole saga about observational studies being better than trials.
In this context, Carl and I appeared in front of the Public Accounts Committee where they had a very good discussion.
And Sally DAVIES, the chief medical officer, obfuscated in a way that did not make me proud of our civil service.
And that was that was the sort of the end of that saga.
But Tamiflu is still out there, and I'm sure it has yet to.
I mean, it will rear itself again. It will be found to be, you know, necessary or needed in some way.
And so I think the most important thing was not about Tamiflu.
That that is that is one area.
The most important thing that it did was to show us what is needed if you really want to get the truth about a single drug.
And I think I'm right in saying, Tom, it was the first, but it was the first real knowledge that was gained about CSL clinical study
reports that prior to that we hadn't really understood the what they were,
how they were kept, who had them, what they would show us.
And so I feel it's been the sort of progenitor of a whole, whole new discipline, which is this much more in-depth,
systematic reviewing that we are going to need to do if unless we move into a whole new era of transparency,
where these things on the table and we began to sort of look more generally at the whole question of hidden data.
And this is an editorial from Elizabeth Loder and Richard Lehmann.
There is an Alice in Wonderland feel to these investigators searching over Hillandale and among the paperwork of regulatory
bodies and drug companies to put together pieces of data that should have been freely available in the first place.
So the question is, why are these data not available in the first place?
What how have we got to a situation where it takes all this absurd effort and and and that's just on one drug.
And we did a number of collections of articles where we asked people externally to send us studies,
research and commentary and narrative and review on the issue of hidden data and what we could do to bring these data to the fore.
And also discussions about what we mean by data and how we manage confidentiality and anonymization,
which are all issues that are still, still ongoing. And we published an editorial looking at what we would do.
The Journal Because I'm always very keen, I think I showed you the mission statement beginning that we want to walk the walk.
It's very easy for journal editors to sort of just go around, say everyone should be better and and do better with you guys.
But we always would like, where possible, to do something ourselves to show that we have skin in the game.
And for us, this was that we would start requiring, if people wanted to publish a clinical trial with us,
that they had to commit to sharing their data on reasonable request.
Now, arguably, it's not much of a problem for us because we don't get nearly the same number of clinical trials sent to us as Lancet in JAMA,
a New England Journal, the other big journals. And so we're less reliant on this kind of type of article.
So if people suddenly decided to stop sending us stuff because of this requirement.
We would not it wouldn't, you know, we wouldn't have great holes in our reprint revenue or, you know,
the money that comes into journals to set of clinical trial reprints wouldn't have been so.
So, I mean, I say this because that's been the pushback kind of said I wrote easy enough for the BMJ.
But actually what's happened is we haven't seen a drop off in our trials and that maybe because we don't publish many industry trials,
but but we have found that people seem to be willing to do this. And I think there is beginning to be a shift in the culture.
And the other thing that came out of this, I think, which was brewing in the background and because of Peter Doshi connection with the Journal and
because of the work that he and others had done and done with them on Tamiflu and calm as well.
And the whole sort of bubbling up under the surface was this new initiative called Restoring Invisible and Abandoned Trials or Riot.
And this front cover, which is where we launched the initiative in the Journal, is really just showing that,
you know, you've got you've got the public trial like a proud flag on top of the iceberg.
And everyone thinks that the totality of the evidence base, but underneath the water is this massive other hidden iceberg.
And here we all are trying to look for evidence,
trying to work out what's going on in his Tom Jefferson and Peter Doshi and others trying to look at the underbelly of the evidence base.
And this, I think, is a really exciting initiative.
And the idea is that where trials have been done and either badly reported, misreported or not reported,
that these that this initiative can step into into play and that the original authors are given an
opportunity to re draft their own work or to draft it in the first place if they haven't done that.
But if they if they either say they haven't got the time or energy or didn't want to do it,
or if they don't reply after a certain period, the idea is that others can then step in and do this.
And we as a journal committed to publishing the results of those reanalysis in the same way we would as an original analysis of the original research.
And the famous case that we knew was in the background was the case across the GlaxoSmithKline trial into antidepressants in teenagers,
which had already been a subject of a lot of concern and public display about
suicidal ideation and self-harm and in children who were taking paroxetine.
So study 3 to 9 was already in the in the aether is something that had been proven to have been
ghostwritten by an industry funded author and was already the subject of a vast legal case in America.
And GSK was fined a large amount of money for wrongfully marketing this drug in this case.
So there was a lot of activity around this drug.
And and because the files because of the legal case that the data were available to it
to be reanalysed and the authors who wanted to do that took it took on the analysis.
It was a vast piece of work for them,
and it was also a vast piece of work for my colleagues at the BMJ to make sure that we were already right about this,
that one of the problems was that the authors themselves had been expert witnesses in this legal case,
and so were considered to some extent to have them potentially not malicious, but at a certain angle on these data.
And so we insisted that the authors introduce an independent review, separate to them, which caused another full saga of delay.
But the data, certainly in terms of the adverse effects of this drug in teenagers, seemed to be quite compelling.
So here is the original paper published still not retracted of the ghostwritten industry funded report.
And these are adverse effects with Broxton, imipramine and placebo.
And so a few, a few suicidal and self-injurious events in the peroxide group, but not vastly different to imipramine.
And then in the SmithKline Beecham, which is the GSK analysis, then you can see rather more suicidal ideation and events in the APA group.
And then this is the right response to a trial which found additional, definitely possible suicide in the jurors events.
So this this seemed to be an important contribution to the role of hidden data in distorting things.
So we published the restored trial and I think again, that has been quite an iconic contribution to the whole debate.
So we now move to our own where we want to take it from here.
And working with Karl and his unit in Oxford, we've produced an evidence manifesto which is looking to improve the development dissemination,
implementation of research, evidence for better health. And so I'll just say what that says.
We believe that the design conduct, quoting healthcare research should be better serve the needs of patients and the public.
Better evidence leads to better healthcare. And we have here four things that we are aiming to do which have come out of the evidence manifesto,
how we want to expand the role of patients and other users in research, in healthcare.
We want to increase the systematic use of existing evidence for better decision making.
We want to make research evidence relevant, replicable, accessible to healthcare professionals, patients, and.
And to take a stand on financial interests by reducing questionable research practices.
And that last thing is something I haven't talked a lot about,
but we've got a big push at the Journal to move towards more independent research and to try to remove the clear,
irreducible conflict of interest that commercial players have in in designing
and performing and reporting their own evaluations of their own products.
So this is a better evidence campaign,
and I've talked a bit about some of this is on this is where you'll find is under that
tab on the website I've mentioned in and Paul's work on 85% of research going to waste.
Half of the results from half of all trials never publish positive results.
Twice as likely to be published. Over 4/5 of a sample of Cochrane reviews did not include data on the main harm outcome.
A systematic review of 39 studies found no robust studies evaluating shared decision making strategies.
Is a real absence of the patient voice. The drug industry has been defined for criminal behaviour,
but little happens to prevent such problems occurring again because these fines, although they seem enormous to us,
are just like water off a duck's back for these large corporations, conflicts of interest,
questionable research practices and manipulation of data happening as routine amongst some of these.
So what is the BMJ currently doing? We working with Oxford Medicine on Evidence Live, which is a I think marvellous thing of course,
which is an annual meeting where we get together to discuss some of these issues and try to work out better ways of doing things.
We've launched the Evidence Manifesto, which I think importantly is intended.
Whether we're succeeding or not, we need to keep questioning.
But what was intended as a way of a bottom up?
It's not intended as a kind of we've got the answer.
It's intended to try to get as many people involved in finding solutions to these endemic problems within the evidence base.
And and then we're looking at this data sharing. So this is the sharing of clinical trial data, the storing invisible about the trials.
We've got a number of other initiatives.
We're working hard on patient partnership because we are convinced that actually the very best type of research,
research where patients have been involved from the outset and also potentially even where patients are leading the research.
And there's an initiative hopefully coming soon in Oxford where that patient led research will be the aim in honour of Rosalind Snow,
who was our patient advocate but sadly died a year ago, but maybe two years ago.
She was a Oxford academic and was a terrific advocate for research that involves patients from the outset and is even led by them.
So another number of things financial interest I've mentioned, and then I get to this campaign for the Stefan's data.
So let me tell you, just before I finish down a little saga about Stefan.
Back in 2013, the BMJ published a an analysis which was prompted by the fact that the Oxford Group that pulled together this systematic review,
the trials on staff on statins,
had produced a systematic review which seemed to suggest that as well as statens be useful for people at high risk, people who've had a heart attack,
who had a stroke, people who have a family history and are therefore at high risk of heart disease and cardiovascular disease
cerebrovascular disease that this treatment would also benefit people who have never had a stroke,
never had a heart attack, do not have a family history, are low risk of cardiovascular and cerebrovascular disease.
And this review published in The Lancet led to Cochrane,
its own review coming up with a similar view that actually extending the statins to these low risk people wasn't
was what was needed and subsequently nice clinical guidelines group coming up with the recommendation that yes,
everyone over 50 would benefit from being on a staff and even if they were at low risk of heart come forward 2013
to this time we've just recently had that indeed further evidence suggesting that people over the age of 75,
pretty much everyone over the age 75 should be taking something.
But in 2013 we published this critique which was really just saying the authors of the critique said, We just don't believe this is true.
We've looked at the benefits and it doesn't hold true. And we've also looked at something that the other studies haven't really looked at,
which is the harms, the small incremental, not necessarily life threatening.
But quality of life threatening arms such as muscle, muscle, pain, fatigue, those sort of adverse effects.
So we published this paper and got an immediate complaint from the Oxford Group.
Rory Collins and his colleagues saying that we had made an error, that the paper contained an error,
that the estimate of adverse effects from statens was overstated and this was going to kill people and a real worry that we had got this wrong.
So I invited Rory Collins to write a rapid response, which is the response to everything.
He declined to do that, and over a period of months we were in correspondence.
And then at some point he went to the press and The Guardian published a thing saying The BMJ
publish this terrible thing and people are going to die because they're not on this stuff.
And by which time, I can't remember quite the chronology, but we published a correction of the article and the question was, should it be retracted?
So we got an independent panel to come and assess for us whether we should retract the paper up to period of weeks.
They came to the view that we should didn't we shouldn't do that. So to some extent, it felt like that was the end of the saga.
But I think what had happened in the process was this had begun as a an issue about too much medicine.
Should these people be on this drug? What was the outcome in terms of benefits?
What would the expressed harms of extending this treatment to so many healthy people?
But what it became in the process for me anyway, of this saga, which was very difficult and tricky and lots of people involved,
and had we done it wrong, we got to write that sort of thing, feeling very much under scrutiny.
What what it did for me was it made me realise this wasn't only a too much medicine story,
it was an open data story because I had been completely unaware that this drug which is being
prescribed is the most commonly prescribed prescribed drug in the developed world class of drugs.
The data for those decisions were not available, and I just thought, oh, my goodness, this is it seems completely wrong.
So so I realised I'm showing the wrong slide in telling all this, but okay, I'll go for it.
I've got these in the wrong order.
So as a result of that kind of moment of revelation, for me it became more of a fight for the data and also the sense that this Chinese wall,
which the Oxford Group have created around their data,
where they can all as chartists analyse each other's data, but that no one independent of those triallists is allowed to look at those data seemed,
I think, wrong because there is no external third party scrutiny.
So we began a long attempt to get the data and without much success,
asking the Oxford Group to if they would share, asking individual trials that they would share.
We got some who said they would. In this case we didn't have a Cochrane group.
We didn't have the time, we didn't have a pizza gauci, we didn't have a car.
We didn't have that. We didn't have people who would, if we got the data, take it.
So there was a slightly different feeling about this, but we just thought,
we've got to try and work out where these data are and I'm going in the completely wrong order anyway.
We haven't really done very well.
And so here we are back in now 2019 with these amazing transport systems in the press which are based on another one by the same group,
the city, which seems to leap to quite a strong conclusion that if all these older people took statins, 8000 lives would be saved every year.
And here's an editorial saying You're never too old to stop and treatment.
But it turns out that actually, when you look at what's in the study and I can see this,
that if you go to the study on the editorial that actually in the actual group of people aged over 75,
there is very little evidence in that group and that a lot of this is extrapolation from studies that looked in different age groups.
And statins have not been shown to reduce cardiovascular events in patients with cardiac or renal failure.
Inclusion of older participants with these conditions in the trials might be an explanation for the failure to find a benefit in this group,
which is borne out by an additional round of excluding trials conducted in these people.
So what's been done is they didn't find the result they wanted.
They then excluded people with cardiac or renal failure and found a slightly better result.
And somehow or other that's interpreted the headline of 8000 Lives Saved.
Carl kindly has done a look at the actual actual numbers here.
So the question is, is life saved? A useful way of presenting?
This is very dramatic. It goes for big headlines. But actually what we always say we want to do is to offer the number needed to treat number.
These are. And this was Carl's.
I think it's more work to go looking at the data and finding that in the 75 hours without backing this stuff and do not reduce major
rescue events that the death or death may cause in over 70 years with vascular disease as a small reduction in vascular events.
And so this 8000 lives saved. It's very hard to quite see where that comes from.
And some of the other evidence suggests that actually there is really a great deal of benefit.
So as I say, I'm rambling slightly here.
Stefan's have that effect on me.
What I wanted to try to clarify is that the too much medicine story and the hidden data story are like sister and brother.
That actually when you look at whether it's too much medicine or too often, there's hidden data hiding behind it.
And I think that's what's going on with Stefan's.
And we do want to see the data.
And as part of our campaign, we are now tracking the efforts of Tom and sounds like it sounds like a sort of Arctic Explorer,
tone deaf and focusing on trying to get these clinical study reports.
The thing we found out about because of Tamiflu, about statins to try to understand what is the evidence base.
Can we be sure that large numbers of people in vast amounts of money are involved in this medicalized prevention, when in fact,
we might be better off cleaning up our air, cleaning up our water, heating up our food to create healthier lives rather than putting people on pills.
So you'll see. It says many requests are still pending.
This comes out there writing to various regulatory bodies to try to get these data, but he might be willing to share some of these.
So my final slide is one that Elizabeth Loder sent me, which is about what is what is the BMJ want to be and how we trying to compete,
as I'm sure we are at one level with other journals or as in seven others, do we wish to be anything but Coca-Cola and I think we need.
What we want to be the UN Journal. Thank you very much indeed.