A provocative set of critiques has been published in Lancet at the outset of 2014 asking---how should medical science change? The problem identified is that existing systems established to assure the quality of science are not performing well enough. The issue can be framed as one of waste, according to Lancet. The current system results in wrong questions being asked by scientists, poor study designs being applied, research that is inaccessible, and findings distorted by selective reporting and other biases, says the Journal.

According to Yale epidemiologist Michael Bracken, one of the authors of the series, “while the biomedical research community currently provides a huge amount of benefit to society, it does so in spite of the present high degree of wasted research, [and] this series documents how much more could be accomplished if we substantially improved the efficiency of the research enterprise.” A 2009 report in the Lancet estimated that an astonishing 85% of the research investment in 2010 amounting to $200 billion was wasted.

Discussion Called For

The Lancet calls for a discussion not only in the Journal but at conferences and other venues. Put succinctly, the question on the table is—how should the entire scientific enterprise change to produce reliable and accessible evidence that addresses the challenges faced by society and the individuals who make up those societies?

Framework

The Lancet series offers a framework to understand the current state of science by noting that political, social, cultural, and economic conditions operate on all of the actors in the enterprise to produce the current situation. These actors, exposed to the various conditions, are driven or choose to act based on their own physical and intellectual abilities, the external opportunities that present themselves, and the motivations or incentives available to energize their behavior, according to Lancet. Changing the system will require altering the determinative conditions and/or drivers.

5 Questions

The Lancet series begins with a series of five articles each seeking to address a specific question. They are:

1. Are research decisions based on questions relevant to users of research?

2. Are appropriate research designs, methods, and analyses used?

3. Is the regulation and management of research efficient?

4. Is research information fully accessible?

5. Are unbiased and usable research reports being produced?

For answers to these questions, see the January 8 2014 online issue of The Lancet.

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