Wednesday, October 03, 2018

Guest Post: Does the BMJ publishing group turn a blind eye to anti-statin, anti-dietary guideline & low-carb promoting editorial bias?

Truth be told, I'm fond of the British Journal of Sports Medicine, but as anyone who reads it knows, it has this strange habit of publishing articles about non-sports related dietary guidelines, the dangers of cholesterol lowering medications, and on the alleged superiority of low-carb diets. That's an odd thing, or maybe it's not, for as today's 4 guest posters (Drs Nicola Guess, Ian Lahart, Duane Mellor, and David Nunan) lay out, it may simply reflect the editor in chief's personal bias. So have a peek at their story, and if while you're reading you're on the fence, ask yourself if it would be odd for the American Journal of Clinical Nutrition to publish ankle sprain treatment guidelines, or if the Journal of the American College of Cardiology published a review of the efficacy of orthotics for plantar fasciitis? And note, at the end of their guest post is a link to an open letter to the BMJ that they've penned, which by following the link, you can also sign.

Scientific journals have the potential to allow researchers to keep up to date with developments in their field, to publish their own research, and to comment on the research and ideas of their peers. Journal editors play a vital role as impartial gatekeepers of this process, and importantly they should ensure their own personal beliefs and prejudices do not impact decisions related to content that is published in their journal.

Here we provide a synopsis of an example of poor gatekeeping we are currently experiencing and how this can skew the scientific discourse in favour of a personal agenda. A full account of this story is available here.

In April 2017, an opinion piece editorial entitled ‘Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions’ was published in the British Journal of Sports Medicine (BJSM), and then repeatedly promoted by the journals Twitter account, which is jointly run by the journal’s Editor in Chief (EIC).* Promotion of an editorial is completely normal—often an EIC will highlight an article or opinion piece that they believe to be of interest. However, it is also normal and expected that the editor acknowledges and welcomes debate and rebuttals from others who disagree with points made in the published article. Two of us (David Nunan and Ian Lahart) emailed the EIC immediately following publication of the original article offering a rebuttal, but received no response. After three months without reply, we published an open rebuttal in PubCommons (latterly Pubpeer) highlighting what we thought were important deficiencies in the original article.

We were surprised to see the EIC tweeting the saturated fat article a year later and stating that ‘importantly’ the editorial had not had any rebuttals. We immediately contacted the EIC again, and after a series of emails received acceptance that our rebuttal would be published in the BJSM.

An important point--one that we believe highlights the bias in gatekeeping at the BJSM—is that the original article was published “open access”, meaning it is was made freely available to academics, public and the media. This is important for openness and access to science, and also allows interested members of public to read articles which frequently are hidden behind a paywall. This of course is good practice. Key here though is that decisions to make articles such as these open access is made entirely by the EIC of the BJSM.

Naturally in the spirit of open debate, we would only consider it reasonable that our rebuttal would be published open access, along with some social media promotion. This way, readers could read both the original article and the rebuttal and consider all the arguments presented. However, we were told by the EIC that our article would not be made available as open access, but that we could instead pay for it (£1,950) to be made free of charge to read.

We were further concerned and surprised when we examined other articles on similar subjects also unrelated to the remit/readership (e.g., dietary guidelines, statins) published in the BJSM. Of 10 such articles, all were open access, they all had narratives that denigrated current dietary guidelines and/or statins and promoted an exclusively low-carb dietary approach. All of the articles were authored by supporters of these narratives, with some writing two or more articles. The EIC, via the BJSM twitter account, has regularly promoted these narratives on social media. Four rebuttals/counter arguments to these articles have been published (including our most recent) – none of these were made available as open access by the EIC. There has also been next to no promotion of these rebuttals via social media from the BJSM twitter account.

Furthermore, during the two-month period we were communicating with the editorial team to have our article published open access, or at the very least a footnote added to state we had been denied free open access (both requests were turned down), the BJSM produced two podcasts from authors of 2 of the 10 free articles, including the one in question here.

To be clear, our rebuttal was not in complete disagreement with all the points made in the original editorial. Our rebuttal was more about using robust methods to emphasize the strength of the evidence and highlighting knowns and unknowns that were overlooked in original editorial. Furthermore, we have healthy disagreements amongst ourselves about the evidence in this field (e.g., dietary guidelines). These disagreements, however, should be debated openly in the scientific literature. The EIC’s role is to facilitate this in an unbiased manner and ensure systems are in place to prevent biases skewing the scientific discourse to the journal’s audience. Imagine if a journal only published and promoted open access articles on the effectiveness of aspirin to prevent heart attacks, yet hid every rebuttal (highlighting potential harms) quietly behind a paywall?

We are concerned about the editorial conduct and procedures of the BJSM. Given the journal is part of the BMJ publishing group (governed by the British Medical Association (BMA)), this also raises questions over governance across over 50 of its journals The BJSM is also co-owned by the British Association of Sports and Exercise Medicine (BASEM). We think this is worth pursuing further and have written an open letter to each of these organizations requesting the issues raised here are looked into.

Our open letter is available for signing (and reading) by clicking here.

[*it would be reasonable to question the fit of such an editorial to the journal’s scope and readership: “…provides original research, reviews and debate relating to clinically-relevant aspects of sport and exercise medicine, including physiotherapy, physical therapy and rehabilitation.”]

Dr Nicola Guess is a lecturer in the Department of Nutritional Sciences at King’s College London in the UK and a Registered Dietitian. Her research interests are on the effect of diet on the pathophysiology of type 2 diabetes. 

Dr. Ian Lahart is a senior lecturer in exercise physiology and researcher at Institute of Human Sciences, University of Wolverhampton. He completed his PhD in the role of exercise in breast cancer. Through his PhD work, he conducted an exercise randomised controlled trial in women with breast cancer. Ian is also the lead author of a recent Cochrane collaboration review on the effects of exercise in women with breast cancer post-adjuvant therapy. Through his role as a research fellow at Russells Hall hospital, Dudley, UK, he helped set up and manage a MacMillan funded exercise-based cancer rehabilitation service. Although his research focus is on the role of exercise in breast cancer rehabilitation and survivorship, he has additionally worked with patients with other cancers, arthritis, cardiovascular disease, and diabetes and related metabolic conditions. He is also interested in the communication of science and meta-research—a field of research that investigates research practices and quality.

Dr. Duane Mellor has worked clinically as a dietitian, mainly in diabetes management and education and then as a researcher in clinical trials. However, reflecting back on the first 2 decades of his career he has begun to question a number of aspects of nutrition and dietetic practice. He is now interested in looking at evidence in nutrition, both in terms of causality and quality along with how this is communicated to the public by the media. Looking to challenge thinking in this area, to consider aspects of benefit and the risks of harm, ultimately looking at how the public can be best supported to eat food they enjoy that also supports good health.

Dr. David Nunan's career in academic research started over 15 years, with a focus on clinical care and evidence-based medicine over the past 8 years. Upon completion of his PhD, he joined the Centre for Evidence-Based Medicine and his role is now divided between research, teaching and outreach activities.