Inspiring People: Doug Altman

Doug Altman

Today whilst scrolling mindlessly through Twitter I saw a post that began, “So sorry to hear of Doug Altman’s passing.” At first I didn’t really believe it – it was like the first time someone told me that Michael Jackson or David Bowie had died, I didn’t think it was real. I scrolled a bit more and saw more posts echoing the same sentiment. Today, we lost Doug Altman.

I was sat in my Mum’s kitchen when I found out. I told her and she asked who Doug Altman was, and I found it genuinely difficult to put into words, ‘Er.. he, well he’s a statistician, a really good one. A lot of the work that I do has his ideas entrenched in it. He’s a big deal, medical-research-wise.’ Shortly after that conversation I left my Mum’s to drive back to my home in Aberdeen. The journey took about 4 and a half hours, and between podcasts and Jon Ronson’s audiobook of ‘So You’ve Been Publicly Shamed‘, I was thinking about Doug Altman and how I wished more people knew who he was. Clearly, in the medical research world we know that we’ve lost a giant, but there are people in other areas of research and in other walks of life that haven’t yet had the joy of discovering Doug’s work. So, Doug Altman is my first entry in a new blog post series called ‘Inspiring People’, where I’ll be sharing details of the people that inspire me – whether in my working life or in my personal life.

So, where do I start with someone like this?

According to Wikipedia..

Douglas Altman FMedSci (born London, UK, 12 July 1948) was an English statistician best known for his work on improving the reliability and reporting of medical research and for highly cited papers on statistical methodology. He is professor of statistics in medicine at the University of Oxford, founder and Director of Centre for Statistics in Medicine and Cancer Research UK Medical Statistics Group, and co-founder of the international EQUATOR Network for health research reliability.

Why did he inspire me?

On the first day on my PhD, my supervisor furnished me with a large pile of papers, links and books to get my teeth into. He drew particular attention to the Testing Treatments book, and a paper titled ‘The scandal of poor medical research‘. I read that paper multiple times, I’ve cited it multiple times in my thesis, and it’s something that I frequently refer to when constructing arguments about the work that I do. Medical research can be done better, and my PhD is taking a tiny, tiny piece of the medical research landscape, and working to improve it. ‘The scandal of poor medical research’ hasn’t just inspired me, it was voted as the paper that the British Medical Journal should be most proud of publishing.

He wasn’t only a ridiculously intelligent man and a brilliant writer, he was a brilliant colleague. I’ve never worked directly with Doug Altman, but everything I’ve heard about him suggests that he was a fantastic person to work with; down to Earth, funny, sarcastic, kind and supportive.

My first big conference presentation was at the Evidence Live conference in 2016. I was presenting work from the Trial Forge group (the wider group that my PhD is set within), but it wasn’t entirely my work, so I was pretty nervous. Before I got up to the lectern I saw Doug Altman. I knew it was Doug Altman, I knew he was about to watch me give my first ever conference presentation, and my nerves escalated. A few minutes into the presentation I remember looking out into the audience and seeing Doug laugh at one of my ‘medical research is not doing it’s job’ related jokes (I know, major nerd alert), after he stopped laughing I saw him nodding along with my points. That tiny interaction is something he likely didn’t even note, but it boosted my confidence more than anything else had when it came to giving presentations. I still think about it now when I get nervous before a talk, I tell myself ‘well if Doug Altman got my joke and liked what I had to say, I must be doing something right’.

I won’t ramble on any more, I’ll just leave with you a list of further reading so you can find out about Doug’s ideas from the man himself.

Doug Altman’s Google Scholar Profile – detailing the papers that have so far earned him 360,483 citations
Practical Statistics for Medical Research (book)
Research Methods for Postgraduates (book)
Absence of evidence is not evidence of absence
Evaluating non-randomised intervention studies
Methodological issues in the design and analysis of randomised trials
Importance of the distinction between quality of methodology and quality of reporting
Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide
A history of the evolution of guidelines for reporting medical research: the long road to the EQUATOR Network
The COMET initiative database: progress and activities update (2014)

Doug Altman – Scandal of Poor Medical Research (filmed at Evidence Live 2017 – I blogged about Doug’s talks at that conference too, see here and here)

We’ve lost a brilliant, inspiring mind today.
In the words of NDORMS (the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences where Doug worked), ‘Thank you, Doug, for all you gave to research and the world.’

Evidence Live Day 2 – 22nd June 2017

As I said yesterday, this week I’ve been in Oxford at the Evidence live conference. Thankfully, Oxford cooled down today and I’m much, much less grouchy as a result.Yesterday’s blog post got a really good response and people seemed to appreciate my write up of day 1, so here’s day 2 for you.

Breakfast session – The REWARD alliance and the EQUATOR network: promoting increased value of research

Iain Chalmers and Doug Altman

Weirdly, breakfast sessions at conferences are usually my favourite talks despite the fact I’m very much not a morning person. The people who attend always seem extra passionate, they’re engaged with discussion, and there’s usually croissants which helps too. This session from Iain Chalmers and Doug Altman was predictably, brilliant. I already knew about the REWARD Alliance and the EQUATOR Network before attending, but this fleshed out my thoughts on both of these initiatives. It also demonstrated that even Doug Altman can struggle to get funding sometimes – the EQUATOR Network doesn’t have grant funding currently. The discussion after Iain’s talk was particularly interesting; during his talk he said that ethical committees are actually being unethical in the way that they approve research but do not make up a big proportion of the people making a noise about research waste. An audience comment (from an ethics committee chair) followed and he made a very good point – we as researchers are often going into the conversation with ethics committees with our guards up. We’re ready for a fight before the first punch has been thrown, and it automatically puts the committee on the back foot before you’ve started. Rather than trying to invent ways to circumvent the bureaucracy we so often encounter, we need to work with ethics committees to change the system so that we can improve the quality of research, and try and make the process of doing so more easy for researchers.

Keynote session – Better data, reduced waste in research and public engagement to transform patient care

Chaired by Tessa Richards, presentations from Trish Groves, Simon Denegri and James Munro

Yet another brilliant keynote session; I think this might have been my favourite session of the entire conference.

Tessa Richards started off by talking about patient perspectives, involvement, and how patients are pushing the research agenda where we are dropping the ball. She signposted to some useful resources: the #WeAreNotWaiting and #patientsincluded movements, and highlighted the lack of patient voices at Evidence Live this year. Hopefully the organisers will hear Tessa’s call and ensure we have patient representation weaved throughout next year’s programme. Trish Groves took to the floor and discussed how we can increase value in health research and make it truly able to improve patient care. The answer? Patient involvement. She highlighted the role of patient reviewers within the BMJ’s publication and review process too which I thought was brilliant.

Next up, Simon Denegri. He started his talk with a series of emojis so that was me immediately on board.. Anyway, yet another fantastic talk that focussed on patients, patient involvement, and the funding gap between research planning and research conduct. We shouldn’t be involving patients throughout every stage of our research work; it can be a waste of their time. To get the most value out of patient insight, and the most efficient use of patient time, we need to work with patients to see where they want to be involved and where they feel they can make the most difference to the research project. Simon also had a great analogy for the tokenistic patient involvement we so often see – a Ford Escort is still a Ford Escort no matter if you add a spoiler, tint the windows and lower the suspension; for you to maintain any street-cred at all, you really just need to re-build.

The session finished with a talk from James Munro from Care Opinion; a website that allows patients to give anonymous feedback about the health services they interact with across the UK. Uniquely, this platform is also linked up with healthcare professionals, this means that concerns, complaints etc can be resolved efficiently. James gave a few examples throughout his talk, one of the most simple being a patient that could not hear when the nurse called her name in the clinic – the seats were faced towards the wall and the patient was deaf in one ear, meaning she couldn’t figure out where the noise was coming from. In just 2 days contact had been made with the clinic involved, and a plan made to turn the seats around to ensure patients don’t run into this problem again. This service isn’t focussed on clinical problems, it really gives patients a voice about any aspect of their interactions with the health services; something as simple as turning the chairs to face a different direction could make the process of visiting a GP so much more comfortable. James also highlighted the need to keep an eye on the ‘small data’ in a world where big data seems to be promising us so much. Big data certainly has the potential to be great, but small data gives meaning. My personal favourite patient quote that James referenced in this talk? ‘Thank you for fixing my brain, it’s chuffing great.’

Parallel session – Clinical trials

Chaired by Jeffrey Aronson, presentations from Amy Rogers, Penny Reynolds, Heidi Gardner (yep, me!), Patrick van Rheenen and Ignacio Atal

A really interesting session that covered a broad range of topics related to clinical trials. Highlights from Amy Rogers from the University of Dundee who gave a brilliant talk, ‘Large streamlined trials – what works, and what doesn’t’. Her talk gave a brilliant overview of the challenges that pragmatic trials can bring, but also the ways that trials units manage to overcome these hurdles in order to conduct brilliant trials. Penny Reynolds’ talk was also brilliant, ‘Why academic clinical trials fail: trial ‘cemetery demographics’ and a case study’. The trials graveyard is something I seem to know quite well given that my research focusses on recruitment – trials are often abandoned due to poor recruitment. Penny’s study drew attention to the management problems that trials faced, and she hypothesised that poor recruitment is a symptom of the underlying disease of bad management.

After these two talks I then presented work on behalf of the HSRU Public Engagement With Research Group – mentioned in this blog post. I talked about our event, ‘Explorachoc’; a chocolate trial that aimed to demonstrate randomisation to the public. I took along the coloured balls we used in Explorachoc, and sweets in yellow and blue bags, and did a live demo of our event. Jeff Aronson who was chairing the session seemed to enjoy being randomised to the blue arm of the trial, which earned him a marshmallow (I did take chocolates with me but they suffered a tragic melting accident between London and Oxford on Tuesday evening, so marshmallows and jelly babies it was!).

A few pictures of my presentation taken by members of the audience:

Picture taken from the The Centre for Evidence-based Veterinary Medicine Twitter page.

Picture taken from the BMC Medical Evidence Twitter page.

Unfortunately I had to leave after this session to catch a bus to Heathrow Airport to make sure I made my flight. British Airways had other ideas though; I’m currently typing this from the Holiday Inn Express at Heathrow because my flight was cancelled due to bad weather. Hopefully I’ll finally make it back to Aberdeen tomorrow morning! I wish I’d known that my flight was cancelled earlier because the final talks looked brilliant, I did manage to keep up to date via Twitter which was great – take a look at #EvidenceLive if you want to find out more!

So that’s it, Evidence Live is over for another year! A brilliant programme filled with inspiring and thought-provoking talks, enthusiastic speakers and a beautiful setting too. This time next year I’ll be nearing thesis submission, so I may have to skip Evidence Live 2018; I’m keeping my fingers crossed that I can make the timings work because it’s one of the most down to Earth, friendly and determined atmospheres I’ve experienced at a conference.

The one thing I wish Evidence Live had this year? A doodler (I don’t think that’s the technical term). Last year Stefania Marcoli was at the conference each day, and she did live summaries including snippets of talks and quotes from attendees. This year we didn’t have anyone doing this, and I think the conference really missed it.

Here’s last year’s summary from day 1:

Credit: Stefania Marcoli

Evidence Live Day 1 – 21st June 2017

This week I’ve been in Oxford at the Evidence live conference – side note: Oxford is currently hotter than the surface of the sun and I genuinely miss Autumn and Winter. As I’m at Evidence Live I thought if would be cool to blog each day; there’s lots of people I have spoken to that wanted to attend but couldn’t, so here’s a run down for those that missed day 1.


Carl Heneghan

As expected, Carl started Evidence Live in a really enthusiastic way. He introduced the Evidence-Based Medicine (EBM) manifesto (more on that later), revealed his new post as Editor-in-Chief of the BMJ’s EBM Journal, and told us how we are currently relying on readers to have ‘a good nose’ when it comes to evidence. Yes, in the 21st century, ‘a good nose’ is apparently a real thing we’re using to distinguish decent research from crap research. Carl highlighted that lots of the things that can have an impact on research are types of biases; when paired with the fact that effects of new interventions are often very small, and we’re left with an evidence-base that’s incredibly vulnerable.

Here Carl talk more here in this short clip recorded after his welcome address.

Workshop – Routinely collected health data (RCD) for randomised controlled trials (RCTs)

Lars Hemkens, Kimberly McCord and Heidi Gardner (yes, me!)

I can’t really give you an unbiased report of this workshop since I was one of the speakers, so I’ll try to remain objective. We uncovered the links between trialists and coffee (the stress of doing trials); why clinical research often fails; what RCD could do for RCTs and why we shouldn’t be thinking of the two concepts as opposites; and also gave a few examples of trials where RCD has been used successfully. Lots of brilliant discussion, and a feeling that we need the infrastructure and IT systems to catch up with our thought process; some cases where a trial team has had to wait over a year for data to be released from NHS Digital, and that’s when the trial’s been up and running for a while beforehand. I really enjoyed this session because the audience were so engaged, ideas exchanged and barriers/solutions brain-stormed. Looking forward to working further with Lars and Kim on this over the next few months; we’ve got a paper almost ready to submit so fingers crossed we’ll have that published before my PhD is over too.

Keynote session – Transparency of trial data, improvement in safety and better quality research to improve healthcare

Chaired by Kamal Mahtani, presentations from Fergal O’Regan, Mary Dixon-Woods and Doug Altman

SUCH A GOOD SET OF KEYNOTE LECTURES. If I can present half as well as these guys one day I’ll be so chuffed with myself. Anyway, fangirl moment over – this session looked at transparency of clinical trial data and pharmacovigilance data from the perspective of the European Medicines Agency (EMA); how we can improve the evidence for improving healthcare, and we finished off with a cracker of a talk from Doug Altman on the scandal of poor medical research. This was my highlight of day 1. Doug published a paper titled ‘The scandal of poor medical research‘ in the BMJ in 1994, and this talk was a reflection on what’s changed in the 23 years since. Sadly, not much. Doug strengthened his message, “let’s start calling it bad research, it’s not just poor, it’s plain bad“, and also gave some brilliant words of wisdom on when to do research, “Ignorance of research methods is no excuse; if you can’t do it well, don’t do it.

Here Mary talk more here in this short clip recorded after her talk.

Workshop – How to write papers that add value in health research and deserve publication

Trish Groves

A brilliant session for early-career researchers and students – and one I found really valuable. Trish gave a few tips on resources that will help budding resources (e.g. checklists as found on the EQUATOR Network website), revealed the acceptance rate for submissions to the BMJ (~4%), and encouraged us to never give up when it comes to publishing; if the science is solid, it will get published somewhere. She also drew attention to the research methods we use, which I thought was a brilliant topic to highlight in this talk. Many people think journals publish based on ‘positive’ results, but the good ones don’t; they’re looking for new, interesting and relevant research questions with solid methodology. After that it doesn’t really matter what the results show. In Trish’s own words, “Methods are the most important part of any paper, without them the rest won’t make sense.

A final word of advice from Trish; keep the writing simple. For the slide below ‘the cow jumped over the moon’ would have worked better.. (slide taken from the Students 4 Best Evidence Twitter page)

Here Trish talk more here in this short clip recorded after her workshop.

Parallel session – Evidence synthesis

Chaired by Jeffrey Aronson, presentations from Tone Westergren, Sietse Wieringa, Carme Carrion, Lyubov Lytvyn, Izhar Hasan and Karolina Wartolowska

A really interesting session that covered lots of different aspects of evidence synthesis. Highlights from Sietse Wieringa who gave a thought-provoking talk titled ‘Has evidence based medicine ever been modern? A Latour inspired understanding of the changing EBM’; Lyubov Lytvyn who gave an overview of the RapidRecs we see in the BMJ with a talk titled, ‘Innovative patient partnership in creating trustworthy guidelines, from protocol to publication: Case studies of BMJ Rapid Recommendations’; and Karoline Wartolowska who discussed the placebo effect and how it changes over time in ‘Temporal characteristics of effect size in the placebo arm of surgical randomised controlled trials – a meta-analysis.’

Open session – Carrots, sticks, or stones? Audit and accountability to improve research quality

Ben Goldacre

Before I came to Oxford I was describing Evidence Live to a friend, I mentioned the usual faces and topics I expected would be discussed, and my friend did not focus on anything academic, none of the topics I’d mentioned; she just said, “Ben Goldacre is kind of a big deal.” I guess she was right, and this talk demonstrated just how many projects/initiatives he is involved in that are working to improve research quality. He talked at length about the need for ‘sustained pressure’ when it comes to getting reporting standards up – this isn’t something that will change over night, but the TrialsTracker will hopefully help.

He specifically asked that sections of the talk weren’t tweeted, and I nodded along when he asked for agreement – so that’s all I’m giving you.

Open session – Better evidence for better healthcare: Consultation

Ben Goldacre and Carl Heneghan

If you haven’t seen or heard of the EBM Manifesto then take a look here. Essentially this aims to kick us into action; we know that evidence generation is not at the standard it should be, patients are being let down as a result, and this manifesto aims to get a sort of action plan together of what we can do to improve things. The infographic below gives a summary of the 9 steps of the EMB Manifesto – which will hopefully lead to us changing the landscape of EBM for the better. I’ll just say that this session started at 6pm and the audience were getting restless at this point; there was the promise of a cold beer and 33 degree heat on the other side, so we made this session quick. That said, the way this was done was brilliant; super efficient and cut out the waffle that usually comes with a consultation of any kind.

One of the things I love about Evidence Live is how solutions-driven it is – speakers openly say that we no longer need to see hundreds of papers published telling us what the problems are with clinical research, we need to get to work and fix them. The aim of this session was exactly that. We were given the task of creating the jobs lists of different stakeholder groups (funders, journal editors, researchers, patient groups etc). We submitted our ideas for jobs along with the problem it’s trying to fix, and how we could measure its success if implemented. Simple as that!

There’s an online version of the form we completed at the consultation here – it’s still open to submissions so please do contribute if you wish.

Overall, an absolutely brilliant first day at Evidence Live; I’m really looking forward to tomorrow’s discussions – check back tomorrow for a blog post covering day 2!