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The public requires of the medical research community success. The public ultimately provides money for medical research for one purpose only—to generate improvements in patient care. Medical researchers, editors, and peer reviewers should be under no illusions: the public does not support research for the pleasure of watching a cultural event. If improved medical care is not delivered, support for medical research—and hence for medical journals—will dwindle and atrophy.
The 2014 Lancet series about waste in research posed the question “Why is research that might transform healthcare and reduce health problems not being successfully produced?”2 Indeed, widely disseminated,3 ,4 albeit challenged5 ,6 estimates suggest that most published research findings are false or exaggerated and that 85% of biomedical research resources are wasted.7 Waste is conceptualised in this context as inefficiencies in all aspects of research, including setting priorities, design and conduct of research, regulation and management of research, and failure to publish results.2
We know our successes in identifying strong causes,8 that is, risk factors which causally contribute to disease in a large proportion of cases: the examples of asbestos-related, smoking-related and drinking water-related diseases illustrate the enormous rewards of successful occupational, environmental and public health research. However, in the recent past, potential risk factors of relatively small effects which may have major impacts on public health proved much more difficult to study. One current challenge in this regard is ‘The Plastics Puzzle’9: what research do we need to falsify the hypothesis that ubiquitous synthetic monomers, such as bisphenol A (BPA), and additives to plastics with expected half-lives of centuries, accumulate in wildlife and humans to possibly become a critical burden?10–14
This journal has continuously addressed facets of how we learn from,15 conduct16 and make …