In this day and age, we would hope that medical research and clinical trials would be tightly controlled and effective.  In 1994, Altman stated  that we should be appalled at the money wasted in shoddy medical research  where the sample size was too small to be representative or the methods were incorrect or not being used correctly  rendering the study useless. He stated that we need “ Less research , better research and research done for the correct reasons.”

Research must improve in quality and design  in order to help reduce wastage. Peer review is essential. Bias in trails can sometime be assessed by improved trial registration and peer review . but it is thought that 50% of trials have avoid-able design flaws and as many as 50% are not published.

Guidelines have been put in place such as CONSORT in 2006. Altman established the  EQUATOR Centre in Oxford in 2006 .

Despite the visibility of the issues , the issue of guidance and establishment of   many  bodies to help advise and improve the standards of medical research such as “ Adding value in research “ by NICE in 2010,  the Evidence based network ( www.EBRNetwork.com ) in 2016,  the Ensuring Value in Research Funders Forum  (EVIR) was established by NIHR, ZonMw in the Netherlands and the Patient- Cantered Outcomes Research  Institute in the United States. It is disheartening that the level of uptake of the recommendation by funders is low.  Ethical , scientific and  economic deficiencies remain and  the wastage of resource remains high.

Altman announced in 2015 that the situation had not improved much since he published his paper in 1994.

In 2018 the EQUATOR Network for good global reports attained the Cochrane award and the Trials Tracker created by Ben  Goldacre based at the Oxford Centre of Evidence Based Medicine  exposed academia as more culpable than industry.

There is still a long way to go to improve the quality of the research and to curb the waste of resources in medical research however Altman has raised awareness, taught  and inspired many and well deserves the “ Lifetime Achievement” award the BMJ has awarded him.