The evidence base for clinical medicine and health policy is "a mess", with major problems affecting journals, regulation and public access to information.

Such were the views of Fiona Godlee, editor-in-chief of the British Medical Journal, who this week delivered the Sense About Science annual lecture.

Research into reporting bias, said Dr Godlee, had found "a major problem affecting the whole of medicine", with effects of intervention overstated and risks understated. Few positive studies remain unpublished, yet it is rare to find a paper reaching a negative conclusion about a drug, she claimed.

At the time of the recent flu "pandemic", some of the guidance offered by the World Health Organisation was written by people with links to industry, and even the term "pandemic" was redefined and diluted to trigger earlier interventions by government.

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Such occurrences, Dr Godlee said, illustrated recurring themes. She cited "undisclosed conflicts of interest, pressures on academics, and industry-funded ghost- and guest-writers", not to mention the "key opinion leaders" the pharmaceutical industry deliberately builds up to influence prescribing decisions.

Nor, said Dr Godlee, can we have total confidence in regulators who are "largely industry-funded but don't declare conflicts of interest".

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When it came to journals, she said, peer review is "slow, expensive, biased and unaccountable. It stifles innovation and is bad at detecting errors."

Sketching out "a more radical future", Dr Godlee said pharmaceutical companies could contribute to a fund for independent research. She urged a return to investigative journalism, and perhaps a medical version of the magazine Private Eye.

But she also said that many drugs were highly effective in relieving suffering while producing harmful side effects in a tiny proportion of cases. Perhaps, Dr Godlee suggested, it is time for greater honesty and "a more mature acceptance that no drugs are entirely safe", which could lead to "a new implicit contract" between drugs companies, regulators and the public.

matthew.reisz@tsleducation.com