Of 1575 reports about cancer prognostic markers published in 2005, 1509 (96%) detailed at least one significant prognostic variable. 1 Kyzas PA Denaxa-Kyza D Ioannidis JP Almost all articles on cancer prognostic markers report statistically significant results. Eur J Cancer. 2007; 43: 2559-2579 Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar However, few identified biomarkers have been confirmed by subsequent research and few have entered routine clinical practice. 2 Anderson NL The clinical plasma proteome: a survey of clinical assays for proteins in plasma and serum. Clin Chem. 2010; 56: 177-185 Crossref PubMed Scopus (403) Google Scholar This pattern—initially promising findings not leading to improvements in health care—has been recorded across biomedical research. So why is research that might transform health care and reduce health problems not being successfully produced? How to increase value and reduce waste when research priorities are setThe increase in annual global investment in biomedical research—reaching US$240 billion in 2010—has resulted in important health dividends for patients and the public. However, much research does not lead to worthwhile achievements, partly because some studies are done to improve understanding of basic mechanisms that might not have relevance for human health. Additionally, good research ideas often do not yield the anticipated results. As long as the way in which these ideas are prioritised for research is transparent and warranted, these disappointments should not be deemed wasteful; they are simply an inevitable feature of the way science works. Full-Text PDF Increasing value and reducing waste in research design, conduct, and analysisCorrectable weaknesses in the design, conduct, and analysis of biomedical and public health research studies can produce misleading results and waste valuable resources. Small effects can be difficult to distinguish from bias introduced by study design and analyses. An absence of detailed written protocols and poor documentation of research is common. Information obtained might not be useful or important, and statistical precision or power is often too low or used in a misleading way. Insufficient consideration might be given to both previous and continuing studies. Full-Text PDF Increasing value and reducing waste in biomedical research regulation and managementAfter identification of an important research question and selection of an appropriate study design, waste can arise from the regulation, governance, and management of biomedical research. Obtaining regulatory and governance approval has become increasingly burdensome and disproportionate to the conceivable risks to research participants. Regulation and governance involve interventions that are assumed to be justified in the interests of patients and the public, but they can actually compromise these interests. Full-Text PDF How should medical science change?In December, 2013, Randy Schekman received a Nobel Prize in Physiology or Medicine for his codiscovery (with James Rothman and Thomas Südhof) of the cellular machinery regulating vesicle traffic. He used the occasion to launch a ferocious attack against what he called “luxury journals”—Nature, Science, and Cell. Although he didn't mention The Lancet, JAMA, or The New England Journal of Medicine, it probably isn't unreasonable to think he would include us in his definition of “luxury journal”. This is what he wrote in The Guardian: “These luxury journals are supposed to be the epitome of quality, publishing only the best research. Full-Text PDF Increasing value and reducing waste: addressing inaccessible researchThe methods and results of health research are documented in study protocols, full study reports (detailing all analyses), journal reports, and participant-level datasets. However, protocols, full study reports, and participant-level datasets are rarely available, and journal reports are available for only half of all studies and are plagued by selective reporting of methods and results. Furthermore, information provided in study protocols and reports varies in quality and is often incomplete. When full information about studies is inaccessible, billions of dollars in investment are wasted, bias is introduced, and research and care of patients are detrimentally affected. Full-Text PDF Reducing waste from incomplete or unusable reports of biomedical researchResearch publication can both communicate and miscommunicate. Unless research is adequately reported, the time and resources invested in the conduct of research is wasted. Reporting guidelines such as CONSORT, STARD, PRISMA, and ARRIVE aim to improve the quality of research reports, but all are much less adopted and adhered to than they should be. Adequate reports of research should clearly describe which questions were addressed and why, what was done, what was shown, and what the findings mean. Full-Text PDF Research: increasing value, reducing wasteThe Lancet Series on reducing waste in research is an important contribution from scientists working in institutions in high-income countries.1 For scientists working in institutions in low-income and middle-income countries (LMICs), one source of relevant waste is the scarcity of opportunities to implement research projects derived from original ideas. Funding is needed to test ideas stemming from scientists, stakeholders, and the general public to identify interventions that can improve the health of their populations. Full-Text PDF