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In May 2018, the following tweet was posted from the BJSM twitter account:
'115K views. via brave iconocolast @DrAseemMalhotra. Importantly, no rebuttals. Real food saturated fat does not clog arteries - beware processed food that causes hyperinsulinemia (& hypertension). #Rethink'
Followed by signposting to a linked editorial(1)
Several people responded, including Catherine Collins (https://twitter.com/RD_Catherine/status/1001707243828596737), pointing out that a number of rebuttals to the editorial in question had in fact been made, not least a 2017 PubMed Commons/PubPeer commentary (https://pubpeer.com/publications/8741FBE4D9D7A38A7802515B33302E), which form the precursor of our rebuttal here. In response to Catherine, the BJSM Editor in Chief (EIC) Karim Khan contacted the lead author here indicating he had missed his email a year previous regarding our commentary originally offered to the BJSM as a formal rebuttal [see PubPeer post]. The EIC indicated he would be happy to publish our PubPeer rebuttal in the BJSM. The lead author thanked the EIC and, with co-authors Duane Mellor, Nicola Guess, and Ian Lahart, submitted a revised version in July 2018.
In the interest of fairness and open debate, we made a request to the EIC and BJSM editorial board that our manuscript be made o...
In the interest of fairness and open debate, we made a request to the EIC and BJSM editorial board that our manuscript be made open access in line with the original editorial that was granted open access status by the EIC. The EIC informed us that the board decided to prioritise other articles for open access. We expressed our disappointment at the board’s decision and added a footnote to our article, the subject of which forms the content of this letter. The addition of our footnote was prohibited but we were invited to submit it for discussion as an e-letter in response to our own editorial.
At this point it is important to highlight the BMJ groups editorial process in relation to publishing articles that are free or open access (OA). The main difference between "free" and "open access" is the license the article is published under. For example, an article that is free to access would still require permission to be sought if someone wanted to reuse the content whereas an article that is published under the OA license would not require this.
Articles published under an OA license are indicated by an open padlock symbol and denotes that costs for publication and licensing of the article have been paid for by the authors, their institution(s) and or the funder if relevant. Articles published under the “free” license denote that costs have been waivered. We have been informed by the journal publisher that the EIC has control over decisions to grant articles with a free license.
The EIC can, therefore, choose which articles will be published under the “free” license. This subjectivity clearly presents a risk of bias if not managed appropriately. We feel it has become apparent that bias has entered this process within the BJSM. Here we provide evidence for this observation in relation to a particular narrative, one that finds an unexpected home in a sport and exercise journal, around dietary guidelines, a specific dietary approach, and statins.
The original editorial(1)—to which we provide a rebuttal—received a large amount of attention, both in the press and social media, partly because it was available free via the 'Editors choice' status granted by the EIC. It was and continues to be widely tweeted by the BJSM twitter account which is managed at least in part by the BJSM EIC. Key narratives of the editorial are the denigration of current dietary guidelines and the promotion of a low-carbohydrate, high-fat diet of which the editorial’s lead author is a well-known advocate.
In the past 3 years, the BJSM has also published 10 articles (https://docs.google.com/spreadsheets/d/1VaPB0Tl9RUrGntkWeaNwIX-CIK4Z6SaJ...) with a similar and related focus including criticism of current (and past) nutritional guidelines and the evidence base around dietary fat, dietary management of type 2 diabetes, physical activity for the management of obesity, and statins. The majority of these articles also promote a low-carbohydrate, high-fat diet and of these types of articles, all are authored by known advocates of this dietary approach. Some authors, including the author of the highlighted editorial, have published two or more of the 10 articles.
All 10 articles were published under the “free” license as granted by the EIC. They were also widely tweeted and retweeted by the BJSM twitter account and some have also been accompanied by podcasts and/or blogs with their respective author(s). Of these articles, only one(2) has had any formal rebuttal published in the BJSM in the form of three responses from different groups, including one from our group(3). None of the rebuttals were made available “free” by the editors, were tweeted only once by the BJSM account with no accompanying blog or podcasts. Therefore, there has not been an open and balanced discourse to any of the 10 articles at the time of their publication in the BJSM.
Finally, on the day our editorial was published Online First, there were no linked tweets from the BJSM account. However, there were several in relation to a BJSM podcast with the lead author of 3 of the 10 articles who makes a living from promoting low carb, high fat diets and dismissing any role of saturated fat in heart disease.
The EBM manifesto is a call to arms against to systematic bias, wastage, error, and fraud in research underpinning patient care(4). It points to the pivotal role of journal editors in safeguarding against communication of over-hyped, inaccurate or misinterpreted evidence. To make fair and informed judgements on the value and relevance of evidence, people must have access to it the manifesto stresses. We believe there is sufficient evidence of bias towards a specific narrative within the editorial group at the BJSM that impedes this important goal. The latest rebuttal is another in a familiar line of missed opportunities to redress this and reaffirms the importance of trustworthiness in key gate-keepers tasked with ensuring open and fair scientific, evidence-based discourse on diet and health.
Catherine Collins (https://twitter.com/RD_Catherine/status/1001707243828596737)
2017 - (https://pubpeer.com/publications/8741FBE4D9D7A38A7802515B33302E)
10 article - https://docs.google.com/spreadsheets/d/1VaPB0Tl9RUrGntkWeaNwIX-CIK4Z6SaJ...
1) Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med 2017;51:1111-1112. https://bjsm.bmj.com/content/51/15/1111
2) Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet.Br J Sports Med 2015;49:967–968. https://bjsm.bmj.com/content/49/15/967
3) Mahtani KR, McManus J, Nunan D. Physical activity and obesity editorial: is exercise pointless or was it a pointless exercise? Br J Sports Med 2015;49:969-970. https://bjsm.bmj.com/content/49/15/969
4) Heneghan C, Mahtani KR, Goldacre B, Goldee F, Macdonald H, Jarvies D. Evidence based medicine manifesto for better healthcare. BMJ 2017;357:j2973. https://www.bmj.com/content/357/bmj.j2973