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The biomedical research complex has been estimated to consume almost a quarter of a trillion US dollars every year. Unfortunately, evidence suggests that a high proportion of this sum is avoidably wasted. In 2014, The Lancet published a series of five reviews showing how dividends from the investment in research might be increased from the relevance and priorities of the questions being asked, to how the research is designed, conducted, and reported. 17 recommendations were addressed to five main stakeholders-funders, regulators, journals, academic institutions, and researchers. This Review provides some initial observations on the possible effects of the Series, which seems to have provoked several important discussions and is on the agendas of several key players. Some examples of individual initiatives show ways to reduce waste and increase value in biomedical research. This momentum will probably move strongly across stakeholder groups, if collaborative relationships evolve between key players; further important work is needed to increase research value. A forthcoming meeting in Edinburgh, UK, will provide an initial forum within which to foster the collaboration needed. [ABSTRACT FROM AUTHOR]

The article discusses waste at all stages in medical research, particularly due to inadequate reporting, best documented in controlled trial reports but occurs in all types of studies. The authors recommend a change in the research rewards and regulations system to encourage improved and more complete reporting, and fund infrastructure development and maintenance in support of better reporting, linkage, and archiving of research elements.

The article discusses obstacles associated with the study design of randomised controlled trials and non-randomised studies evaluating surgical interventions. It describes the issues related to the nature of surgical interventions such as their complexity, range of outcomes, and surgeon-related factors. Other challenges in surgery are discussed including traditional master-student model, lack of regulation and lack of methodological expertise. It is concluded that surgery does not have accepted guidelines for generating valid evidence wherein surgical practice can be based.