Doug Altman’s prescience in recognising the need to reduce biases before tackling imprecision in systematic reviews

I came to know Doug Altman during the 1980s when we were both members of the editorial team at the British Journal of Obstetrics and Gynaecology (BJOG). I was working at the National Perinatal Epidemiology Unit at that time; Doug was at the Division of Medical Statistics at the Medical Research Council’s Clinical Research Centre. Our meeting at the BJOG was the beginning of what became a very close friendship. Doug and I shared an interest in trying to improve the quality of the manuscripts submitted to the BJOG. We commissioned three papers providing reporting guidelines for those submitting reports of controlled trials, assessments of screening and diagnostic tests and observational studies – early examples of an interest that would become manifested in Doug’s creation of the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research). We also discovered that we had both become interested in the scientific quality of reviews of research evidence, and the potential for statistical synthesis of estimates derived from several similar studies. I had used this approach in a review of four randomised comparisons of different ways of monitoring fetuses during labour, the results of which prompted a very large further controlled trial which confirmed the results of the meta-analysis. Doug’s interest in the scientific quality of reviews of research evidence had been stimulated by two papers published in the late 1970s by Richard Peto. These led Doug to prepare a seven-page typescript entitled ‘Evaluating a series of clinical trials of the same treatment’ for presentation at the 1981 meeting of the International Epidemiological Association in Edinburgh. Over the next two years, Doug extended the material in the seven-page typescript to a 40-page typescript with the same title. Doug’s pioneering conceptualisation of systematic reviews and the role of meta-analysis