COVID-19 advocacy bias in the<i>BMJ</i>: meta-research evaluation

ABSTRACT Objectives During the COVID-19 pandemic, BMJ , the premier journal on evidence-based medicine worldwide, published many views by advocates of specific COVID-19 policies. We aimed to evaluate the presence and potential bias of this advocacy. Design and Methods Scopus was searched for items published until April 13, 2024 on “COVID-19 OR SARS-CoV-2”. BMJ publication numbers and types before (2016−2019) and during (2020−2023) the pandemic were compared for a group of advocates favoring aggressive measures (leaders of both the Independent Scientific Advisory Group for Emergencies (indieSAGE) and the Vaccines-Plus initiative) and four control groups: leading members of the governmental Scientific Advisory Group for Emergencies (SAGE), UK-based key signatories of the Great Barrington Declaration (GBD) (favoring more restricted measures), highly-cited UK scientists, and UK scientists who published the highest number of COVID-19-related papers in the entire scientific literature (n=16 in each group). Results 122 authors published more than 5 COVID-19-related items each in BMJ . Of those, 18 were leading members/signatories of aggressive measures advocacy groups publishing 231 COVID-19 related BMJ documents, 53 were editors/journalists, and 51 scientists were not identified as associated with any advocacy. Of 41 authors with >10 publications in BMJ , 8 were scientists advocating for aggressive measures, 7 were editors, 23 were journalists, and only 3 were non-advocate scientists. Some aggressive measures advocates already had strong BMJ presence pre-pandemic. During pandemic years, the studied indieSAGE/Vaccines-Plus advocates outperformed in BMJ presence leading SAGE members by 16.0-fold, UK-based GBD advocates by 64.2-fold, the most-cited scientists by 16.0-fold, and the authors who published most COVID-19 papers overall by 10.7-fold. The difference was driven mainly by short opinion pieces and analyses. Conclusions BMJ appears to have favored and massively promoted specific COVID-19 advocacy views during the pandemic, thereby strongly biasing the scientific picture on COVID-19. Summary box Section 1: What is already known on this topic Advocacy is intensely debated for its merits to science and policy. Many journals increasingly publish pieces by advocates and it is thus important to understand the nature, scale and impact of this phenomenon. Section 2: What this study adds This study provides a detailed quantitative assessment of journal-promoted advocacy, focusing on the world’s premier evidence-based medical journal, the BMJ . We show that BMJ had massive bias towards specific COVID-19-related advocacy favoring aggressive measures. Our study reveals a need for editorial guidelines on journal-promoted advocacy.