# Douglas G. Altman
**Douglas Graham Altman** (1948–2018) was a British medical statistician, professor of statistics in medicine at the [University of Oxford](https://www.edgepedia.org/university-of-oxford), founding director of the Centre for Statistics in Medicine, and founder of the EQUATOR Network for the improvement of health research reporting.[1](https://www.bmj.com/content/361/bmj.k2588) He was born in 1948 and died on 3 June 2018.[2](https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998) According to his BMJ obituary, his work ranged across meta-analysis methodology, clinical trial reporting, and the measurement of agreement between clinical methods, and he served as The BMJ's chief statistical adviser for more than 20 years.[1](https://www.bmj.com/content/361/bmj.k2588)
| Key fact | Detail |
|---|---|
| Full name and dates | Douglas Graham Altman, 12 July 1948 – 3 June 2018[2](https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998) |
| Field | Medical statistics: trials methodology, meta-analysis, research reporting[1](https://www.bmj.com/content/361/bmj.k2588) |
| Training | BSc in statistics, University of Bath; DSc by publication, University of London[1](https://www.bmj.com/content/361/bmj.k2588) |
| Main posts | MRC Clinical Research Centre 1976–88; Imperial Cancer Research Fund (later Cancer Research UK) 1988–95; Oxford from 1995; professor from 1998[3](https://doi.org/10.1016/s0140-6736(18)31480-6) • [2](https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998) |
| Signature work | The I² inconsistency statistic for meta-analyses (BMJ, 2003)[4](https://doi.org/10.1136/bmj.327.7414.557); ["Randomisation and baseline comparisons in clinical trials"](https://doi.org/10.1016/0140-6736(90)90014-v), *The Lancet*, 1990 |
| Honour | Fellow of the Academy of Medical Sciences, elected 2011[6](https://acmedsci.ac.uk/fellows/fellows-directory/ordinary-fellows/fellow/Professor-Douglas-Altman-0010400) |
## Education and career
Altman was rejected by every university he applied to before the newly established [University of Bath](https://www.edgepedia.org/university-of-bath) offered him a place to read statistics; he remained "Mr Altman BSc" for 25 years until the [University of London](https://www.edgepedia.org/university-of-london) awarded him a [Doctor of Science](https://www.edgepedia.org/doctor-of-science) by publication.[1](https://www.bmj.com/content/361/bmj.k2588) According to his obituary in *The Lancet*, he then worked at St Thomas's Hospital Medical School in London, mainly on the health and growth of school children.[3](https://doi.org/10.1016/s0140-6736(18)31480-6)
In 1976 he moved to the [Medical Research Council](https://www.edgepedia.org/medical-research-council)'s Clinical Research Centre in north London, where he stayed until 1988, when he became head of the newly formed Medical Statistics Laboratory at the Imperial Cancer Research Fund, a forerunner of Cancer Research UK.[3](https://doi.org/10.1016/s0140-6736(18)31480-6) • [7](https://clinicalstudydatarequest.com/Documents/IRP%20Panel%20Member%20Bio%20Doug%20Altman.pdf) The University of Oxford appointed him Professor of Statistics in Medicine in 1998.[2](https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998) *The Lancet* obituary records him as director of the Centre for Statistics in Medicine until 2014, while *Who Was Who* records the founding directorship as running from 1995 to 2016.[3](https://doi.org/10.1016/s0140-6736(18)31480-6) • [2](https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998) At Oxford he also played a key part in establishing the [Cochrane Collaboration](https://www.edgepedia.org/cochrane-collaboration).[1](https://www.bmj.com/content/361/bmj.k2588)
## Representative work
**The I² statistic.** In a BMJ paper published on 4 September 2003, Measuring inconsistency in meta-analyses, Altman and his coauthors introduced I², a quantity describing the consistency of results across the studies combined in a meta-analysis; according to the paper itself, this measure was proposed to quantify inconsistency in meta-analyses.[4](https://doi.org/10.1136/bmj.327.7414.557) The conventional statistical test of heterogeneity is susceptible to the number of trials included, so the authors designed I² to give a better measure of consistency between trials; without knowing how consistent the studies' results are, they argued, the generalisability of a meta-analysis's findings cannot be determined.[4](https://doi.org/10.1136/bmj.327.7414.557) Cochrane Reviews began including I² to help readers judge consistency, and it became a standard element of meta-analysis reporting.[4](https://doi.org/10.1136/bmj.327.7414.557) • [8](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000127/full)
**Other work.** An early methodological review, [*Randomisation and baseline comparisons in clinical trials*](https://doi.org/10.1016/0140-6736(90)90014-v), is available here.[9](https://doi.org/10.1016/0140-6736(90)90014-v) His textbook Practical Statistics for Medical Research, first published in 1990 and still in print at his death, remains among his best-known works.[1](https://www.bmj.com/content/361/bmj.k2588) From 1994 he coauthored the Statistics Notes series running in *The BMJ*, short explanations of the methods clinicians actually meet.[1](https://www.bmj.com/content/361/bmj.k2588) In the last decade of his life, according to a Biometrical Journal tribute, he contributed to the design and analysis of INTERGROWTH-21st, a WHO-funded study producing age-related reference intervals for fetal size and growth.[10](https://doi.org/10.1002/bimj.202000053)
## The Magpie Trial
Altman's work on clinical trial reporting and methodology is illustrated by the Magpie Trial. The 2002 *Lancet* report of the Magpie Trial described a randomised placebo-controlled trial of magnesium sulfate in pre-eclampsia covering 10,141 women randomised in 33 countries, 5,071 to magnesium sulfate and 5,070 to placebo.[11](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/abstract) Women allocated magnesium sulfate had a 58% lower risk of eclampsia (95% CI 40–71) than those allocated placebo: 40 women (0.8%) versus 96 (1.9%), or 11 fewer women with eclampsia per 1000.[11](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/abstract) Side-effects were far more common in the treated group, reported by 1,201 of 4,999 women (24%) versus 228 of 4,993 (5%) on placebo.[11](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/abstract) Maternal mortality was lower among women allocated magnesium sulfate (relative risk about 0.4, 95% CI 0.26–1.14), and for women randomised before delivery there was no clear difference in the risk of the baby dying (relative risk about 1, 99% CI 0.92–1.14). The trial's conclusion was that magnesium sulfate cuts the risk of eclampsia by more than 40% and probably reduces the risk of [maternal death](https://www.edgepedia.org/maternal-death), without substantive harmful effects on mother or baby.[11](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/abstract)
## EQUATOR and the reporting-guidelines movement
The first CONSORT guidelines for reporting randomised controlled trials appeared in 1996, and Altman helped draft the updated statement published in 2001.[1](https://www.bmj.com/content/361/bmj.k2588) • [10](https://doi.org/10.1002/bimj.202000053) Over the following decade he became a leading advocate of such guidelines.[1](https://www.bmj.com/content/361/bmj.k2588)
In 2006 he founded the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research), with initial funding from the UK National Knowledge Service; the founding paper appeared in *The Lancet* on 5 April 2008.[5](https://pdfs.semanticscholar.org/ccaa/295f5a9100d14bab4ac73902e352304b1e69.pdf) EQUATOR was created because reporting guidelines were not widely supported by medical journals or followed by researchers, leaving the quality of health-research reporting unsatisfactory.[5](https://pdfs.semanticscholar.org/ccaa/295f5a9100d14bab4ac73902e352304b1e69.pdf) It is an umbrella for all areas of health research reporting: an accessible repository of virtually all reporting guidelines, including MOOSE, STARD, STROBE, PRISMA, and SPIRIT, aiming to become a global center providing resources and training and assisting the development, dissemination, and implementation of guidelines.[5](https://pdfs.semanticscholar.org/ccaa/295f5a9100d14bab4ac73902e352304b1e69.pdf) • [12](https://jamanetwork.com/journals/jama/fullarticle/2731154) The success of CONSORT led to guidelines for other study designs, including STROBE for observational research and PRISMA for systematic reviews, published in 2009 with Altman on its executive group.[10](https://doi.org/10.1002/bimj.202000053) • [8](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000127/full) According to a 2024 review in *Clinical Radiology*, he is listed among the figures behind QUADAS, TRIPOD, and DAMOCLES.[13](https://www.sciencedirect.com/science/article/pii/S0009926024001958)
## Criticism of research practice
Altman spent much of his career documenting how medical research was done badly. His 1982 paper in the inaugural issue of *Statistics in Medicine* concluded: "The general standard of statistics in medical journals is poor."[1](https://www.bmj.com/content/361/bmj.k2588) In 1994 he published the *BMJ* editorial "The scandal of poor medical research"; at the 2015 REWARD/EQUATOR conference he said his only regret about it was using the word "poor" rather than "bad".[14](https://link.springer.com/article/10.1186/s13063-022-06415-5) The criticism was empirical as well as rhetorical. A 1995 *JAMA* study of 250 controlled trials drawn from 33 meta-analyses found that odds ratios were exaggerated by 41% in trials with inadequate allocation concealment, by 30% where concealment was unclear, and by 17% in trials that were not double-blind.[15](https://jamanetwork.com/journals/jama/fullarticle/386770) A 2007 *PLoS Medicine* cohort study of 44 industry-initiated trials approved in Copenhagen and Frederiksberg in 1994–1995 found evidence of ghost authorship in 33 trials (75%; 95% CI 60–87%), rising to 91% when acknowledged contributors were counted; in 31 of the trials the ghost authors identified were statisticians.[16](https://journals.plos.org/plosmedicine/article/file?id=10.1371%2Fjournal.pmed.0040019&type=printable) Throughout, he maintained that expert analysis cannot salvage poorly designed research.[17](https://www.telegraph.co.uk/obituaries/2018/06/11/douglas-altmanstatistician-obituary/)
## Honors and editorial roles
Altman was elected a Fellow of the Academy of Medical Sciences in 2011.[6](https://acmedsci.ac.uk/fellows/fellows-directory/ordinary-fellows/fellow/Professor-Douglas-Altman-0010400)
## Death and legacy
Altman died on 3 June 2018.[18](https://www.equator-network.org/2018/06/04/doug-altman-12-july-1948-3-june-2018/) His death was marked with obituaries and tributes in *The BMJ*, *The Lancet*, *JAMA*, and at the Royal Statistical Society Annual Conference.[1](https://www.bmj.com/content/361/bmj.k2588) • [10](https://doi.org/10.1002/bimj.202000053) His methodological legacy has remained in active use: CONSORT and its successor guidelines continue to evolve, I² remains embedded in Cochrane's meta-analysis methods, and scholarship in 2024 still presents his reporting-guideline program as a model for other specialties to learn from.[8](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000127/full) • [13](https://www.sciencedirect.com/science/article/pii/S0009926024001958)
## References
1. Douglas G Altman: statistician, researcher, and driving force behind global initiatives to improve the reliability of health research. *BMJ* 2018. https://www.bmj.com/content/361/bmj.k2588
2. Altman, Prof. Douglas Graham. Who's Who & Who Was Who. https://www.ukwhoswho.com/display/10.1093/ww/9780199540891.001.0001/ww-9780199540884-e-255998
3. https://doi.org/10.1016/s0140-6736(18)31480-6
4. Measuring inconsistency in meta-analyses. *BMJ* 2003;327:557. https://doi.org/10.1136/bmj.327.7414.557
5. EQUATOR: reporting guidelines for health research. *The Lancet*, 5 April 2008 (reproduced with permission). https://pdfs.semanticscholar.org/ccaa/295f5a9100d14bab4ac73902e352304b1e69.pdf
6. Professor Douglas Altman. Academy of Medical Sciences fellows directory. https://acmedsci.ac.uk/fellows/fellows-directory/ordinary-fellows/fellow/Professor-Douglas-Altman-0010400
7. Doug Altman, IRP Panel Member Bio. https://clinicalstudydatarequest.com/Documents/IRP%20Panel%20Member%20Bio%20Doug%20Altman.pdf
8. Doug Altman's legacy to Cochrane and evidence synthesis. Cochrane Library editorial. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000127/full
9. https://doi.org/10.1016/0140-6736(90)90014-v
10. Doug Altman: Driving critical appraisal and improvements in the quality of methodological and medical research. *Biometrical Journal*. https://doi.org/10.1002/bimj.202000053
11. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/abstract
12. A Tribute to Douglas G. Altman, DSc. *JAMA*. https://jamanetwork.com/journals/jama/fullarticle/2731154
13. Doug Altman, medical statistician par excellence: What can radiologists learn from his legacy? *Clinical Radiology* 2024. https://www.sciencedirect.com/science/article/pii/S0009926024001958
14. Tolerating bad health research: the continuing scandal. *Trials* 2022. https://link.springer.com/article/10.1186/s13063-022-06415-5
15. Empirical evidence of bias in controlled trials. *JAMA* 1995;273:408-412. https://jamanetwork.com/journals/jama/fullarticle/386770
16. Ghost authorship in industry-initiated randomised trials. *PLoS Medicine* 2007;4(1):e19. https://journals.plos.org/plosmedicine/article/file?id=10.1371%2Fjournal.pmed.0040019&type=printable
17. Douglas Altman, statistician – obituary. *The Telegraph* 2018. https://www.telegraph.co.uk/obituaries/2018/06/11/douglas-altmanstatistician-obituary/
18. Doug Altman, 12 July 1948 – 3 June 2018. EQUATOR Network. https://www.equator-network.org/2018/06/04/doug-altman-12-july-1948-3-june-2018/
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*Topic: Encyclopedia › Physical world and mathematics › Physical and mathematical scientists › Mathematicians and statisticians › Researchers in statistics, probability, and data science methodology › Causal inference and research methodology*
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