Transparency in Science Reporting: A Call to Researchers and Publishers

A recent science communication meeting highlighted a common pitfall in scientific communication: the failure to link the "what" - the findings - to the "so what" - their real-world implications. The real world is complex, and exploring the complexities of "living world phenomena" requires addressing the interconnectedness and interdependencies of the many variables that shape the patterned outcomes of patient conditions we see in everyday practice. While scientific methods by necessity must simplify complexities, these simplifications should be transparently communicated to foster trust and understanding. Randomised controlled trials (RCTs) aim to eliminate contextual confounders, producing statistically significant average outcomes for a hypothetical "average" patient. While they ensure high internal validity, RCTs often lack external validity, limiting their transferability to real-world practice, where patients differ from the average trial participant. This is an inherent problem of RCTs that cannot be overcome. What is not inherent and should be changed are the outcome elements of the study design and especially their reporting. To achieve "statistical significance", trials use large sample sizes, surrogate and arbitrarily designed composite endpoints, and typically emphasise relative benefits, obscuring absolute benefits, which are often clinically marginal. Transparent reporting of absolute benefits, contextualised to patients' realities, is crucial for informed, shared decision-making. Patients and clinicians alike must weigh small disease-specific benefits against potential harms, especially when interventions compromise overall well-being or ability to manage daily life circumstances. Transparency matters, it is a moral and ethical imperative. Applied to medical sciences, it is no longer acceptable to argue that the statistical significance of research findings justifies a tacit paternalism that undermines patient autonomy. We propose a transparency framework that could enhance clear and honest communication of research findings - this is crucial to empower both clinicians and patients in making well-informed clinical or public health decisions.