Celebrating Alessandro Liberati, his vision, books, journals, libraries, “anti libraries,” and radical thinking

The football-loving medical philosopher, founder of the Italian Cochrane Centre, and former member of the BMJ editorial board Alessandro Liberati died 12 years ago, but he was remembered with great fondness earlier this year when Mariangela, his wife, donated almost 150 of his books to the hospital library of Reggio Emilia Arcispedale, one of the finest and best restored medical libraries in Italy.1

Alessandro was passionate about some of the most famous writings on evidence based medicine, including the 1994 BMJ editorial by statistician Doug Altman, who wrote: “We need less research, better research, and research done for the right reasons.”2 Alessandro tried to improve the quality of research by increasing the funding for independent and relevant clinical trials and research. He feared that the well of research might be poisoned, and 12 years after Alessandro’s death Altman’s words have not been heeded. There is vastly more research, and much of it is not only poor but fake, the product of paper mills and researchers desperate for publications.

One of the friends of Alessandro was Drummond Rennie, the deputy editor of JAMA, founder of the Peer Review Congress, and the author of the greatest sentence ever to appear in a medical journal: “There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print.”3

Recently, Richard Horton, editor of the Lancet, reflected on the role of medical journals in making evidence available: “[Ian] Munro [former editor of the Lancet] is quoted as saying that a decent clinical research paper was increasingly a thing of the past.4 The plea was that the Lancet should be more concerned with explanation and interpretation, not the publication of primary research data.” Horton disagrees, arguing that journals should continue to publish science and that the science fits with the Lancet’s radical journalism on society’s concerns, but we think we need more discussions, explanations, and interpretations of research findings.

Books were as important for Alessandro as journals, and since migration is now a central theme in global health and politics, Alessandro would have been interested in the recent book by French writer Daniel Pennac, Eux, C’est Nous in which he deals with migration.5 He looks at numbers and shows that there are not “many or millions” of migrants and that they are not “invading” us or our territories. He tells of the importance of engagement and a sense of communion, both of which mattered to Alessandro. Pennac quotes Nietzsche: “One must shed the bad taste of wanting to agree with many. Great things remain for the great, abysses for the profound, nuances and shudders for the refined, and, in brief, all that is rare for the rare.”

Books continue to pour out, but libraries are under threat. Panos Mourdoukoutas, a professor of economics in the US, argues that “Amazon has provided something better than a local library without the tax fees. This is why Amazon should replace local libraries. The move would save taxpayers money and enhance the stockholder value of Amazon all in one fell swoop.” He saw Starbucks as an alternative to expensive public libraries, “places for people to read, work, and socialise.” There were so many angry reactions from readers that the publisher Forbes was forced to remove the post.6

Public libraries are struggling in the United States, with a decline in funding and staff.7 In the UK 800 libraries closed between 2010 and 2022, and the most deprived areas were four times more likely to lose a library than the richest.89 Scientific libraries in Italian health institutions are closing, and meeting rooms are preferred to libraries.10

“In a culture that is increasingly privatized, libraries are among the last free spaces we have left,” wrote Robert Dawson in a famous book of photographs of public libraries.11 Libraries are places of meeting and knowledge, of study, accessible to all, that foster the growth of citizens who are protagonists of democracy.12 Library networks are “a system of non-commercial centres that help us define what we value and what we value to share.” Libraries “are essential to the functioning of our society,” improving education and literacy and community involvement. Yet despite their benefits, their future is threatened, not least because some believe that it makes no sense to use public space to store books and journals that are hardly ever consulted.

Yet there are those—such as the mathematician and philosopher Nicholas Taleb—who argue that the books yet to be read are more valuable than those we have already known.13 The Italian author Umberto Eco owned an extensive personal library (of 30 000 volumes), and classified visitors to that library into two categories: those who reacted by saying: “Gosh, Professor Eco, what a library! Have you read all these books?” and a small minority who understood that a personal library is not an appendage of one’s ego, but a research tool. A library should contain as many books on unknown subjects as we can afford. The unread books are an “antilibrary,” and an “antilibrary” has a highly symbolic meaning in a research centre, underlining the uncertainty that characterises scientific knowledge and the indispensable curiosity that drives research.

Alessandro brought many people together (including the three of us) and encouraged us to research, challenge, think radically, and share our findings and thoughts through journals and books. He infused us with a sense of belonging to a common international research community engaged in promoting solidarity and progress in major public health issues.