She qualified as a doctor in 1985, trained as a general physician in Cambridge and London, and is a fellow of the Royal College of Physicians. Since joining The BMJ in 1990 she has written on a broad range of issues, including the impact of environmental degradation on health, the future of the World Health Organization, the ethics of academic publication, and the problems of editorial peer review. In 1994 she spent a year at Harvard University as a Harkness fellow, evaluating efforts to bridge the gap between medical research and practice.
On returning to the UK, she led the development of BMJ Clinical Evidence, which evaluates the best available evidence on the benefits and harms of treatments and is now provided in 9 languages worldwide to over a million clinicians. In 2000 she moved to Current Science Group to establish the open access online publisher BioMed Central as editorial director for medicine.
In 2003 she returned to BMJ to head up its new Knowledge division.
She has served as president of the World Association of Medical Editors (WAME) and chair of the Committee on Publication Ethics (COPE) and is co-editor of Peer Review in Health Sciences.