Reconsidering the medical literature priorities: how beautiful writing or how important observation?
Article Type: Clinical report
Subject: Publishing industry
Author: Christodoulou, Irene
Pub Date: 04/01/2010
Publication: Name: Archives: The International Journal of Medicine Publisher: Renaissance Medical Publishing Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Renaissance Medical Publishing ISSN: 1791-4000
Issue: Date: April-June, 2010 Source Volume: 3 Source Issue: 2
Topic: Computer Subject: Publishing industry
Product: Product Code: 2700020 Publishing; 2700000 Printing & Publishing NAICS Code: 511 Publishing Industries SIC Code: 2711 Newspapers; 2721 Periodicals; 2731 Book publishing; 2741 Miscellaneous publishing
Accession Number: 263251115
Full Text: Success in medical writing frequently leads to success in publishing medical manuscripts. Some medical authors are so good in medical writing that their manuscripts are more than what could have been submitted during a lifetime by a whole Unit or even a whole University! To publish easily in medical journals is an art, to publish with great difficulty however is an issue that we have to reconsider!

To write well means to be well informed in modern medical terminology, to handle perfectly the design and structure of the study, to analyze properly your results, to explain in detail what you found and to make wise conclusions. But practically, many parts of the study may be missing.

A concept that never became a study

A very important concept may never come to the phase of a completed and well-written study. Many times this failure derives from the need for teamwork in an institute/Hospital/ organization. If teamwork is impossible then good concepts may be lost. When many Departments or many Hospitals should co-operate, then competitive relationships and disagreements for the authorship may become the reason for failure. The publication will never come because the study was not executed properly.

A faulty design of the study may "burn" the study results and conclusions

Faults in the design of the study can be seen in the phase of the peer review process; if the study should be repeated this means new expenses on experimental equipment and longer to very long-time. However, minor faults can be corrected and the study can be re-submitted. Such manuscripts may be rejected according to the reviewer. The characterization of a fault as minor or major many times depends on the judgment of the reviewer who examines the paper. If a study has something important to offer, then the correction of the research design may bring into the light unexpected results and conclusions.

Statistical Problems

This is a very common problem among medical doctors. It is not at all bad to have the help of professionals in statistics when a study has important results to offer. The statistical corrections may prove things that could not be proved before the proper handling of the numbers (or the opposite). A study with statistical "gap" should be corrected and published. However, major statistical errors cannot be corrected by the reviewers. What is major depends on the reviewer's opinion.

Handling of the results

Some studies start with one or more aims, but in the end they find just nothing. They are called studies with negative results and many journals deny to publish such studies because they are believed to be unimportant and do not contribute to the international literature. However, the experimental costs and animal sacrifice could be reduced if negative results were known to everyone before a team starts an experiment. Of course, a journal that would publish negative results only would not be so interesting for the readership! Some negative results are more important than positive results, because they have to do with important molecules/investigated variables.

Also, the secondary results sometimes may be more important than the primary results. Thus, when the reviewer detects important secondary results may help the author team to highlight what important was found in a study that was previously thought to be a failure even by the researchers themselves.

Translation of the results

Who does not understand what he has just found? The wiser you are the most things you understand out of a "fresh" result. Meta-analyses may reveal outcomes that the primary researchers could not even imagine when they submitted their paper for publication. This is common in basic science studies where the clinicians find things that basic researchers could never have known due to none or limited experience in clinical medicine. In a team that basic research is well translated with the help of clinicians the success is guaranteed for the publication and for the readership. However, in most cases, the real result translation may come months or years after the primary publication of an important study.

Translation of the results may be helped by the reviewers but they cannot translate in full or in depth the results. Because, in that case, the reviewer might become one of the co-authors, which is the ethical policy. If the research team cannot shape a translation of their results, then either the study should not be published or the results will be published without a complete explanation of their importance. The latter option is almost the majority of studies coming from one department.

Coming to conclusions of a research study

Conclusions may be corrected by the reviewers of a manuscript, and in that case their help may change radically the total value of the study. Multi-author teams should be aware of the very common phenomenon that their conclusions have nothing to do with the aim of their study (!). The more the authors, the worst for the manuscript; because a study with many authors should be extended/ multi-phased and very well written. To conclude that "other researchers should come and tell us what will happen with this matter in the future" is not a conclusion but this phrase is seen in more than 20% of submitted manuscripts.

Geographical Origin of the Study

This is a good reason to publish a study that was already held in other countries. Because, variations may appear, and in that case, even if having differences in the secondary results only, we may have important outcomes.

Linguistic problems

Beautiful writing is like beauty of someone you meet in the street. How wonderful to have a well written manuscript in your hands! But the study should be important, too. Linguistic problems should not be the main reason for the rejection of an original research study. In reviews, where critical thinking is of principal role, perhaps writing skills should still have a role for the decision for the publication of a study. However, professionals can give their help for the final formation of a study.

Problems with Authorship

How unbelievable is to hear that the manuscript you have in your hands has more than 10 authors? The more the authors, the "better" the study should be. If a study has such work that no more than one person could have done, then multi-authorship IS a reason for rejection. Because if we publish such studies, readers are educated to present their studies with many authors. Important results should be published only if the submitters behave with ethical manners towards the journal and the readership. Ethics includes the multi-authorship issue.

Studies from poor countries

Research can be done in a fully equipped laboratory with skilled personnel and research can also be done by scientists who do not have research facilities for making their best. Manuscripts coming from poor countries that do not have results of international interest should be published in the following cases:

a) If they give results that have importance for their country. Perhaps a result that is not important for London may be important for a poor country. Here, the geographical location has the meaning not only of the variation of results but also the meaning of what is important for this country. For example, the surgical results of morbidity and mortality in a Hospital of a poor country are very important. Because, if a new surgeon from a poor country wishes to execute a pancreatectomy in his country he will be aware of the 50 or even 100% mortality in the conditions of his Hospital, and won't hope for the results of a large Hospital in New York. To see what you should wait after an operation is very important for saving lives and avoiding complications.

b) The international readership should know what every country can do in the various medical fields. Not because they may travel to a poor country. But because the international reader should be aware that Medicine, as a science may "reach to the moon", but medical doctors in many countries may be still decades back to the Medicine of the past, due to educational gaps and due to financial borders. In this way, the medical community should be united in the field of medical education and should have the generosity to educate medical doctors on one hand and on the other let them participate in the international journals with what they can offer.

The answer "Your article does not have an interest for an international readership" is well known to authors coming from small and poor countries. Thus, medical manuscripts are divided in two categories. The ones that come from rich countries and the ones from countries with wealth available for education and research. Ethics in medical publishing includes awareness to promote what important may come from poor countries and to protect their knowledge and concepts like a new-born baby. Otherwise, repeated rejections will lead to the death of publishing from a number of countries.

Each reviewer should read in detail all submitted articles and should not close the submitted file if the language is not so good, if the structure is faulty and if the origin seems to be not the excellence center he would adore. Many important scientific discoveries came from small laboratories and from poor scientists. We need to know that in the ages of free medical knowledge via internet scientists from poor countries should be helped even more and be encouraged to publish articles.

Irene Christodoulou

Editor in Chief
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