The Inside View on Writing for Medical Journals Ppt

8/8/2019 The Inside View on Writing for Medical Journals Ppt

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The inside view on writing for medical

journals

Richard Smith

Editor, BMJ


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What I might talk about

Why publish?

What do editors want?

The basics of writing a paper The rudiments of style

Peer review processes

Authorship/contributorship

Conflict of interest

Redundant publication

Good practice in publishing


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Why publish?

Because you have something important to say

To change practice

To promote thought or debate

To allow examination of your work

Fame and the love of beautiful women

Money

Career advancement

To entertain/divert/amuse

To educate

To console


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What do editors want?

Excitement/ wow

Importance

Originality

Relevance to the audience

True Clearly written

Engagingly written


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Utility of information

Utility=relevance x validity x interactivity

work to access


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The basics of writing a paper

1. Before you begin

What do I have to say?

Is it worth saying?

What is the right format for the message?

What is the audience for the message? Where should I publish the message?

How can I best use paper and the web?


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2. The importance of structure

Structure is everything.


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3. Possible structures Beginning, middle, end (AA beginning, a muddle, and an

end.@ Philip Larkin)

Tell people what you are going to say, say it, tell them

what you=ve said

Rudyard Kipling: (AI keep six honest serving me, (Theytaught me all I knew), Their names are What and Why and

When, And How and Where and Who?)


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3. Possible structures continued News story: (Story in the title; story in the first line;

expand slightly on the story in the first paragraph; give the

evidence for the story; give the counter view)

ImraD (Introduction, methods, results, and discussion)

Stream of consciousness

Chronology: diary, autobiography


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3. Possible structures continued

A list

Something very formal: for example, sonnet, limerick,

haiku

Ulysses


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4. Still structure

Make sure that readers knowwhere they are, where they are

going, and why.


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5. IMRaD Introduction--Why did I do it?

Methods--What did I do?

Results--What did I find? Discussion-- What might it mean? What is our overall

finding? What are the strengths and weaknesses of the

study in relation to other studies? Why might we have got

different results? What might the study mean, particularly

for clinicians or policy makers? What questions remain

unanswered and what next?


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5. IMRaD (Introduction) Why did we start?

What has gone before - ? A systematic review

Why was this study needed?

Be sure that readers understand the importance of

the study-but don=t overdo it short

Don=t try to show readers that you have read

everything

Short, short, short


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5. IMRaD (Methods) Like a recipe

For informed readers this is the most important section

Describe how subjects were selected and excluded Don=t describe standard methods in detail - use references

Statistics

Ethics

Remember that you can put more detailed methods on theweb--for example, questionnaire


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5. IMRaD (Results) Stick to what is relevant

Be sure to include basic descriptive data

The text should tell the story

The tables give the evidence

The figures illustrate the highlights

Don=t include just percentages or p values

Include confidence intervals

Think about absolute risk, number needed to treat, etc

Avoid beginning to discuss the implications or strengths and

weaknesses of your study


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5. IMRaD (Discussion)

Statement of principal findings

Strengths and weaknesses of the study Strengths and weaknesses in relation to other studies,

discussing particularly any differences in results

Meaning of the study: possible mechanisms and

implications for clinicians or policymakers Unanswered questions and future research

Go easy on the last two


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6. Topping and tailing Title: Include design; Don=t try to be clever

Abstract: Must be structured; Include some

numbers, not all

References: Keep to the essentials

Covering letter: Something very crisp

Authorship, acknowledgements,

competing interests


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The rudiments of style

George Orwell: AGood prose is like a window

pane.@

Somerset Maugham:ATo write well is as hard as

to be good.@

Jonathan Swift: AProper words in proper places

make the true definition of style.@

Matthew Arnold: AHave something to say and

say it as clearly as you can. That is the essence of

style.@


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The rudiments of style I

Short words

Short sentences

Short paragraphs

No jargon

No abbreviations

Prefer Anglo Saxon over the Latin Prefer nouns and verbs to adjectives and adverbs

Cut all cliches


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The rudiments of style II

Avoid figures of speech and idioms

Prefer active to passive

Prefer the concrete to the abstract

Avoid the Anot unblack cat crossed the not

unwide road@

Don=t hector

Be unstuffy


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The rudiments of style III

Don=t be too chatty

Don=t be pleased with yourself

Be careful with slang

Use the scalpel not the sword

AToo many notes, Mozart.@

Add a dash of colour, just a dash


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As many processes as journals or grant giving

bodies

No operational definition--usually impliesexternal review

Was largely unstudied

Benefits come from improving what ispublished rather than sorting the wheat from

the chaff


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Problems with peer review

A lottery

A black box

Ineffective

Slow

Expensive

Biased Easily abused

Cant detect fraud


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Stand at the top of the stairs with a pile of

papers and throw them down the stairs.

Those that reach the bottom are published.

Sort the papers into two piles: those to be

published and those to be rejected. Thenswap them over.


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BMJ peer review process I

6000 papers

1000 rejected by one editor: unoriginal, too specialist,

so what, invalid, incomprehensible (standardrejection list)

2500 rejected by two editors

2500 sent to one reviewer, who is revealed to the

authors Discussed at minihang

1000 rejected by reviewer and editors


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BMJ peer review process II

200 accepted as short reports after approval

by statistician

1500 to one of three hanging committees

A hanging committee comprises two

practitioners/researchers, one statistician,

and one editor

300 accepted, almost always after revision


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BMJ peer review process III

Always willing to consider first appeals--

but must revise the paper, refute criticisms,not just say the subject is important

Perhaps 20% accepted on appeal

No second appeals; always ends in tears;

plenty of other journals


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Who is an author? I

A totally blind haphazard study of the effect of being a Mason on

promotion within medicine

A. Professor Sir Joshua Fulloftosh, president of the university.Raised the grant, got permission for the study from the Masons

B. Professor Michael Halfpenny, British American Tobacco

professor in the joint department of respiratory, Masonic, and

imaginary studies. Suggested the idea for the trial before departing fora six month sabbatical in the Seychelles and handled the

postpublication media coverage by satellite


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Who is an author? II

C. Dr Alec Fedup, senior lecturer in the department of Masonic

studies. Drew up the protocol, wrote the grant proposal, and then died

in mysterious circumstances.

D. Sir Bloated Corpulent, visiting consultant. Allowed his staff to be

entered haphazardly into the study

E. Dr Alice Holditalltogether, senior registrar. Ran the study,

collected the data and sent them to the statistician, arranged for thewriting up of the study, and negotiated with the editors


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Who is an author? III

F. Polly Paired-T-Test, statistician. Did all the analysis, prepared the

tables

G. Pamela Poltergeist, editorial adviser to the Masons. Wrote thepaper

E. Professor Avaricious Loadsapesetas, director of the Acapulco

Institute of International Masonic and Financial Studies. Allowed his

name to be added to the paper in exchange for a lucrative consultancy.Unfortunately didn=t have time to read the paper.


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Criteria for authorship of the International

Committee of Medical Journal Editors

Authorship should be based only on a substantial

contribution to:

i Conception and design or analysis and

interpretation of data and

ii Drafting the article or revising it critically for

important intellectual content and

iii Final approval of the version to be published.


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Why does authorship matter? I

Authorship is about credit and responsibility

Academic life revolves around publication - credit

comes from publishing, which implies being anauthor

Publication brings Afame and the love of beautiful

women@

Research evaluation is based on publication

Grants depend on/demand publication


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Why does authorship matter? II

In some parts of medicine you need publications

to get a job You may have a disease named after you - for

example, Crohn=s disease

Authorship means you are accountable; who is the

author of a fraudulent paper?

Authors can be sued for libel


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What are the problems with

authorship? The two basic problems of credit and

accountability

Many authors on papers have done little - do notmeet ICMJE criteria

Gift authorship

People don=t know about the criteria of authorship

People think that the definition is unworkable

People are left off papers


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Options for responding to the

problems of authorship

Status quo

Loosen up the criteria

Enforce the ICMJE criteria more strictly

Tweak the ICMJE criteria - for instance, allow statisticians

to be included

Other ideas--for example, limits on numbers of authors Abandon the idea of authorship - go for film credits,

contributors with a guarantor


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Competing interest

What is conflict of interest?

A person has a conflict of interest when he

or she has an attribute that is invisible to the

reader or editor but which may affect his or

her judgement.


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Competing interest

Why does it matter?

Because it may have a profound effect on

somebody=s judgement.

Because of the perception that a person=s

judgement may be affected--whether it is or

not


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Competing interest: evidence that

it mattersViews of authors with financial relationships with the

pharmaceutical industry on whether calcium-channel

antagonists are safe

Manufacturer Supportive

N = 24

Neutral

N=15

Critical

N=30

P value

for trend

Calcium channel

antagonist

96 60 37


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How should we manage conflict of

interest?

Ignore it--unaceptable

Avoidance - hard

Disclosure - to the editor, author, or reader?


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Problems with conflict of interest

Should it be just financial or personal, academic, political,

religious, anything?

People don=t declare it because a) it implies wickedness; b)

they are confident that their judgement is not affected

Might we avoid these problems by changing Aconflict of

interest@ to Arelevant@ or Acompeting@ interests?


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The best policy on competing

interest

Always declare a conflict of interest,

particularly one that would embarrass you if

it came out afterwards


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Redundant publication I

Happens commonly--perhaps 20% of

studies

Negative studies are often not published;positive studies are more likely be

published more than once

Distorts what the evidence says


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Redundant publication II

There is lots of room for arguing over the

degree of overlap and whats legitimate

Disclosure is the key

Always send copies of overlapping papers

and reference them

The problem is not the publication but thelack of disclosure


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Good publication practice

Read Guidelines on good publication

practice from the Committee on

Publication Ethics (COPE)

Available free at www.publication

ethics.org.uk


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COPE guidelines on good publication

practice cover

Study design and ethical approval

Data analysis

Authorship

Conflicts of interest Peer review

Redundant publication

Plagiarism

Duties of editors

Media relations

Advertising

Dealing with misconduct, including sanctions


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Last advice

Disclosure is almost a panacea.

John Bailar, professor of statistics, University of Chicago

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The Inside View on Writing for Medical Journals Ppt

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