Edward Davies: The American Heart Association and why the world needs journals

Edward DaviesYou would sometimes be forgiven for thinking that we are now living in the last days of the traditional medical journal. Everything from payment models, to access, and even peer review is up for grabs.

Editors are a needless middleman, messing with the researchers’ genius and peer reviewers merely inflict their own bias on the reader, multiplying the no doubt manifold pre-existing faults of the research.

Well here at the American Heart Association in Los Angeles I am having my faith restored.  Journals, good ones at least, do an incredibly important job.

And the two-fold reasons are well worn but well worth revisiting.

This is a big conference. There are 20,000 to 30,000 doctors here, all with some axe to grind, hypothesis to expound and research to sell. The resulting conference programme comes looking rather more like a bulky encyclopedia than the slim match day programme you might usually annotate and ignore. Each day the press team of the American Heart Association sifts through the upcoming deluge and filters out the best few dozen (yes dozen) pieces of research for the hundreds (yes hundreds) of news reporters. They are then relayed to the press at a string of press conferences in blocks of up to six or seven pieces of research at a time.  I left the conference yesterday evening with 30 (yes, 30) handouts of the standout pieces of research from the day. And that was just a tiny fraction of those I could have walked away with.

It is a big conference but that was one day of one conference of one specialty in one country. The point of medical journals is to improve medical practice. There is no way on God’s green earth that any practising physician could give these 30 bits of research even close to the attention they required to make any impact at all on their practice, let alone the other four billion bits of research presented yesterday.

Important thing that journals do number 1: They sift through the crap (and sweet Moses there is a lot of crap) to make sure physicians see the bits that will be most important to their patients.

Secondly there is the matter of communication. Hats off to any researcher who stands up in front of a room of his peers to put his findings before the baying and unforgiving mob of medical opinion. It’s not easy. But nor is it easy to sit through, sometimes. While the marketers would have you believe these conference rooms are full of the energetic cut and thrust of international scientific debate, more often than not they are a room of native Mandarin speakers staring blankly at a mumbling Estonian professor reading off a bunch of figures from an illegible Powerpoint graph. Again, nobody is at fault and far be it from me with my dodgy holiday French to criticise another’s linguistic skills, but it does not make for a thorough understanding of complicated topics. And that’s long before we consider the wider presentation, public speaking, and written skills of researchers.

Important things that journals do number 2:  They edit the not always adroitly communicated conclusions of research into a format that at least gives the audience something approaching a chance of understanding it.

Now, of course there will be researchers who read this who feel their work, at least, is not the crap that needs sifting. And their findings, at least, are always perfectly communicated. Editors merely insert mistakes and discard the indispensible. This Davies character is defending his livelihood for fear of those that could do it better.

Other than the BMJ, journals aren’t perfect. But if you are thinking the above, you are probably one of the worst offenders.

This conference has been a showcase of the increasingly tenuous acronyms that researchers like to give their work.  One of my favourite was SCIPIO. So keen were the (largely Italian) researchers to name their work after the famous Roman general that somehow they pulled it from the title “Cardiac stem cells in patients with ischaemic cardiomyopathy” – surely that spells CSCIPWIC? I think conferences like this need prizes for the most outlandishly named research.

Edward Davies is the US news and features editor, BMJ.