{"id":40722,"date":"2017-11-28T12:25:59","date_gmt":"2017-11-28T11:25:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40722"},"modified":"2017-12-08T18:18:58","modified_gmt":"2017-12-08T17:18:58","slug":"richard-smith-angry-at-the-delay-waste-and-inefficiency-caused-by-medical-journals","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/28\/richard-smith-angry-at-the-delay-waste-and-inefficiency-caused-by-medical-journals\/","title":{"rendered":"Richard Smith: Angry at the delay, waste, and inefficiency caused by medical journals"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-33037\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014-150x150.jpg\" alt=\"richard_smith_2014\" width=\"128\" height=\"128\" \/><\/a><span style=\"font-weight: 400\">A friend from a middle income country writes to me in despair about the way he and his colleagues have been treated by medical journals. His story made me angry at medical journals and the delay, waste, and inefficiency they cause for no obvious benefit.<\/span><\/p>\n<p><span style=\"font-weight: 400\">My friend and his colleagues conducted a huge pragmatic cluster randomised trial of a complex intervention to improve the care of a common and serious condition in communities (not just individual patients). The result was no improvement on the primary endpoint, although there were substantial improvements in the number of patients treated.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The study has asked an important question and provided a reliable answer. The paper is clearly written (some of the authors are native-English speakers and highly published); the strengths and weaknesses of the study are well described; and the conclusions are not overblown.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The paper is clearly publishable, and none of the many reviewers who have seen the paper have said otherwise. It\u2019s important that it be published, and it would be misconduct for it not to be published.<\/span><\/p>\n<p><span style=\"font-weight: 400\">My friends thought that they would like the study to be published in a high impact journal, and they were optimistic that such a large study in a middle income country on an important question with strong methods and a reliable answer would make it into a major journal.<\/span><\/p>\n<p><span style=\"font-weight: 400\">There are perhaps three main reasons for publishing in a major journal. Firstly, it might make it more likely that the study will lead to real improvement in the real world. This would be a good reason, but I don\u2019t think it\u2019s true: the route from a study to major scale up is long and complex, and publication is a necessary, but small and mostly unimportant step on that path. Secondly, your study may be noticed more, which is probably true\u2014but interviews on the BBC and articles in the <\/span><i><span style=\"font-weight: 400\">New York Times<\/span><\/i><span style=\"font-weight: 400\"> are flattering but usually not consequential. The third reason is academic credit, and the sad truth is that where you publish continues to be the major form of academic assessment even in countries, like Britain, where the assessing authorities warn against it.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For whatever reason my friends sent their study to major journal A. Both reviewers were impressed by the study but had quibbles and, it must be said, misunderstandings. Their comments were, however, cogent, and my friends responded to them clearly, politely, and effectively. Nevertheless, the journal rejected the paper as not a priority, meaning it wasn\u2019t in the top 5% or so the editors publish. This process took months and involved many hours of authors and reviewers. It probably involved far less time of editors, the only party being paid for their involvement in the process.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Essentially the same thing happened with major journal B and major journal C. Major journal D did at least reject the study quickly, simply saying it wasn\u2019t a priority. (What, you wonder, is a priority if a huge, well done study on a major condition in a middle income country is not? It isn\u2019t, you hope, a sexy study on some new, extremely expensive drug for treating a comparatively rare cancer.) <\/span><\/p>\n<p><span style=\"font-weight: 400\">None of the journals rejected the study on the grounds that it was \u201cnegative\u201d (the wrong word), but inevitably you wonder.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Years have now passed, some eight reviewers and multiple editors have assessed the paper, and the study is still not published. <\/span><\/p>\n<p><span style=\"font-weight: 400\">My guess is that the study wasn\u2019t ranked in the top 5-10% that the major journals publish, but was probably in the next 10%. As publishing is something of a lottery and the top 10% of one journal is not the top 10% of another, there is a logic to continuing to try for a major journal if you care about publishing in one. Most authors probably, however, drop to the second tier or go for a megajournal after two rejections.<\/span><\/p>\n<p><span style=\"font-weight: 400\">My advice to all authors is to consider their objectives. If their objective is real change in the real world, as I believe it should be, then they should publish as quickly as possible\u2014in a megajournal or <\/span><i><span style=\"font-weight: 400\">F1000Research\u2014<\/span><\/i><span style=\"font-weight: 400\">and put their energy into dissemination and implementation. Unfortunately, most authors are academics and have to worry about getting credit.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I think, however, that it\u2019s tragic that this important study is taking so long to publish, that so much time of the authors and reviewers has been wasted, and that much legitimate scientific discussion (the points made by the reviewers and the authors\u2019 responses) has been lost. This story, which is typical, shows a process hugely wasteful of time, intellectual effort, and money.<\/span><\/p>\n<p><span style=\"font-weight: 400\">And for what benefit? The only logic could be that the process is sorting science so that readers can find the most important by concentrating on a few journals; but we know this is a fiction. Scientists need to see the totality of the evidence, which is scattered across thousands of journals (or not published at all); and we know that major journals have a bias towards the new and sexy, which is why unsurprisingly what they publish is more likely to be wrong or retracted than in less grand journals.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We need to do better, and new models for publishing science are emerging.<\/span><\/p>\n<p><em><strong>Richard Smith<\/strong>\u00a0was the editor of The BMJ until 2004.<\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interest<\/strong>: RS spent 25 years being well paid for working as an editor on the BMJ and while chief executive of the BMJ Publishing Group was also responsible for the group\u2019s specialty journals. He now receives a generous pension from the BMA, which owns the BMJ and its accompanying journals. RS has been paid for consulting on <\/span><span style=\"font-weight: 400\">F1000Research <\/span><a href=\"https:\/\/f1000research.com\/\"><span style=\"font-weight: 400\">https:\/\/f1000research.com\/<\/span><\/a><span style=\"font-weight: 400\">, one of the new models for publishing science, and is working on the Open Pharma <\/span><a href=\"https:\/\/openpharma.blog\/\"><span style=\"font-weight: 400\">https:\/\/openpharma.blog\/<\/span><\/a><span style=\"font-weight: 400\"> project which is encouraging pharmaceutical companies to join funders like Wellcome and Gates in encouraging improvements in the publishing of science.<\/span><\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A friend from a middle income country writes to me in despair about the way he and his colleagues have been treated by medical journals. His story made me angry [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/28\/richard-smith-angry-at-the-delay-waste-and-inefficiency-caused-by-medical-journals\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-40722","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: Angry at the delay, waste, and inefficiency caused by medical journals - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/28\/richard-smith-angry-at-the-delay-waste-and-inefficiency-caused-by-medical-journals\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: Angry at the delay, waste, and inefficiency caused by medical journals - The BMJ\" \/>\n<meta property=\"og:description\" content=\"A friend from a middle income country writes to me in despair about the way he and his colleagues have been treated by medical journals. 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