Abstract
I have read that more than 100,000 medical journals are being published currently. No one can possibly read them all; few of even the most diligent would read more than one tenth of one per cent of the total. Some will be so esoteric that only their authors will understand their contents; others will be aimed at the general medical reader. Whole libraries of medical books are published each year; their advertisements lead you to believe that it would be dangerous to practise without a full knowledge of their contents.
On top of all that is information from the Royal Colleges, the AMA, the medical defence organisations and a dozen other worthy bodies trying to keep us properly informed and out of trouble. There is endless material from the pharmaceutical companies and then there is the Net. Doctors are not deprived of information, they are drowning in it.
THE POTENTIAL READERS
One unpublished study showed that about a fifth of the potential medical readership had specific routines for keeping up with the literature and a further 10% achieved this state when concerned with direct and immediate goals, such as accreditation. A quarter of them felt that they knew enough and studied only topics that interested them and about half had almost given up, looking for easily accessible information on particular patients. A few had succumbed completely. These results will not apply to all possible readerships, but they give at least an indication of how things may be.
THE DUTIES OF EDITORS
The first duty of editors is to discover the nature of the target readership. This is not as easy as it sounds: not only is it likely to have the qualities set out above but interests may vary widely. Thus the editor of a psychiatric journal will be aware that some of its readers will be behavioural therapists, others psychoanalysts, others enthusiastic neuroimagists and some will have interests which are arcane indeed.
The task is to tread a path which will involve them all to a significant degree and to identify some interests common to most of them, such as avoiding being sued, increasing their incomes or climbing further up the academic ladder. Then one can add information and education.
Next one has to do one's best to entice potential readers of the journal to pick it up, open it, start reading and keep on reading. Even better, they may look forward to the next issue.
Appearance matters. The cover illustration, the table of contents, the typefaces, the amount of colour these and other technical considerations are important. Here we are more concerned with the contents.
THE QUALITY OF THE CONTENTS
Readers are entitled to feel confident that the information they are acquiring is accurate and up to date. Editors have to ensure that this is the case. There are problems. Some articles are submitted by authors whose enthusiasm for particular topics and procedures has overthrown their judgment, others by authors who have received grants from particular entities to write about specific treatments. The literature has many examples of research which reflect its financial backing. For example, the quality of the trials published in supplements to major journals is generally of inferior quality to that of articles in the parent journal. It will be understood that most supplements exist because of sponsorship.[1]
Other problems faced by editors are plagiarism and eminent persons allowing their names to be submitted as authors of articles to which they have not contributed. This has been given the wonderful name of ‘polyauthoritis giftosa’.[2] There is also the offering of material which has already been published - slightly altered - in one or several journals. Thus, one clinical trial was published in 83 separate journals.[3]
You may believe that peer reviewing will protect editors against debacles of this kind. It is an essential process but it has its limitations. It is common for two peer reviewers, expert in the relevant field, to give diametrically opposed opinions. Enlisting two more equally eminent reviewers may well produce the same result. Editors have to make up their minds and take responsibility in the end.
Again, peer reviewers are human. In one study, 12 articles already published in a particular journal had the names of the authors or the institutions altered and were sent to reviewers of the same journal. Only 3 of the 12 articles were recognised as having been published, and 8 of the other 9 were rejected by their new reviewers.[4]
Even worse, a study reported in Brain concluded that agreement between reviewers in clinical neurosciences was little greater than would be expected by chance alone.[5] Two consequences are that editors have to read everything very carefully indeed and that anyone who has absolute faith in the peer reviewed literature should think again.
If you are a peer reviewer, concentrate on the specific rating scales that the journal has given you - come to your global opinion only after doing that. Do not write comments in the text of the article sent to you. The editor may have sought the opinion of a number of referees and it is time-wasting and irritating to have to inspect every page of every copy sent out for review to discover what the reviewers could have said on the summary sheets.
WHAT AUTHORS CAN DO TO HELP
One of the difficult things for editors to do is to write letters to hopeful contributors of all levels of standing explaining why their article is not acceptable. In my experience the most common reason is that they have written without keeping their potential readers in mind. Most readers most of the time turn to articles which are likely to help them with the problems they meet in their daily clinical life. It is true that work which is likely to win the Nobel Prize is quite different, but then it is likely to be published in very specialised journals. If you are writing for most of your colleagues, reflect upon what they are looking for in the journal.
A common problem is the high level of specialised knowledge possessed by the authors. His or her paper would interest those at the same level, but most readers, after encountering for example some paragraphs of complex immunological arguments, will give up and move on.
The notion that a scientific paper should be written in a special language is nonsense: it should be in good, plain English. People do not ambulate and take oral fluids; they walk and they drink. Why say ‘aetiology’ when you mean ‘cause’, and why accomplish something by the utilisation of X when you mean that you do it by using X.
Avoid the passive voice and do not shrink from using the first person -‘I did this’. Use as few acronyms as possible and spell each one out the first time you use it.
The use of subheadings helps authors to achieve a logical development of their ideas. If the journal format accepts it, offer four or five simple short sentences which summarise what you have to say so that they can be highlighted or placed in a box.
Be brief. Few medical topics are fascinating. Even though you write with clarity and elegance most readers' minds will have begun to wander after 2000 words and few will remain after 3000. Aim for the lesser figure; do not exceed the greater, for if you do the editor has to spend time crossing out all the unnecessary material which has inflated the length of your article.
Sometimes an illustration, a table or a flow chart can replace many words.
CONCLUSION
Editors have to work hard to make their journals readable, reliable and informative. Their burdens would be less if potential contributors would remember that the central purpose of publication is communication and that to be read and understood one must keep one's readers in mind.
If you have funding or a position which could give you a potential conflict of interests, then let the editor know.