Plus ça change . . .
Bruce P. Squires, MD, PhD
CMAJ 1997;157:1720-1
Dr. Squires is the former Editor-in-Chief of the CMA Publications Department and CMAJ. He is currently Vice-President of the World Association of Medical Editors.
© 1997 Canadian Medical Association
cientific publishing in peer-reviewed medical journals has seen dramatic changes in the last 2 decades. First, the introduction of the fax machine and the personal computer changed the way in which manuscripts are prepared, peer reviewed and published. In the early 1980s personal computers at CMAJ were rare, and processing manuscripts was laborious for both authors and editors -- endless typing, retyping and proofreading of hard copy as it evolved, step by step, from the authors' submitted version to the final published article. Now manuscripts are accompanied by electronic files, from which articles are edited and typeset on screen and transmitted to the printer by disk or modem. Furthermore, medical information is now disseminated not only through print journals, but also on an ever-growing number of journal Web sites.
For all this change, has the quality of information improved? Unfortunately, the electronic revolution has not altered in any fundamental way the most essential component of processing scientific medical information: its validation. Peer review still adheres to the same process that developed in the 17th century, and editing is essentially the same process, be it with quill pen, pencil or electronic keyboard. Only recently have peer review and medical editing become the focus of serious study and research.
|
Bedtime reading, 1997
|
It was confirmed recently at the third International Congress on Biomedical Peer Review and Global Communication, held in September in Prague, that peer review and editing do, indeed, improve the quality of medical manuscripts. However, both are fraught with imperfections. Peer reviewers and editors are often untrained and frequently miss major flaws in manuscripts under review, and they may have biases that unfairly influence the ultimate publication of manuscripts. And authors often lack the knowledge or the will to present their study findings clearly and honestly. The solution, at least to this observer, lies in concerted education of all medical scientists in the preparation and appraisal of reports of medical studies.
It was heartening at the Prague meeting to observe chinks in some of the shibboleths of the peer-review process. For example, editors who have painstakingly tried to ensure that authors and reviewers do not discover each other's identity will be pleased to learn that the task is probably not worth the effort. They will not be pleased, however, by the observation that they are selecting reviewers who do not necessarily have the competencies needed to evaluate manuscripts and that they are inconsistent in evaluating the work of their peer reviewers.
Authorship is also an object of increasing controversy. The number of authors per manuscript continues to grow, and authors seem to ignore or misunderstand what justifies being an author. The literature is still replete with manuscripts in which the stated authors are not authors at all or in which the real author is not given credit for authorship. The issue has become sufficiently hot that some editors are calling for a full listing of all contributors to a manuscript or study1 or at least demanding, as JAMA has done for some years, an explanation of what each stated author did to justify authorship. However interesting these approaches may be, editors will ultimately have relatively little effect on who is designated as an author; the authors' parent institutions are the only bodies that can set enforceable standards.
Of particular interest in this last decade has been the emergence of a myriad of clinical practice guidelines (CPGs). The CMA can be justifiably proud of its influence in the development of criteria for formulating and reporting evidence-based practice guidelines. Nevertheless, the job is not over. Too few CPGs have been validated by proper clinical trials, and relatively little effort has been expended to ensure that the guidelines are appropriately disseminated and implemented. Publication alone is insufficient to ensure that clinicians adopt CPGs; specific educational strategies are necessary to ensure that what is known is properly adopted into practice.
What is the place of the World Wide Web in medical publishing? Some would suggest that print journals are doomed to be succeeded by electronic ones; indeed, many journals -- CMAJ was one of the first -- already publish their tables of contents, abstracts and at least some articles in full text on their Web sites, and totally electronic journals have emerged, particularly in the physical sciences. Certainly, specialty journals that "talk" only to a few other similar specialists will probably be the first to take advantage of the economies and speed available through electronic publishing. General medical journals, I believe, will be slower to make the transition; their dependence on subscription and advertising revenue demands innovative approaches for ensuring financial viability on the Web. As well, many physicians do not yet use the Web routinely as a source of medical information. Nevertheless, editors cannot avoid for long the challenge to adapt their journals to the electronic media. But whatever the vehicle of publication, the quality of what is published will still depend on the competence of the authors, the peer reviewers and the editors.
It was in the interest of achieving that competence that the first meeting of the World Association of Medical Editors (WAME) was held this past September in Prague. Conceived in Bellagio, Italy, in March 1995, WAME now has almost 200 members worldwide and comprises not only editors who make substantive decisions about medical manuscripts, but also people who seriously study "journalology" -- a term coined by Stephen Lock, former editor of the BMJ. WAME aims to improve the quality of medical journals and to encourage research on medical editing. Rather than holding regular conferences, it will function as an electronic network to facilitate communication, education and support among editors. More information about WAME may be found at its home page (ama-assn.org/wame).
Medical publishing is changing, but the quality of information being published will not improve unless authors, peer reviewers and editors have the knowledge and skills to prepare, evaluate and revise reports of scientific studies. There is much yet to be done.
Reference
- Rennie D, Yank V, Emmanuel L. When authorship fails: a proposal to make contributors accountable. JAMA 1997;278:579-85.
 |
Send a letter to the editor responding to this article
Envoyez une lettre à la rédaction au sujet de cet article |
