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The material was
submitted to The Lancet. Copies of the
correspondence, plus reviewer's report, are
available. Funding: Tim Albert
Training Conflict of
Interest: Tim Albert Training provides courses in
writing scientific papers. OPENING
SENTENCES: Seminar:
'Onchocerciasis is a major public health and socio
economic problem in many rural areas of
Africa'. Alarmist:
'During the current decade in China there will be
about 15 million deaths from strokes, plus much
disability'. Much discussion
recently: 'Medical discussion about the end of
life for neonates and infants is under debate in
the Netherlands'. LAST
SENTENCES: Another puzzle
solved: 'It is clear, however, that care
guidelines for people with IDDM should now include
the treatment of early-stage renal disease with ACE
inhibitors, even in normotensive
patients'. More research is
indicated: 'Further studies will be needed to
determine optimum doses and duration of
therapy'. Perhaps
possibly: 'The prevention of rickets through
such means as health education, exposure of infants
to sunlight and vitamin D, and/or calcium
supplementation, as well as early treatment of
rickets, may be an important part of the global
effort in the control of acute respiratory
infection'. (All examples taken
from The Lancet, June 1997) |
Towards evidence based writing
One of us (KH) examined 50 consecutive research articles, dating from June 1, 1997, in three general journals (New England Journal, Lancet and BMJ) and three specialist paediatric journals (Journal of Pediatrics, Pediatric Research, Archives of Disease in Children). Three of these journals (BMJ, Lancet, Archives) are UK-based; the other three are US-based. In each article she counted the number of words in each headline, the presence or absence of a verb, and the presence or absence of a colon. She counted the number of authors, paragraphs in each section, use of 'we' in the methods section, figures, tables and references. She noted whether the last sentence of the introduction answered the question: 'what we did?' and the first sentence of the discussion answered the question 'what we found'. Using our previous classifications2, she allocated the first sentence of the introduction to one of three categories ('seminar', 'alarmist' and 'much discussion recently') and the last sentence of the discussion to one of three categories ('a puzzle solved', 'perhaps possibly' and 'more research is indicated'). The results are shown in table 1. Thirty three of the 50 BMJ articles contained a colon in the title (proportion = .66, 95% CI .529 to .791) compared with 28 of the 250 other journal articles (proportion = .112, 95% CI .073 to .151). Forty six of the 150 US articles contained a verb in the title (Proportion = .307, 95% CI .233 to .380) compared with 10 of the 150 UK articles (proportion = .067, 95% CI .023 to .107). The average number of authors in NEJM and Lancet articles (the two with the highest impact factor) was 7.72 (SD 3.45, 95% CI of mean 7.04 to 8.40). For articles in Archives of Disease in Childhood and Pediatric Research (those with the lowest impact factor) the average was 4.74 (SD 2.30, 95% CI of mean 4.28 to 5.20). A total of 97 of the 150 articles from general journals used 'we' in the methods section (proportion =.647, 95% CI .570 to ..723) compared with 41 of the 150 specialist journals (proportion = .273, 95% CI .202 to .345). Ten of the 50 Lancet articles had an alarmist opening sentence (proportion = .20, 95% CI .089 to .311) compared with 15 of the other 250 journal articles (proportion + .06, 95% CI .031 to .089). Nine of the 50 BMJ articles had a 'much discussions recently' opening sentence (proportion = .18, 95% CI .074 to .286) compared with 16 of the other 250 journal articles (proportion = .064, 95% CI .034 to .094). The findings throw up some challenging questions: Is the prestige of a journal the main determinant of the number of authors listed? Why do US journals have longer headlines, more paragraphs and more references? Do general journals prefer the active because they have more full-time staff working on the copy? Why is the Lancet more sensational than other journals? More importantly, the findings show that there are some clear differences in the journal 'market', and this has important implications. Intending authors should study their target journal closely and use this market research to inform the way they prepare the paper. We can describe this process as evidence-based writing. References: 1. Cameron H, Robertson A. The colon in medicine: nothing to do with the intestinal tract. BMJ 1997: 315: 1657-8. 2. Albert T. Winning the publications game. Oxford: Radcliffe Medical Press, 1997: 28 and 33.
Letter from Lancet: 'Many thanks for submitting
your Research Letter entitled, "Towards evidence based
writing". We sought external advice, but I am afraid that
our decision is against publication here. I enclose some
comments from my adviser which I hope prove some help, but
editorial priorities also contributed to our decision. Comments from reviewer (anonymous): 'This letter presents a novel way of looking at an author's ability to publish related to writing style rather than manuscript content. It is an interesting idea - knowing your audience is an important part of any form of presentation; written or verbal. 'Firstly, one would hope that the discerning journal editor would place greater emphasis on manuscript content than writing style. The latter is relevant but meaningless in the absence of the former. As a peer-reviewer, for example, the number of paragraphs is irrelevant to a recommendation for or against publication. There are many other (more important) factors that contribute to the ability to successfully publish a manuscript. The contribution of each factor needs to be considered in the light of all the others. 'An important question is whether or not it is the journal editors or the authors who change a manuscript to suite a particular journal's style. Is the style of the published article, therefore, a reflection of the original submission or of editorial licence. The study currently reported is a retrospective review of published manuscripts and we cannot answer this question using the information to hand. We also know nothing about the manuscripts submitted at the same time and subsequently rejected. 'I am not sure the content of this letter helps authors to "know" their audience any better. When writing a manuscript a decision is made somewhere along the line as to which journals might be appropriate. The criteria used by authors to select journals was de scribed in a study by F Frank (Authors' criteria for selecting jouronals. JAMA 272 (2), 163-4, 1994). The top 5 criteria identified were: - the journal's prestige 'We can conclude from the current study that journals have different styles. Whewther or not knowing this can help authors to successfully get their manuscripts through the peer-review process and published is debatable.'
Appeal to Lancet: 'Thank you for your prompt response to our research letter. I read with interest the comments from your reviewer. Having spent many happy hours in training courses advising writers to appeal if they can make a logical and sensible case that the reviewer has misinterpreted the paper, I thought I would take my own advice… '1. The prevailing ideology among scientists is that the publication of scientific papers is based on rational selection (or the nearest one can get to it). We believe that the publication of scientific papers can be seen also as a commercial process. There is a market economy, in which those who can match most closely the needs of the client will have the greatest success. '2. No-one disputes that journals vary in terms of content. What we have found resistance to is the notion that there are other (structural) variables. What our study set out to test was whether this was in fact so. '3.We were delighted that your reviewer felt this was a novel idea. We were also delighted to note that he had no methodological queries. '4.However, your reviewer then went on to reject this finding as of no interest. This is based not on data but on opinion: 'I would hope… I am not sure…'. The only paper your reviewer cites is based on writers' self-reported views on why they submit to certain journals, which is not relevant here. '5. We believe that your reviewer's attitude demonstrates why the letter should be higher in the list of priorities for a journal like The Lancet that aims to challenge established dogmas. As your reviewer states, it is 'arguable' whether writers will benefit from seeing the publication process as not just an academic exercise but a marketing one as well. We believe it should be discussed in public, and - for the first time - provide some data to inform the arguments. 'I would therefore formally ask you to reconsider your decision. Yours sincerely...'
Response from Lancet: 'I have discussed your appeal letter with the Deputy Editor,...but I am afraid that our decision remains the same - against publication here. We take your points about our reviewer's comments, but are unpersuaded that our e ditorial priorities need change in this case.' Yours sincerely...' |
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