How can I get my paper published in
the BMJ?
Tony Delamothe
deputy editor, BMJ
With a little help from Trish Groves and Richard Smith
What I want to talk about
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Knowing me, knowing you
Why do you want to publish?
What do journals want to publish?
What is the publication process?
How is publishing changing?
What’s the BMJ?
• In print since 1840
• Online since 1995; full text since 1998
• Research articles remain Open Access.
Recent changes
• Direction: “to help doctors make better decisions”
• Look and feel of print journal: more magazine-like
• New online model: publishing oblivious to print.
General medical journals
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Annals of Internal Medicine
BMJ
JAMA
Lancet
New England Journal of Medicine
PLoS Medicine
Why do you want to publish?
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Answers please on a flip chart
Why publish?
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Because you have something important to say
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To change practice
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To promote thought or debate
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To allow examination of your work
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To get your work in a high impact factor journal (aka “Fame and
the love of beautiful women” or men)
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To make money
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To advance your career/keep your job
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To entertain/divert/amuse
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To educate
What do medical journals want to publish?
medical journal
Remember journalistic values
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new
true
important
of interest to our readers
Medical journals want to publish material that is:
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new
true
important
of interest to our readers
Our commonest reasons for rejection are:
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Too
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Too
well known
specialist
inconsequential
far removed from patient care or public policy
The brutal reality
• A mismatch between what you as
authors/researchers want and what we as
medical journal editors want
(and guess who gets to decide?)
• In journalism readers take precedence over
authors
Published and be damned?
• “Why is medicine so obsessed with those who can
convince others to read what they have written? Other
professions- dentists, lawyers, accountants - are judged
on what they can do, rather than how many papers they
have published…
• “Ultimately our love of publications comes from the
misguided belief that being scientists and researchers is
a critical part of the practice of medicine. While this may
indeed have been true during the past – Paul
Langerhans discovered the pancreatic islets while at
medical school – the professionalisation of medical
research means that such discoveries are unlikely to be
replicated in the future…
Writing that paper: before you begin
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What do I have to say? (“The message”)
Is it worth saying?
What is the right format for the message?
Who is the right audience for the message?
Where should I publish the message?
Select journal on basis of its audience, not its
impact factor or “reputation”
Writing that paper: before you begin
• Who is the right audience for the message?
• Where should I publish the message?
Select journal on basis of its audience, not its impact
factor or “reputation”
What do I do next?
Find out what the journal wants from its:
Instructions to authors
Advice to contributors
Resources for authors
Not just research articles..
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Editorials
Letters
Analysis articles
Educational articles (from Clinical review to
case reports)
• Personal views, reviews
BMJ - general guidance to follow
• Guidelines for reporting research, at the EQUATOR network
resource centre
http://www.equator-network.org/
• International Committee of Medical Journal Editors uniform
requirements for manuscripts submitted to biomedical
journals
http://www.icmje.org/
• The code on good publication practice produced by the
Committee on Publication Ethics
www.publicationethics.org.uk/guidelines/
COPE guidelines on good publication practice cover
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Study design and ethical approval
Data analysis
Authorship
Conflicts of interest
Peer review
Redundant publication
Plagiarism
Duties of editors
Media relations
Advertising
Dealing with misconduct, including sanctions
Ethics: not an optional extra
Think about the wider ethical aspects of your research,
even if the study was approved by an ethics committee:
• might the paper allow patients’ identities to be revealed?
• does the paper say enough about the information
participants were given before consenting?
• how much does this deviate from current normal
(accepted, local) clinical practice?
• what was the full burden imposed on participants?
• what total risks were participants or others exposed to?
• what benefit might accrue to participants or others?
• what are the potential benefits to society and future
patients?
• Do you have an ethical obligation to report research on
humans?
Good reporting is part of good scientific practice
• Manuscripts should present sufficient data for
readers to:
– Reproduce the study
– Fully evaluate the information and reach their own
conclusions about the results
• So the key sections are: Methods and Results
• Misrepresentation of studies and misleading
information abound
Writing that paper
Structure is all.
Make sure that readers know where
they are, where they are going, and
why.
Writing that paper: IMRaD
• Introduction—Why did I do it?
• Methods--What did I do?
• Results--What did I find?
and
• Discussion-- what might it mean?
Writing that paper: Introduction
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Why did we start?
Tell “the story so far”
Why was this study needed?
Be sure that readers understand the importance of the
study-but don’t overdo it
• Don’t try to show readers that you have read everything
• Short, short, short
Writing that paper: Methods
• Should be given in enough detail to allow
another researcher to repeat the study
• like a recipe
• describe inclusion and exclusion criteria
• describe outcome measures
• describe intervention
• give references for standard methods
• explain ethics issues
• follow reporting guidelines as explained at
(http://www.equator-network.org/
Writing that paper: Results
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Stick to what is relevant
Be sure to include basic descriptive data
The text should tell the story
The tables give the evidence
The figures illustrate the highlights
Use confidence intervals rather than p values
Think about absolute risk, number needed to treat, etc
Avoid starting discussion
Essential summary statistics for results
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For a clinical trial:
– Absolute event rates among experimental and control groups
– RRR (relative risk reduction)
– NNT or NNH (number needed to treat or harm) and its 95%
confidence interval (or, if the trial is of a public health
intervention, number helped per 1000 or 100,000)
• For a cohort study:
– Absolute event rates over time (eg 10 years) among exposed and
non-exposed groups
– RRR (relative risk reduction)
• For a case control study:
– OR (odds ratio) for strength of association between exposure and
outcome
• For a study of a diagnostic test:
– Sensitivity and specificity
– PPV and NPV (positive and negative predictive values)
Writing that paper: Discussion
• statement of principal findings
• strengths and weaknesses of the study
• strengths and weaknesses in relation to other
studies (especially systematic reviews), and
key differences
• meaning of the study: possible mechanisms
and implications for clinicians or policymakers
• unanswered questions and future research
• go easy on the last two
Topping and tailing
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Title: Include design; Don’t try to be clever
Abstract: Must be structured
References: Keep to the essentials
Covering letter: Something very crisp
Authorship, acknowledgements,
competing interests
Pesky bits
• Trial registration
• Authorship and contributorship
• Competing interests
(publishing in journals is definitely becoming
more onerous - because the realisation that
the effects of journal articles can be profound)
Trial registration
• Include the registration number of the trial and the
name of the trial registry. Please add these to the last
line of your paper’s structured abstract. The BMJ’s
criteria for a suitable public trial registry are: free to
access, searchable, and identifies trials with a unique
number; registration is free or has minimal cost;
registered information is validated; registered entry
includes details to identify the trial and investigator and
includes the status of the trial; and the research
question, methodology, intervention, funding, and
sponsorship must all be disclosed.
• FDAAA additions
Authorship and contributorship
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credit and accountability
many authors on papers have done little
people’s names are left off papers
authors do not know the authorship criteria
contributorship statement is more inclusive
and accurate – says who did what
Authorship
Authorship credit should be based only on substantial
contribution to:
• conception and design, or data analysis and
interpretation and
• drafting the article or revising it critically for important
intellectual content and
• final approval of the version to be published.
All these conditions must be met.
Participation solely in the acquisition of funding or the
collection of data does not justify authorship.
All authors included on a paper must fulfil the criteria
No one who fulfils the criteria should be excluded
Contributorship
• contributors (some of whom may not be
included as authors) listed at the end of the
paper, giving details of who did what in
planning, conducting, and reporting the work
• one or more are guarantors, who accept full
responsibility for the work and/or the conduct
of the study, had access to the data, and
controlled the decision to publish
• researchers must decide among themselves
the precise nature of each contribution
Who did what?
Helen C Eborall, post-doctoral research fellow1,
Simon J Griffin, programme leader2, A Toby Prevost,
medical statistician1, Ann-Louise Kinmonth, professor
of general practice1, David P French, reader in health
behaviour interventions3, Stephen Sutton, professor
of behavioural science1
Contributors: SS, DPF, ATP, A-LK, and SJG conceived
and designed the original protocol. All authors were
involved in amending the protocol. HCE coordinated the
study throughout. Data entry was carried out by Wyman
Dillon Ltd, Lewis Moore, and HCE. HCE cleaned the data
and ran preliminary analysis with input from Tom
Fanshawe. ATP analysed the data. ADDITION trial data
were supplied by Lincoln Sargeant and Kate Williams.
HCE wrote the first draft of the manuscript with ATP and
SS. All authors contributed to subsequent and final
drafts. HCE is guarantor of the paper.
Conflict of interest: a definition
Conflict of interest is a set of conditions in
which professional judgement concerning a
primary interest (such as patients’ welfare or
the validity of research) tends to be unduly
influenced by a secondary interest (such as
financial gain).
Thompson DF. Understanding financial conflicts of interest. N Engl J
Med 1993; 329: 573-6.
Competing interest
A person has a competing interest when he or
she has an attribute that is invisible to the
reader or editor but which may affect his or
her judgment.
Why does a competing interest matter?
• it may have a profound effect on authors’
judgment
• there’s a perception that this can happen,
whether it does or not
The best policy on competing interest
Always declare a conflict of interest,
particularly one that would embarrass you if it
came out afterwards
Problems with conflict of interest
• Should it be just financial or personal, academic, political,
religious, anything?
• People don’t declare it because a) it implies wickedness; b)
they are confident that their judgment is not affected
• Might we avoid these problems by changing “conflict of
interest” to “relevant” or “competing” interests?
Transparency and integrity
• The BMJ expects authors to present their work
honestly and fully
BMJ transparency policy is at:
http://resources.bmj.com/bmj/authors/editorial-policies/transparency-policy
The rudiments of style
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Short words
Short sentences
Short paragraphs
No jargon
No abbreviations
Prefer Anglo Saxon over Latin words
Prefer nouns and verbs to adjectives and adverbs
Cut all cliches
Prefer active to passive tense
Prefer the concrete to the abstract
BMJ’s publication process
BMJ process
The average time from
submission to first
decision is two to three
weeks and from
acceptance to publication
eight to 10 weeks. These
times are usually shorter
for original research
articles.
What is peer review?
• As many processes as journals or grant giving bodies
• No operational definition--usually implies “external
review”
• Benefits come from improving what is published
rather than sorting the wheat from the chaff
BMJ open peer review
• we ask reviewers to sign their reports and
declare any competing interests on any
manuscripts we send them
• reviewers advise the editors, who make the
final decision (aided by an editorial manuscript
committee meeting for some articles, including
original research)
BMJ peer review process I
• 7000 research papers, 7% accepted
• approximate numbers at each stage:
– 1000 rejected by one editor within 48 hours
– further 3000 rejected with second editor
– within one week of submission 3000 read by senior
editor; further 1500 rejected
– 1500 sent to two reviewers; then 500 more rejected
– approx 1000 screened by clinical epidemiology editor
and more rejected
BMJ peer review process II
• 400-500 to weekly manuscript meeting attended by the
Editor, an external editorial adviser (a specialist or
primary care doctor) and a statistician..
• …and the full team of BMJ research editors, plus the
BMJ clinical epidemiology editor
• 350 research articles accepted, usually after revision
• value added by commissioned editorials and
commentaries
Appeals
• always willing to consider first appeals (letter
first; no need to submit revised paper initially)
• more success if authors respond in detail to
editors’ and reviewers’ criticisms
• perhaps 20% accepted on appeal
• no second appeals
Reasons for us to say no
Triage questions: treatment papers
• Is it a randomised controlled trial or a systematic
review (see later)?
• If it is not an RCT, is it reasonable not to have done
one?
• Look for an answer to the question in the paper. If
you can’t find one, reject.
• If it is an RCT, was it really randomised?
• If it wasn’t, reject unless you can find a good
reason for not randomising
Triage questions: prognosis studies
• Is there a cohort of patients followed
followed prospectively from when they
were first identified with the disease?
• Are 80% of patients followed up?
• If the answer to these questions is no, we
probably don’t want it.
Triage questions:
Questionnaire survey
• We probably don’t want. This is people saying what
they do rather than evidence on what they do
• But is it telling us something important that we
probably can’t get information on in any other way?
• Or might it be a peg for an educational article.
• If the response rate is below 55% we almost
certainly don’t want it.
Triage questions: two sorts of studies we don’t want
• Prevalence study
• Boring
• Usually not possible to generalise beyond the
particular population
• Cost of illness study
• Boring
• Value is in the exactness, which is usually of
interest to only a few
• Again hard to generalise
And when we do publish your article...
BMJ open access
• every research article published in the BMJ is
immediately accessible on bmj.com to everyone at no
charge
• the full text of all research articles is also sent, without
further intervention from the author, to PubMed Central,
the National Library of Medicine's full text archive, which
makes it fully accessible without delay
• the BMJ immediately fulfils the requirements of the US
National Institutes of Health, the UK Medical Research
Council, the Wellcome Trust, and other funding bodies
to make publicly funded research freely available to all
Thanks
Tony Delamothe
tdelamothe@bmj.com