Writing, Publishing, and
Reviewing Papers
Howard Bauchner, MD
Editor-in-Chief, JAMA and The JAMA Network
Senior Vice President, AMA
Professor of Pediatrics and Public Health
Boston University School of Medicine
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Talking Points
• JAMA
• Brief Biography
• Writing and Publishing
• Peer-Review Process
• Other Issues
• Slide 2
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JAMA
• First published in 1883
• General medical journal
• Appears 48 times per year
• Occasional theme issues
• Flagship publication of AMA
• Editorial independence
• Importance of the brand
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Readers, Networkers, Listeners
Viewers, Learners
Readers
Listeners
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• 18,000 listen weekly to EICs weekly podcast
• 2,000 listen to weekly author VP reading
• 5,000 listen to other podcasts
330,000 subscribers
150,000 MDs read weekly content in CMJ
575,000 weekly eTOCs
900,000+ weekly online first alerts
105,000 registrants of TJN Reader
25M PDF/HTML downloads per year
JAMA Pediatrics 3M PDF/HTML per year
20,000 MDs view content on Univadis weekly
1000 subscribers to daily news@JAMA
(monthly hits ~9000)
Social Networkers
• Twitter 125,000+
• Facebook 190,000+
Viewers
• 2,000 view our weekly author videos
• 20,000,000 see weekly JAMA report videos
Learners
• 2,000 participate in weekly CME
quizzes completed
• 2,600 readers responses to Clinical Challenge
We touch ~ 1M physicians each week with our content
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JAMA
Archives of Dermatology
Archives of Facial Plastic Surgery
Archives of General Psychiatry
Archives of Internal Medicine
Archives of Neurology
Archives of Ophthalmology
Archives of Otolaryngology—Head &
Neck Surgery
• Archives of Pediatrics & Adolescent
Medicine
• Archives of Surgery
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JAMA
JAMA Dermatology
JAMA Facial Plastic Surgery
JAMA Psychiatry
JAMA Internal Medicine
JAMA Neurology
JAMA Ophthalmology
JAMA Otolaryngology—Head & Neck
Surgery
• JAMA Pediatrics
• JAMA of Surgery
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Brief Biography
• Training BUSM, BCH (BMC), Yale-New Haven
• Pediatrician and Hospitalist
• Training in Epidemiology and Biostatistics
• Division Chief, Vice-Chair, Mentor
• Sabbatical at Packard Foundation and AHRQ
• Editor in Chief of ADC 2003-2011
• Editor in Chief of JAMA 2011• Slide 7
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Writing and Publishing
 http://www.equator-network.org
 Theme and organization
 Abstract, introduction, methods, results, discussion
 Keys to success
 First draft and common mistakes
 Submitting your paper
 Responding to peer-review
• Slide 8
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Major Theme of Paper
 What are your 2-3 important points (that is remembered)
 Emphasize in results section of the abstract
 Conclusion of the abstract should reflect these points
 Highlight in results section of paper
 Emphasize in tables
 Highlight in first paragraph of conclusion
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Structure of an Article
• Introduction
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2-3 paragraphs
Brief 300-400 words
The frame for your study
Invoke higher authority
• Methods
– 3-5 paragraphs
– Explain in English and justify use of unusual statistics
• Results
– 5 paragraphs
– 1st paragraph describe the sample
– Text should not duplicate tables/figures
• Discussion (structured)
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Principal findings
Strengths and limitations
Strengths and Limitations vis a vis other studies
Meaning of study
Unanswered questions/future research
• References – landmark papers and most recent publications
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Follow the Instructions!
 Article type – original, review, etc.
 Cover page – title, word count
 Length – critical issue (less is more)
 Abstract – single most important page
 Cover letter – concise statement of importance
 Speak with editor(s) first – although often
generates a standard response
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A Good Abstract
 90% of us read ONLY the abstract
 Structured
 Concise (300-400 words, 10,000 characters)
 Keep odd abbreviations to a minimum
 Some data
 Accuracy of data
 Beware dataless abstracts
 Conclusions
 Best to have outside reader
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Dataless Abstracts!!!
 Results Mixed-modeling analyses were used to examine differences in the rate of
weight gain over time based on the extent to which children exhibited the ability to selfregulate in the behavioral procedures. Compared with children who showed high selfregulation in both behavioral protocols at ages 3 and 5 years, children who exhibited a
compromised ability to self-regulate had the highest BMI z scores at each point and the
most rapid gains in BMI z scores over the 9-year period. Effects of pubertal status were
also noted for girls. l
 Results Multivariate linear regression analyses showed that increased sugarsweetened beverage intake was independently associated with increased HOMA-IR,
systolic blood pressure, waist circumference, and body mass index percentile for age
and sex and decreased HDL cholesterol concentrations; alternatively, increased
physical activity levels were independently associated with decreased HOMA-IR, lowdensity lipoprotein cholesterol concentrations, and triglyceride concentrations and
increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugarsweetened beverage intake and high physical activity levels appear to modify each
others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing
high-density lipoprotein cholesterol concentrations.
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Poor Abstract
Purpose: To determine the prognostic value of early electroencephalograms (EEGs)
in full-term neonates suffering from hypoxic ischemic encephalopathy (HIE) exposed to
whole body hypothermia (cooled group), compared to neonates treated conventionally
(control group).
Design: This retrospective observational study included all full-term neonates born at
Grenoble Hospital between 2000 and 2006 with symptoms of HIE. The first two EEGs
were reviewed retrospectively and classified according to current electrophysiological
criteria. EEGs in the cooled group were performed at a mean body temperature of
33°C. Neurological outcome was correlated with EEG pattern.
Results: An EEG pattern of inactivity (stage 4) on the first EEG was associated with
death in 60% of the control group, while all survivors had neurological sequelae. In the
cooled group, this EEG pattern was only predictive of death in 40% and all survivors
but one had a normal outcome. Mild abnormalities on the first EEG correlated with a
good prognosis in both groups. The second EEG had a high predictive value,
particularly in the cooled group. Persistence of stage 4 three days after birth was
always associated with death.
Implications: Early EEGs are good prognostic indicators of outcome in neonates with
HIE. Stage 4 EEGs may not always indicate a poor prognosis in neonatal HIE treated
with hypothermia.
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A Good Introduction
• Short
• Focused
• Evoke higher authority
• 10-15 references
• Can be 25% shorter
• Criticize others with care
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Good Introduction
Artemisinins are established antimalarial agents with an excellent safety
profile.1 Artemisinin-based combination therapies are now recommended by
the World Health Organization (WHO) as first-line treatment of uncomplicated
falciparum malaria in all areas in which malaria is endemic.2 Replacing
ineffective, failing treatments (chloroquine and sulfadoxine–pyrimethamine)
with artemisinin-based combination therapies has reduced the morbidity and
mortality associated with malaria.3,4,5 Parenteral artesunate is replacing
quinine for the treatment of severe malaria.6 Recently, there have been signs
that the efficacy of artemisinin-based combination therapy and artesunate
monotherapy have declined in western Cambodia.7,8,9,10 Artemisinin
resistance would be disastrous for global malaria control. To characterize
treatment responses to artemisinin derivatives and provide evidence for
planning containment-measure strategies, WHO and the National Malaria
Control Programmes of Cambodia and Thailand established a multipartite task
force. The trials reported here were conducted as part of this initiative.
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Methods
• Clarity and details
• Hypothesis and outcomes
• Describe the study – who, what, where, when
• Measurement
• Use common methodological and statistical
terms
• Understanding what happened to a single
patient
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Statistics
• Details
• Power and sample size
• Describe all tests and assumptions
• Details on model building and assessment
• Describe uncommon statistics
• Treatment of missing data
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Results
• Describe the sample
• Primary outcome
• Secondary outcome
• Exploratory outcome
• Text vs Tables and Figures
• Supplemental Data
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Discussion
• Very difficult to write
• Summarize key findings
• Place results in greater context
(other research, societal issues)
• Meaning of study
• Other issues
• Limitations
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Keys to Success
 Clarity (abstract)
 Brevity (2500 words)
 Novelty (why this journal)
 Modesty (some)
 Read the journal (often)
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Your First Draft
 Just write!
 Do tables or abstract first
 Circulate as a full paper
 Double space except for tables/references
 Do not list authors without talking with senior author
 Date all drafts, number pages
 Prompting your co-authors
 Get examples of similar papers
 http://www.equator-network.org
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Oops! Common Mistakes
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Circulating a draft before discussing authorship
Rushing the abstract at the end
Poorly referenced paper
Spelling errors in text and references
Data in abstract that are not in the paper
Data in abstract that are different from the paper
Bait and switch – emphasizing secondary rather than
primary outcomes
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Common Mistakes (con’t)
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Relative vs absolute differences
Too many messages and comparisons
Inconsistencies
Lack of clarity
• Exaggeration of findings
• Methodological/statistical clarity
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Submitting Paper
• Choosing Journal
• Suggesting Reviewers
• Cover Letter
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Is it the Correct Journal?
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This is a critical issue for authors and journals
Can be subjective decision by journal
Beware of case-reports
Is the topic timely
• Most journals can reject without review
• Review the journals you are considering
• Is it worth shooting high, but failing (impact factor)
• Must read journal prior to submission
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Impact Factors* - 2013
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AIM
BMJ
Cell
Health Affairs
JAMA
JAMA-IM
JAMA-Neuro
JAMA-Peds
JAMA-Psych
Lancet
Nature
NEJM
PLOS
Science
16 (5266/327)
16 (9696/592)
33 (24936/753)
4.3 (2277/527)
30 (13735/452)
13 (4093/309)
7.0 (2558/365)
4.3 (1162/274)
14 (3423/249)
39 (23093/589)
42 (72420/1710)
54 (38584/709)
14 (3374/241)
31 (53605/1703)
*No. of citations/no. substantive reports previous 2 years
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Cover Letter
• Correct name and spelling of editor
• Short and Sweet
• Why this journal
• Why is paper important
• Recommend (or not) specific reviewers
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Peer-Review
• Processing of Manuscript
• Peer-Review
• Rejection without Review
• Slide 30
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Manuscript Processing at JAMA
Triaging Editor
(paper can be
rejected)
Triaged to
Manuscript
Meeting (stats
review mandatory)
Returns to
Manuscript
Meeting
Associate Editor
(paper can be
rejected)
Assigned to 2-5
Peer-Reviewers
(paper can be
rejected)
Rejected or
Revised or ERBR
Manuscript
Returned to
Author for
Revision
ACCEPTED or REJECTED !!!
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Rejection without Review
 Usually editors/sometimes committee
 JAMA – Pediatrics (2014)
 1142 original research reports
 66% rejected without review
 Acceptance rate 9%
 JAMA – Neurology (2014)
 1227 original research reports
 81% rejected without review
 Acceptance rate 12%
 JAMA – Internal Medicine (2014)
 1703 original research reports
 87% rejected without review
 Acceptance rate 9%
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JAMA – 2014 Key Data
• 4846 research submissions - ~4% accepted
– 66% rejected without review – within days
– ~1650 papers sent out for review - decision in 2-3 months
– ~ 220 papers revision requested ~ 85% accepted
– ~ 4% acceptance rate
• No delay from acceptance to publication
• Late-breakers - ~ 46 published in 2013
• 1500 VPs submitted - ~12% accepted
• 125 editorials solicited – vast majority accepted
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Rejection without Review – Why?
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Wrong journal – journals have specific missions
Incorrect format (editors are sensitive beings)
Data too old to be relevant
Not new or novel
Poorly written abstract
Poorly designed/wrong analysis
Sweeping conclusion
Case-report
You did not read the journal
Editor having a bad day (this happens) !!!
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Paper Accepted for Review
 Assigned to editor (not EIC)
 Most editors have areas of expertise
 Editors may send article out for review
(rejection without review can occur here)
 No magic number of reviewers – 2-5
 At JAMA every research paper undergoes
statistical review prior to manuscript meeting
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Peer-Reviewers
 You can recommend reviewers to editor (and
individuals not to review – plus/minus)
 Recommended reviewers rate paper the same as others,
but more often recommend acceptance
 Chosen from “list” of reviewers that journal
generally uses
 Some subject areas difficult to find reviewers –
editors search reference list or Medline
 Process takes 1-3 months
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Peer-Review
 Little science – a fair amount of research
 Quality varies, best reviewers are 35 to 45
 Time – 2-4 hours depends upon manuscript
 Not much difference between blinded and
unblinded reviews
 Increasing concern about biases/conflicts of
interest of reviewers
 Transparency being debated
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What Do Reviewers Assess
 Importance
 Clarity
 Design and analysis
 Should review abstract, text, tables, figures, references,
acknowledgements/support
 Make recommendation to editor
 Opinions of reviewers are not binding
 Usually provide comments to authors and separate
comments to editors
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Editors
 Review paper
 Review comments from peer-review
 May request statistical help
 Make recommendation to and participate in
manuscript review meeting
 Accept; accept with revision; reject with revision; reject; short
report; research letter
 Discussed vis a vis importance and validity
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Responding to Reviews
 Answer completely, answer politely, answer with
evidence
 Most times the reviewer/editor are correct
 Reviewers provided conflicting suggestions - ask editor
 You do not have to respond to every issue, but must
articulate why not
 Follow directions – i.e. number responses, indicate
changes in manuscript and where they can be found
 Long explanations to editor in cover letter is not the
same as modifying the text
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Responding to Comments
Dear Dr. Moyer,
We are pleased to resubmit the revision of our A/R - Manuscript 2010-3686,
Management of Children with Sickle Cell Disease: A Comprehensive Review of the
Evidence” for Pediatrics. We appreciate the valuable and detailed comments provided
by the reviewers. In addition to the point-by-point responses, we have provided our
responses to the items from the editors below. Please do not hesitate to contact us if
you have additional suggestions on improving the paper. Thank you.
I. Response to Editors:
1) Your revised paper should not exceed 2700 words (excluding the abstract, acknowledgments,
references, tables, figures, and appendices).
Response: The word count of this revised manuscript is 2699 words. Minor edits were made
throughout this manuscript in order to address the reviewers’ comments.
2) Your main title in the Scholar One title box (see above) is different from your main title on the
manuscript itself. They should be the same.
Response: We apologize for this confusion. The title in the Title Box now matches the title on the
Manuscript, “Management of Children with Sickle Cell Disease: A Comprehensive Review of the
Evidence.”
• Slide 41
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Polite Responses
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We agree with the referee that ---- but…
The referee is right to point out ---- yet…
Although we agree with the referee that…
We, too were disappointed by the low response rate.
• We support the referee’s assertion that ---, although…
• With all due respect to the reviewer, we believe that this point is
not correct.
Data not words are a better response
• Slide 42
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Dear God:
Thank you for submitting your paper about “Creating Life.” Your paper was
reviewed by external editors and the consensus is that it will not be acceptable
in its present form. We were quite concerned about your methodology. The
main issue raised by the Reviewers were:
- How do we know Life would not have happened without you. You need
better controls. The fact that you did it a few billion times since then does not
matter. It was not randomized and might be subject to selection bias. Finally,
we need more outcome data about your creation. What is Life supposed to
achieve?
Please resubmit addressing all the reviewers concerns point by point. Given
the extensive changes required, your paper will be treated as a new
submission.
We look forward to seeing more high impact research from you.
• Slide 43
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Other Issues
• Authorship
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Ethics
Fabrication and Falsification
Plagiarism
Duplicate publication
• Honorary authors
• Ghost authors
• Conflicts of interest
• Spin and boasting
• Common mistakes
• Slide 44
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Authorship – ICMJE Requirements
• Substantial contributions to the conception or design of the
work; or the acquisition, analysis, or interpretation of data for
the work; AND
• Drafting the work or revising it critically for important
intellectual content; AND
• Final approval of the version to be published; AND
• Agreement to be accountable for all aspects of the work in
ensuring that questions related to the accuracy or integrity of
any part of the work are appropriately investigated and
resolved.
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Ethics
• Always seek ethics committee approval
• Researchers should never decide for
themselves if IRB approval is necessary
• Quality improvement versus research
• Slide 46
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Fabrication and Falsification
• Fabrication – making up data or results
and recording or reporting them
• Falsification – manipulating research
materials, equipment, or processes, or
changing or omitting data or results such
that the reach is not accurate represented
in the research record
• Slide 47
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Plagiarism
 Definition:
 To steal and pass off (the ideas or words of another) as one's own
 To use (another's production) without crediting the source
 To commit literary theft
 To present as new and original an idea or product derived from an existing source.
 Types:
 Ghost author – author turns in another’s work, word-for-word
 Photocopy – writer copies significant portions of text straight from a single source
 Self-stealer – borrows generously from previous work (self-plagiarism)
 Forgotten Footnote – writer mentions user’s name, but neglects the reference
 Too-Perfect Paraphrase – writer properly sites source, but neglects quotation marks
*http://www.plagiarism.org/, last accessed March 20, 2011
• Slide 48
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Duplicate Publication
 Definition: is the publication of a paper that overlaps substantially with one
already published. Both papers need not be identical to be considered a
duplicate/redundant publication. Other terms that have been used include dual,
divided, republication, fragmented, prior, repetitive, and salami slicing. It is
especially inappropriate when an author does not notify the editors nor reference
the similar/redundant work in the body of the submitted paper
 Types:
 Identical articles or articles with identical paragraphs
 Highly similar articles with similar data, patients, experiments
 Segmented articles where “salami slicing” produced several articles when
one would have been appropriate
 Sequential research articles based on previously methodology with no new
concepts
 Ask/Inform the editor – it is not worth it!
http://www.wame.org/wame-listserve-discussions/duplicate-publication, last accessed March 20, 2011
• Slide 49
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Honorary Authors
 Definition: individuals who are named as authors but
have not met ICMJE authorship criteria
 Substantial contribution to conception and design, or acquisition of data,
or analysis and interpretation of data; AND
 Drafting and revising it critically; AND
 Final approval of version submitted for publication AND
 Agreement to be accountable for all aspects of the work in ensuring that
questions related to the accuracy or integrity of any part of the work are
appropriately investigated and resolved.
 Approach:
 Authorship should be discussed at start of project
 Never circulate a draft with names without discussion
• Slide 50
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Ghost Authors
 Definition: individuals who have made a substantial
contributions to the work reported in an article but are not
named as authors
 Wislar et al (BMJ, 2011): queried 896 authors of research
and review articles and editorials published in JAMA, AIM,
Lancet, Nature Medicine, NEJM in 2008
 630 responded (70.3%)
 21% had honorary or ghost authorship or both
 17.6% had honorary authorship
 7.9% had ghost authorship
• Slide 51
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Conflicts of Interest
• “For an investigator, a conflict of interest exists when the prospect of
some personal advantage is strong enough to pose a realistic possibility
that he or she might compromise the researcher’s primary obligation to
adhere to sound scientific procedures in an unbiased search for the
truth.”
Cohen J, Academic Medicine, 2001
• “Conflicts of interest are ubiquitous and inevitable in academic life. The
challenge for academic medicine is not to eradicate them, which is
fanciful and would be inimical to public policy goals, but to recognize
and manage them sensibly and effectively.”
Korn D, JAMA, 2000
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Spin and Boasting
• Exaggeration of Importance
– “has reached alarming proportion,” drastic increase”
• Unfairly disparaging previous research
– “crisis of credibility, ”methodologic flaws”
• Using words to convince, not illuminate
– “these analyses provide clear answers," the robust
association”
• Boasting
– “findings open new frontiers,” “strong new evidence”
• Slide 53
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Getting Articles Published
 Revise and revise – 10 drafts
 Senior colleagues are critical
 Good luck – it feels great!!!
• Slide 54
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