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How can I get my paper published in the BMJ?


Title: The real shit on writing for medical and public health journals Author: bma Last modified by: tkk Created Date: 3/14/2001 5:44:12 PM Document ... – PowerPoint PPT presentation

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Title: How can I get my paper published in the BMJ?

How can I get my paper published in the BMJ?
  • Tony Delamothe
  • deputy editor, BMJ
  • With a little help from Trish Groves and Richard

What I want to talk about
  • 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?

Whats 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
  • Look and feel of print journal more
  • New online model publishing oblivious to print.

General medical journals
  • Annals of Internal Medicine
  • BMJ
  • JAMA
  • Lancet
  • New England Journal of Medicine
  • PLoS Medicine

Why do you want to publish?
  • Answers please on a flip chart

Why publish?
  • Because you have something important to say
  • To change practice
  • To promote thought or debate
  • To allow examination of your work
  • To get your work in a high impact factor journal
    (aka Fame and
  • the love of beautiful women or men)
  • To make money
  • To advance your career/keep your job
  • To entertain/divert/amuse
  • To educate

What do medical journals want to publish?
  • medical journal
  • Remember journalistic values
  • new
  • true
  • important
  • of interest to our readers

Medical journals want to publish material that
  • new
  • true
  • important
  • of interest to our readers
  • Our commonest reasons for rejection are
  • Too well known
  • Too specialist
  • Too inconsequential
  • Too far removed from patient care or public

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

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
  • 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
  • new
  • true
  • important
  • of interest to
  • our readers
  • 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

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Not just research articles..
  • 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//
  • International Committee of Medical Journal
    Editors uniform requirements for manuscripts
    submitted to biomedical journals
  • http//
  • The code on good publication practice produced by
    the Committee on Publication Ethics

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COPE guidelines on good publication practice
  • 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
  • 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
  • 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
  • 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
  • IntroductionWhy did I do it?
  • Methods--What did I do?
  • Results--What did I find?
  • and
  • Discussion-- what might it mean?

Writing that paper Introduction
  • 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 dont overdo it
  • Dont try to show readers that you have read
  • 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

Writing that paper Results
  • 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
  •  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

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
  • 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
  • Title Include design Dont 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 papers structured
    abstract. The BMJs 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
  • credit and accountability
  • many authors on papers have done little
  • peoples names are left off papers
  • authors do not know the authorship criteria
  • contributorship statement is more inclusive and
    accurate says who did what

  • 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

  • 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

Why does a competing interest matter?
  • it may have a profound effect on authors
  • theres 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 dont 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//

The rudiments of style
  • 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

BMJs publication process
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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
  • 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
  • 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
  • and the full team of BMJ research editors, plus
    the BMJ clinical epidemiology editor
  • 350 research articles accepted, usually after
  • value added by commissioned editorials and

  • 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 cant find one, reject.
  • If it is an RCT, was it really randomised?
  • If it wasnt, 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 dont want it.

Triage questionsQuestionnaire survey
  • We probably dont 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 cant get information on in any other
  • Or might it be a peg for an educational article.
  • If the response rate is below 55 we almost
    certainly dont want it.

Triage questions two sorts of studies we dont
  • 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 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