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How can I get my paper published in the BMJ?

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Presentation on theme: "How can I get my paper published in the BMJ?"— Presentation transcript:

1 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

2 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?

3 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.

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

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

6 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

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

8 Medical journals want to publish material that is:
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 policy

9 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

10 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…

11 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”

12 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”

13 What do I do next? Find out what the journal wants from its:
Instructions to authors Advice to contributors Resources for authors



16 Not just research articles..
Editorials Letters Analysis articles Educational articles (from Clinical review to case reports) Personal views, reviews

17 BMJ - general guidance to follow
Guidelines for reporting research, at the EQUATOR network resource centre International Committee of Medical Journal Editors uniform requirements for manuscripts submitted to biomedical journals The code on good publication practice produced by the Committee on Publication Ethics



20 COPE guidelines on good publication practice cover
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

21 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?

22 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

23 Writing that paper Structure is all. Make sure that readers know where they are, where they are going, and why.

24 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?

25 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 don’t overdo it Don’t try to show readers that you have read everything Short, short, short

26 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 (

27 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

28 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 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)

29 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

30 Topping and tailing 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

31 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)

32 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

33 Authorship and contributorship
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 The uniform requirements for manuscripts submitted to medical journals state that authorship credit should be based only on substantial contribution to: conception and design, or analysis and interpretation of data drafting the article or revising it critically for important intellectual content and final approval of the version to be published.  All these conditions must all be met. Participation solely in the acquisition of funding or the collection of data does not justify authorship.  We want authors to assure us that all authors included on a paper fulfil the criteria of authorship. In addition we want assurance that there is no one else who fulfils the criteria but has not been included as an author. We believe that the definition of authorship, produced by the International Committee of Medical Journal Editors (or Vancouver Group, see has some serious flaws.  The current definition of authorship does not make clear who has contributed what to the published study, nor does it clarify who is responsible for the overall content. It also excludes those whose sole but often large contribution has been to collect data.  We now list contributors in two ways. Firstly, we publish a list of authors' names at the beginning of the paper and, secondly, we list contributors (some of whom may not be included as authors) at the end of the paper, giving details of who did what in planning, conducting, and reporting the work.  One or more of these contributors are listed as guarantors of the paper. The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. See Contributorship and guarantorship are concepts that were applied first to original research papers, and are sometimes hard to define for other articles. Each contributorship statement should make clear who has contributed what to the planning, conduct, and reporting of the work described in the article, and should identify one, or occasionally more, contributor(s) as being responsible for the overall content as guarantor(s). For BMJ articles that do not report original research such as editorials, clinical reviews, and education and debate please state who had the idea for the article, who performed the literature search, who wrote the article, and who is the guarantor (the contributor who accepts full responsibility for the finished article, had access to any data, and controlled the decision to publish). For non-research articles that include case reports such as lessons of the week, drug points, and interactive case reports, please also state who identified and/or managed the case(s). Researchers must determine among themselves the precise nature of each person's contribution, and we encourage open discussion among all participants. Authorship Posted January 10, 2007 Authorship is a way of making explicit both credit and responsibility for the contents of published articles. Credit and responsibility are inseparable. The guiding principle for authorship decisions is to present an honest account of what took place.  Criteria for authorship apply to all intellectual products, including print and electronic publications of words, data, and images.  Journals should make their own policies on authorship transparent and accessible. Criteria for Authorship.   Everyone who has made substantial intellectual contributions to the study on which the article is based (for example, to the research question, design, analysis, interpretation, and written description) should be an author.  It is dishonest to omit mention of someone who has participated in writing the manuscript (“ghost authorship”) and unfair to omit investigator who have had important engagement with other aspects of the work.  (See the WAME policy statement, “Ghost Writing Initiated by Commercial Companies”) Only an individual who has made substantial intellectual contributions should be an author.  Performing technical services, translating text, identifying patients for study, supplying materials, and providing funding or administrative oversight over facilities where the work was done are not, in themselves, sufficient for authorship, although these contributions may be acknowledged in the manuscript, as described below.  It is dishonest to include authors only because of their reputation, position of authority, or friendship (“guest authorship”). Many journals publish the names and contributions of everyone who has participated in the work (“contributors”).  Not all contributors necessarily qualify for authorship.  The nature of each contributors’ participation can be made transparent by a statement, published with the article, of their names and contributions and WAME encourages this practice.  One author (a “guarantor”) should take responsibility for the integrity of the work as a whole.  Often this is the corresponding author, the one who sends in the manuscript and receives reviews, but other authors can have this role. All authors should approve the final version of the manuscript. It is preferable that all authors be familiar with all aspects of the work.  However, modern research is often done in teams with complementary expertise so that every author may not be equally familiar with all aspects of the work.  For example, a biostatistician may have greater mastery of statistical aspects of the manuscript than other authors, but have somewhat less understanding of clinical variables or laboratory measurements.  Therefore, some authors’ contributions may be limited to specific aspects of the work as a whole. All authors should comply with the journals’ policies on conflict of interest. Number of Authors.  Editors should not arbitrarily limit the number of authors.  There are legitimate reasons for multiple authors in some kinds of research, such as multi-center, randomized controlled trials.  In these situations, a subset of authors may be listed with the title, with the notation that they have prepared the manuscript on behalf of all contributors, who are then listed in an appendix to the published article.  Alternatively, a “corporate” author (e.g., a “Group” name) representing all authors in a named study may be listed, as long as one investigator takes responsibility for the work as a whole. In either case, all individuals listed as authors should meet criteria for authorship whether or not they are listed explicitly on the byline. If editors believe the number of authors is unusually large, relative to the scope and complexity of the work, they can ask for a detailed description of each author’s contributions to the work.  If some do not meet criteria for authorship, editors can require that their names be removed as a condition of publication. Order of Authorship.   The authors themselves should decide the order in which authors are listed in an article.  No one else knows as well as they do their respective contributions and the agreements they have made among themselves.  Many different criteria are used to decide order of authorship.  Among these are relative contributions to the work and, in situations where all authors have contributed equally, alphabetical or random order.  Readers cannot know, and should not assume, the meaning of order of authorship unless the approach to assigning order has been described by the authors.  Authors may want to include with their manuscript a description of how order was decided. If so, editors should welcome this information and publish it with the manuscript. Authorship Disputes.  Disputes about authorship are best settled at the local level, before journals review the manuscript. However, at their discretion editors may become involved in resolving authorship disputes.  Changes in authorship at any stage of manuscript review, revision, or acceptance should be accompanied by a written request and explanation from all of the original authors.

34 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

35 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

36 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.

37 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:

38 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.

39 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

40 The best policy on competing interest
Always declare a conflict of interest, particularly one that would embarrass you if it came out afterwards

41 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?

42 Transparency and integrity
The BMJ expects authors to present their work honestly and fully BMJ transparency policy is at:

43 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

44 BMJ’s publication process


46 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. For accepted original research articles we offer full online publication as soon as the authors have approved the proofs, with print publication a few weeks later. We aim to publish other articles within three months of final acceptance after any necessary revisions.  

47 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

48 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)

49 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

50 BMJ peer review process II
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

51 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

52 Reasons for us to say no

53 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

54 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.

55 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.

56 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 Value is in the exactness, which is usually of interest to only a few Again hard to generalise

57 And when we do publish your article...

58 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 See

59 Thanks Tony Delamothe

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