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“If you leave the system, you won’t survive”

“If you leave the system, you won’t survive”

Photographer:Fotograaf: Magda Rakita

Publication tips from the editor-in-chief of the British Medical Journal

Scientific articles should first and foremost be made available in a database that is freely accessible to everyone and only after that be published in journals. Surprisingly, this statement comes from the editor-in-chief of the renowned British Medical Journal (BMJ). An interview with Fiona Godlee.

Thursday afternoon, 21 April. There is nobody to be seen in the hotel lobby of the NH hotel in Veldhoven, except for a tall, grey lady at a wooden table. Fiona Godlee is bent over her laptop. Just one more e-mail, she apologises. 

The editor-in-chief of BMJ has just landed at Eindhoven Airport and will give a master class to young scientists in the afternoon, entitled: How to improve your publication chances for high impact journals? A chance not to be missed by young talent. The master class is part of the so-called CaRe Days, an annual two-day meeting of the national research school CaRe, of which the Maastricht Caphri institute is a part.

Then she closes her laptop. "Tea?"

In 2005 Godlee (1961), originally a doctor, became the first female editor-in-chief of the famous BMJ since its first edition in 1840. It is one of the top journals in medicine, with an impact factor of 17. The natural competitors are New England Journal of Medicine (56), The Lancet (45), JAMA (35) and PLOS Medicine (14).

Open access

Every year, approximately five thousand draft articles are dropped onto the editors’ desks in London (fifty employees), four thousand of which immediately end up in the waste paper basket after an internal check. While reading, the editors ask themselves three questions, says Godlee. Do I understand this? Do I believe this? And then, do I care? In the end, 5 per cent is published – on paper or online. “And after publication it is not a case of: shut up and disappear. On the contrary, that’s when it really starts. We want the authors to react as much as possible to comments, which is something that takes time. If someone shirks, we will mention this with the article.”

Godlee remembers the BMJ article in which Dutch researchers expressed bitterness about the publication culture (see p. 8-9). “It is no different in England. The pressure to publish is ever increasing. We also see researchers being influenced in their choice of journal by the impact factor and not by the readership. The added disadvantage is that these authors would probably not be quick to choose open access, and that is a shame. BMJ is completely behind open access, it is not the subscriber who pays us, but the author.” 


The editor-in-chief sees the dominating importance of the impact factor as a huge problem, but fears that little can be done about it. “Journals will continue to do everything to boost their impact factor. BMJ has always been sceptical, because of the corruptive effect. The impact factor determines which research is published and that is not automatically the most useful research for clinical practice.”

What the high-impact journals are blamed for, is that they are only interested in sexy topics. After all, those are quoted more often and thus increase the impact factor of a journal. “That risk is always present, and one can see it happening. Scientific quality is absolutely sacred to BMJ, even though, of course, we hope for articles that are both interesting and of a high quality. We do ask ourselves sometimes how good our pieces are on current issues such as the Zika virus. You want to publish quickly, help the debate along, contain the disease.”


BMJ - 120 thousand printed copies and 1.5 million online hits per month - is a journal that takes a stand. Godlee has waged many a crusade over the past years, against American nutritional guidelines based on shaky research, but also against governments who squander millions with inferior flu medication. She calls these campaigns a selling point for BMJ, intended to explain controversial subjects. Other - safer - spearheads are overtreatment and unnecessary care, ‘patient participation’ in GP practices, and openness about research data. 

“We put the whole publication history, including all revised versions online along with the article. The same is done with the raw data, which we require from all authors. We feel that transparency is very important. That is why we switched to open peer review about eighteen months ago, so far the only medical journal to have done so. The names of the reviewers are passed on to the author and if there is a rival among them, we hear so immediately. We put all criticism and comments online, which is also valuable if something is wrong with an article. For instance, I would have liked to have read the reviews for the MMR article in The Lancet at the end of the nineteen-nineties [in which it was suggested that measles vaccination could cause autism]. How did an article like that get past the peer review? What went wrong? When we asked, we were told that the comments had been destroyed in a fire. Hmmm.”


Another advantage is that reviewers will think twice before they spout rude and downright vicious criticism, as has happened all too often in the past. “All remarks must be substantiated. Some have even received praise since everything has been made public. The review becomes ‘a piece of work’ that can be tweeted. The danger is that they become too polite. Anyway, we do not place an article based solely on external reviews. We also have an internal assessment process and we regard reviewers as advisors.”

With the demand for transparency - whether it is about peer review or research data - journals such as BMJ can contribute towards a better publication culture, says Godlee. “We have at times thought about quitting the publication of research articles and just bringing news, visions and comments, but we decided against it. We regard it as our duty to call researchers to account.”

However, with a view to long term, Godlee has doubts about the present system. “I can imagine a better system, in which all studies are published in open databases, including the setup, all raw data, and the findings. All researchers, but also businesses, could analyse or reproduce the results. In such a system, journals would have a different role: selecting instead of publishing. Journals would then write about the most creditable studies.”

Why is it not done like that? “Because the present system suits the journals, because publishers earn enough money from it. Scientists, journals, everyone is trapped in the same system. If you leave the system, you won’t survive.”

How does one make it into BMJ?

Your greatest chances are with a meta-study or a systematic review, says Fiona Godlee in her master class. The hall – in the Koningshof congress centre in Veldhoven – is filled with young scientists. “We used to publish a lot of qualitative research, but we hardly do that anymore because these studies are not quoted very often. I believe some scientists are angry about this.” 

The first tip: take the time to think. “My motto is: Think for a week and write for an hour. You can think things through anywhere, during a walk, on your bicycle, or in the pub. I always make a mind map. Maybe that is something you could do too. The main thing is that you keep the main point in sight.

Do you ever publish negative results, a researcher in the hall asks. “We feel that we should be interested in that. The strange thing is that we hardly ever receive them. A matter of self-selection, it seems.”

Another tip: when choosing a subject don’t forget the “easy pickings” at the GPs’ surgery, said the editor-in-chief. “That doesn’t need to cost much and it doesn’t take you years. I remember a study about rectal bleeding. How worried should a GP be about this? Interesting study.”

Getting turned down is not the end of the world, says Godlee. “Speak to your colleagues about it. And ask yourself if the rejection was justified. If not, submit the article again. Write a friendly e-mail to the editor - ‘I know you are busy, but …’. We also make mistakes.”

Three fifths of the BMJ authors are from Great Britain or the US; one fifth is from Europe. The Americans are the most quoted, one year after publication (eleven times on average); the Europeans are the least quoted (seven times). 



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