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Publish or
perish
Publish or
perish
Alexander Woywodt
Consultant Physician and Nephrologist / Hon. Senior Lecturer
Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust
Preston
Alexander Woywodt
Consultant Physician and Nephrologist / Hon. Senior Lecturer
Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust
Preston
1
Manchester, 20. August 2009
22
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Why publish
How to convert a study into a publication
How to succeed
How to get started
How to fail
Why publish
How to convert a study into a publication
How to succeed
How to get started
How to fail
(separate talk)(separate talk)
3
Why publish?Why publish?
Scientific progress does not happen without
publications
Without publications there is no evidence on which
to base clinical decisions (or, if there was, the world
wouldn’t know)
Publications effectively constitute the knowledge
base in medicine
They are also the basis for discussion and feedback
regarding your own ideas
Eventually they help you to connect and become a
member of the scientific community
4
Why publish?Why publish?
Publications are universal, global currency for a career in medicine
Clinical skills and experience are difficult to gauge in an interview setting
To invest in publications is (probably) safe
5
The future of medical publishingThe future of medical publishing
6
In defence of the humble case reportIn defence of the humble case report
‘I hastened the demise of the case report,
to exclude what I see as psychiatric
trivia. I published original research’
‘I hastened the demise of the case report,
to exclude what I see as psychiatric
trivia. I published original research’
Wilkinson G, editor emeritus,British Journal Psychiatry
Wilkinson G, editor emeritus,British Journal Psychiatry
‘Psychiatry is not unique in having been
seduced by the scientific process. […]
Psychiatry needs to return to its core
Values […] A part of this process must be the
rehabilitation of the detailed case report.’
‘Psychiatry is not unique in having been
seduced by the scientific process. […]
Psychiatry needs to return to its core
Values […] A part of this process must be the
rehabilitation of the detailed case report.’
Williams DDR,BR J PSYCHIATRY18 , 84 (2004)
Williams DDR,BR J PSYCHIATRY18 , 84 (2004)
7
In defence of the humble case reportIn defence of the humble case report
•
June 1961 Lenz observed a cluster of birth
defects
•
Early November 1961 noted that several of
these mothers had taken Thalidomide in
pregnancy
•
15th
November 1961 phoned company and
suggested an immediate recall of the drug
•
19th
November presented case report in a
meeting
•
Letter in the Lancet published 1962 by Mc
Bride
Lancet 2: 1358 (1962)
W. Lenz (1919‐1995)
W. McBride(b. 1927)
888
How to succeedHow to succeed
9
Find a nicheFind a niche
ANCA-associated vasculitis
10
Ask a simple question that has not been asked beforeAsk a simple question that has not been asked before
Vasculitis = damage to
and eventually death of
endothelial cells
Vasculitis = damage to
and eventually death of
endothelial cells
??Woywodt et al.
Circulating endothelial cells as markers for
ANCA‐associated small‐vessel vasculitis
Lancet 2003 361: 206‐210
Woywodt et al.
Circulating endothelial cells as markers for
ANCA‐associated small‐vessel vasculitis
Lancet 2003 361: 206‐210
1111
Be a detectiveBe a detective
•
Arthur Conan Doyle was a medical doctor
•
Sherlock Holmes is modelled after Joe Bell, a professor of
medicine in Edinburgh where Doyle studied
•
Doyle was never successful as a doctor and wrote stories while
waiting for patients (who never came)
•
Much of Holmes’
success is through observation and deduction
•
“You look, Watson, but you do not observe” (The Hound of the
Baskervilles)
22 May 1859 – 7 July 193022 May 1859 – 7 July 1930
1212
The man who drank perfumeThe man who drank perfume
35 year old man was admitted with acute
liver failure
GPT 16726 U/l, lactate dehydrogenase
38180 U/l, INR 8.29
According to relatives he was an alcoholic
His wife reported that she had removed all
alcohol from the property
She then went shopping and on her return
found him in the bathroom where he had
drank all perfume and cosmetics
He had a 2 cm scar on his left buttock
13
The man who drank perfumeThe man who drank perfume
Alcohol dehydrogenase(9 subclasses)
Alcohol dehydrogenase(9 subclasses)
Disulfiram implantDisulfiram implant
Disulfiram causes fulminant hepatitis after alcohol excessDisulfiram causes fulminant hepatitis after alcohol excess
1414
Or, rather like
Hercule Poirot?Or, rather like
Hercule Poirot?
One must seek the
truth within‐‐not
without.“
(Agatha
Christie,
Poirot
investigates, 1924)
One must seek the
truth within‐‐not
without.“
(Agatha
Christie,
Poirot
investigates, 1924)
1515
A hypertensive secretaryA hypertensive secretary
•
38 year‐old female with horrible headache
and BP 230/130 mm HG
•
Long history of migraine, no maintenance
treatment
•
Secretary, spends a lot of time in front of
computer
•
Required triple anti‐hypertensive therapy on
day 1
•
Needed only double anti‐hypertensive
therapy on day 2
•
BP well controlled on one drug alone on day
4
1616
Be creative Be creative
1717
A cardiac murmur…A cardiac murmur…
•
51 year‐old male with end‐stage
dilated cardiomyopathy
•
Admitted with decompensated
congestive heart failure
•
Had most peculiar systolic cardiac
murmur
•
Echo showed an abnormal chorda
through right ventricle
1818
…turned into Opus 99…turned into Opus 99
19
Be curiousBe curious
20
The curious story of Dr Friedrich
WegenerThe curious story of Dr Friedrich
Wegener
•
In Breslau Wegener autopsied a case of rhinitis
and renal failure
•
1936 Presented case at congress of German
Society Pathology
•
1939 Published article on the case
•
1939‐1945 Army pathologist in Lodz / occupied
Poland
•
1954 Godman and Churg coined term
Wegener‘s granulomatosis
Dr F. Wegener (1907-1990)
21
The curious story of Dr Friedrich
WegenerThe curious story of Dr Friedrich
Wegener
April 2002 Task force founded in coffee
shop in Cleveland
April 2006 Lancet article published(Woywodt et al. Lancet. 2006 Apr
22;367(9519):1362‐6)
April 2002 Task force founded in coffee
shop in Cleveland
April 2006 Lancet article published(Woywodt et al. Lancet. 2006 Apr
22;367(9519):1362‐6)
2007 ACCP rescinded all awards
2009 ACR appoints committee to
review and possibly change eponym
2007 ACCP rescinded all awards
2009 ACR appoints committee to
review and possibly change eponym
2222
How to get startedHow to get started
2323
Publish early, often, alwaysPublish early, often, always
•
You need to start as early as possible,
preferably as a student
•
Find an enthusiastic
senior
•
Focus on quality
•
Don‘t be too worried about journal and
impact factors
•
Unlike wine, manuscripts do not improve
with age
•
Aim for steady productivity
2424
How to failHow to fail
2525
The “medical
Madoff”The “medical
Madoff”
2626
Duplicate / Salami publicationDuplicate / Salami publication
BMJ
1997;315:635‐640
Meta‐analysis of Eighty four trials (11 980
patients receiving
ondansetron) published
between 1991 and September 1996.
Data from nine trials had been published in
14 further
reports, duplicating data from
3335 patients receiving
ondansetron;
none
used a clear cross reference
Inclusion of duplicated
data in meta‐
analysis led to a 23% overestimation of
ondansetron's
antiemetic
efficacy.
BMJ
1997;315:635‐640
Meta‐analysis of Eighty four trials (11 980
patients receiving
ondansetron) published
between 1991 and September 1996.
Data from nine trials had been published in
14 further
reports, duplicating data from
3335 patients receiving
ondansetron;
none
used a clear cross reference
Inclusion of duplicated
data in meta‐
analysis led to a 23% overestimation of
ondansetron's
antiemetic
efficacy.
2727
The research waste problemThe research waste problem
Chalmers et al., Lancet published online June 15, 2009
2828
See you…See you…
