So, welcome to this next module. We're very privileged to have with us here
today Dr. George Lundberg.
He's going to be telling you about the publication process and also giving you
some tips about how to get your paper published.
So thanks George. Hi, thank you very much for having me
today. I, I hope we can say something that might
be useful. So, I want to tell you little bit about
Dr. George Lundberg.
He spent seventeen years as editor-in-chief of the Journal of the
American Medical Association, which is one of the highest impact medical journals, as
well as all of its archives. So, he was there until 1999,
After that, he was editor-in-chief of the Medscape Journal of Medicine, which was
one of the first open access journals, as well as editor-in-chief of eMedicine at
WebMd. He's currently and editor-in-chief of
CollabRx. He's an editor at Large at MedPage Today, also a consulting professor
at Stanford University, serves on the board of the National Library of Medicine.
So he has just a wealth of experience in publishing that he can share with us so,
so thanks again for being here. Yeah I've done, I've done medically
editing now for about 30 years full time. Yes [laugh].
So so... Hm.
I'm going to just start with a question here.
Besides good science, what key elements are journal editors looking for, in a
paper? They want papers that will make their
journal look good. So one of the key points for an author is
to figure out where is the best fit for the product the author is producing in the
medical literature. And, that is a minorly complicated process
but a lot of authors just want to go for high impact journals because, but that
depends on what they're looking for. If the author is looking for sensational
information, something important for the CV, something that's great to hang the
next grant application onto, that's one thing. If the author is interested in
influencing the field. It might be an entirely different journal
to pick. So, is your author interested in a
readership? Who does the author want to have read the
journal? I mean, the readers, readers read some
journals, they don't read other journals. So, a lot of this has to do with the
matching process between what the editor's looking for,
What that journal likes to publish, And what the author is trying to
accomplish by the publication. So do you, as an editor, spend a lot of
time when paper comes in, sort of figuring out in your own head, is this the right
fit for the, the science that was done and [inaudible] journal.
I think that, that's what one does, actually from the very beginning.
A paper comes in, You, whatever editor is assigned to handle
it. In the big journals, there are lots of
editors, and the editor-in-chief tries to get that editor who has the most knowledge
in that particular subject area at the hand of the paper.
And that editor then is assigned the paper and that editor, because of that amount of
knowledge, has the authority to reject without consulting anyone.
And in the big journals, that's 50, 60% of articles that get right there before
they're ever seen by another pair of eyes. There's a risk involved there.
What if this editor is biased? What if this editor is not knowledgeable
in that area? What if the editor, oh,
Is arrogant or maybe is in competition with that field or knows somebody else who
is working in that field? There's all kinds of human things coming
to there, Which unfortunately I've seen happen too
often. But the usual author ought to trust the
editorial process as being in the best interest of science, medicine, if it's a
medical science, patients, the public health, the public interest, in general.
But, It isn't all that hard to get an article
into print, but it's very hard to get an article out of print.
Uh-huh, that's a really good point. [laugh] So, the authors, the authors
especially young authors, should view this issue of the review process, the editorial
process, as designed to keep egg off of their face.
Yeah. And be thankful for help.
Yeah. Making the manuscript better or maybe even
making it never be seen by any other. [laugh] I think that's a really good point
that the viewing the whole publication process is a way to improve your article
and improve your. For the reader.
Yeah. And for the author.
Yeah, yeah. So that's what the review process is all
about. Yeah, Good, good.
And what do you think is the number one mistake that scientists make when they're
submitting their paper for publication? I would say if they, picked the proper
journal, The best journal for it, which may be the
number one mistake not picking [laugh] Okay The best journali and being rejected
at that point. Yeah But beyond that one which we've
already mentioned I think writing it too long is a very, very common mistake.
Another very common mistake is not writing it for that journal by following the
instructions for authors. All journals have instructions for authors
some of them publish them every issue, some publish them once a year.
Now, in the age of the Internet it's easier to find the instructions for
authors so many authors don't find them, and if they find them, they don't follow
them. And the editor can smell that immediately
if this person didn't follow the instructions for authors,
The editor wonders, well, if this author can't even follow the instructions for
authors why should I believe the content of the science.
Maybe they're not very careful with the science either.
So, follow the instructions for authors. As I say, try to get the right journal.
Follow instructions for authors. Don't write it too long.
And don't draw conclusions that go beyond the data.
[inaudible]. That's a very common problem.
[inaudible]. Sorry, you asked for one.
[laugh]. No those are all.
A gave you several [inaudible]. Fantastic, tips, yeah.
[inaudible] number one. Yeah, great.
You know, that's a, those are really great.
In sort of along those same lines, what can authors do to increase their chances
of getting published do you know, in the higher impact or in lower even just
getting published if you're starting out. Be humble, but don't be,
Excessively humble. Hm.
Take, be willing to take chances, but realize if you take a chance, you may have
to come back and try it again in some other place.
Shoot high but, Why would you want to shoot for the moon
with one of the three or four or five top journals in the world if you really know
that your paper isn't quite up to the level that you see published in that
journal at the time? So I think, as I've already said, try to
figure out the, the right venue, Whether it'll be a, reading audience that
is what you're trying to reach, that would be sympathetic to your topic, and what
you're trying to say. And then follow the instructions for
authors, Really do.
Yeah. And once you've done that, and tried to
write it concisely, that's pretty good. Now,
If you have a lot of co-authors, that's good,
But it's also hard, because they all have to agree...
Yes. On the final product.
If you don't have many co-authors, I recommend that when you think you're
finished and ready to send that paper in, Don't.
[laugh] Instead stick it in a drawer or on your computer.
Turn off the computer for a day or two. I know you are really hot to trot,
But yeah, Let it cool and then go back and pretend
you are the meanest editor in the world. [laugh] And see whether you the meanest
editor in the world really think this is a really good paper,
And if not, see how it could be made better and then choose your own reviewer,
At leastt one or two whom you know, and ask them to tell you what they really
think about the paper. And then when they tell you remember you
asked them. [laugh] what, what they really think,
Yeah, About the paper because you want them to
tell you the truth so you can make the paper better.
Those are some of the hints on the early side.
Yeah that's great advice I think spending that time to go back and look at it.
We've been talking a lot in this course about being concise so also going back and
cutting down your work and having somebody else read to get that outside.
Right. Feedback.
Yeah. It's real.
And I was hoping you'd give some advice, especially to young scientists.
So, since a lot of the class are, are younger scientists who are kinda just
starting out, having the first experiences of getting, trying to get a paper
published. Is there some advice, specifically for,
for the younger folks of the class? Well, the young scientist who wishes to be
a scientist, obviously knows, it's publish or perish.
Unfortunately, a lot of people publish and they perish anyway,
But that's another side of the story. But, be suitably in awe of the scientific
enterprise so that you're very careful but don't be excessively.
Put down by it, because if you have confidence in what you're doing, and
others around you who have knowledge about it and who are honest, also have
confidence in what you're doing. Don't be afraid.
But also, don't expect to hit the moon the first time.
[laugh] Yeah. So one of the, questions I wanted to ask
you is to give some advice. Let's say you're a first time author and
you get rejected. You know, is there some, some, some
encouraging words you can give for, for some author who gets, The first thing they
submit gets to [inaudible] back as an outright rejection.
No one likes rejection. Yep.
[laugh]. Everyone experiences it.
Well for example, I tried to get into medical school three years in a row,
before I was finally accepted into medical school.
And I didn't like that rejection, but I figured, I really wanted to be a doctor,
and I figured I had what it took, but the commissions committee just didn't
understand that yet. So you go back and figure, what did I not
do the way it is, how can I make things better?
So, accept rejection as a real likelihood. When you look at a journal, a high impact
journal like, New England Journal, JAM, or the Lancid, you're looking for rejection
rates for unsolicited manuscripts on the range of 95%..
95%, wow. Yeah,
So, most likely people who are watching us talk know a little better about
statistics. [laugh] They're 95% that means it's hard.
Yeah, yeah. And it is hard the journals that are not
that hard to get into have much lesser rejection rates all the way up to
rejection rate in the five, ten, fifteen percent range.
But mostly those journals won't tell you that, and mostly you don't have any good
way to know. Because there's unfortunately, there's not
a lot of transparency in the publishing process.
Right, right. But can you, again, assume for, even for a
moderate impact journal that the rejection rates are likely fairly high.
The rejection rate is going to be a majority of papers that are submitted to
it. Okay.
In a moderate impact journal. I think it's helpful for people to know.
Yeah. If you.
What they're getting into. But, when you talk about impact journals,
you're, you're coming into a very nebulous area.
Yes. What does it mean for impact?
[laugh] There's people like to have numbers to put on things,
Like, if you're looking out in the morning and you see what kind of day is it going
to be? A lot of times you see well, there's a 94%
percent chance of rain today. On the other hand, there.
What would that, that really mean? I'm not sure.
Yeah. But, in fact, factor is something that
Gene Garfield created a long time ago, and he wished he hadn't,
Because it puts a number on an article, a number on a journal that really is, is,
not. That important.
But it has grown into a measuring stick for journals, for authors.
Yeah. And for papers at some level.
So, to me, an impact has to do with, does it change the field?
Right, right. Not, do a lot of people read it and quote
it because it was wrong. [inaudible] put it down stimulating and
interesting. So, but nonetheless, there, there's a, a
range of journals in terms of the, the level of difficulty and getting into them.
Right. And I think it's natural, for people who
are naturally competitive to want to get into journalism.
The hardest thing is, in part, because, hey there's a big mountain, I'd like to
climb it. Yeah.
And in part, because they know their colleagues and their future potential
employers are going to know. Wow, it was that hard to get in there.
That person got there. I know that when I ran the [inaudible]
journals and which included the archives of general psychiatry, that journal had an
acceptance rate so low and a, and a, a review process so long and tedious that it
had become of such that if a person in those days could get one paper published
in the archives of general psychiatry, you could probably get catered.
Wow. [laugh] So that was the mystique.
Yeah, yeah. But there were also data to support it
because everybody who'd written a review. It was hard to get into.
It happened that way because it was so hard, but that was in part because Danny
Freedman, the editor for a very long time, commonly would have twelve to fifteen peer
reviewers per. That's very unusual.
[laugh] And yeah. Yeah.
[laugh] On the, flip side of that, just so, you know,
People a, who are just starting out understand.
So you've mentioned the, the rejection rates in a lot of journals are very high.
How often does something just get accepted outright?
Just to give people a sense of what they're looking at,
About the only time a, an article gets accepted at a good journal outright is if
it was solicited by the editor. So you're usually looking at one of these
rejected but re-submit [laugh] kind of where you're.
Beyond that. You're looking at what,
Well no, what an author's going to get by and large, is if the author is lucky,
they're gonna get a list of suggestions and criticisms which say that this paper
is important, this paper is interesting. This paper seems to have valid data, this
paper seems to have conclusions that do not go beyond the data.
The subject matter is timely, the subject matter of interest to the readers of the
journal, I'm the editor speaking of that now, and it's timely.
So we'll give it a priority. And that's the process the editor goes
through. Okay.
With the reviewers to help decide whether this paper gets rejected instantly or.
Accepted with minor revision, which does happen, and.
[inaudible]. But not often to science.
Heavy scientific papers rarely get accepted with minor revision.
Okay. There's usually a rather lot of revision.
Right. Commentaries, viewpoints, opinion pieces,
invited editorials things like that, can get accepted with very little change
sometime, but I don't think that I ever wrote an editorial for JAMA myself that
got accepted without revisions. So that's good to know.
Remember that. And I was the editor, but I was, I was
generally intelligent enough and humble enough to let somebody else look at my
stuff. Yeah.
Before publish it because, I, I want somebody else to see it.
Yeah. And fortunately, I kept ink off my face
most of the time. Right, right.
Normally. So In terms of if you get one of these
back where there are a lot of revisions that are requested of you and maybe it
hasn't been, you know, rejected with a chance of resubmission.
What is it out there, a journal editor looking for when they get a paper back?
I mean, what's the, you know, how what are some tips for how to respond to reviewers?
And is there some kind of bar that you have in terms of like, what is it, what do
the authors have to achieve? First off, the author should be very
pleased if the journal that they want their paper published in comes back and
says, we're interested in this paper, and if you'll do this, this, this, this and
this, we'd be happy to look at it again, But it is subject to additional review.
Many authors think they make the jump, the assumption that if they do what their told
to do it will be accepted like that, no. It's always subject to additional review,
but its encouraging. Yeah.
If an editor sends back such a review, and
has two, three, four reviewers, all of whom, anonymously usually, have listed
what they think about the journal, about the article, and how it can be made
better, And the editor has decided that these
things can be encountered, they can be dealt with.
Now, the author doesn't have to do everything the reviewers say,
Because the author may disagree strongly with some points. But the author either
has to do everything the reviewer say or has to argue effectively as to why he did
not do what reviewer said and then that's okay. But to do this all the authors if
there are many, Although, hopefully there'd be one who
would take the lead, You need to go through the reviewer
comments, and in the process of making the revision, write a cover letter for the
revision that takes every reviewer comment, and indicates how it was dealt
with. For example, we did this.
Page two or we didn't do this, because this reviewer really doesn't understand
the science, he's different from whatever you would think, see this reference.
Yeah. Or something like that.
Very specific. So, yeah.
Item by item, so that the cover letter could become as long as a manuscript but,
you know, the editor is going to look at that and get to see, oh, this was well
done, but you better do what you say you did because the editor's going to go back
and see if you really did what you say you did. Yeah, that's a good point, yes.
[laugh] I have to tell you, Kristen, sometimes authors don't, they say they did
it, but if you check it. I have reviewed papers where that's the
case, yeah. Maybe they didn't do that.
Now the stupidest thing an author or group of authors can do in my view is to take a
manuscript that's been rejected but has been encouraged to be revised.
Get angry, Get on your high horse and say, I ain't no
better than those reviewers, I don't want to go there anyway.
We'll send it to another journal. And it's so much trouble to go through all
those revisions. We're just going to send it on to another
journal and see how it goes there. It's really stupid for a lot of reasons
because most likely, those reviewer comments are useful and can make the paper
better, and second. It's entirely possible that, that second
journal is going to send the article to the same reviewer who saw it the first
time and I've had articles come back me the editor from a reviewer who said, I
already reviewed his paper for the whatever, whatever journal,
And I recommended it be, write, revised, it had value, but there had to be a lot of
changes. I can't, it looks to me like they haven't
done anything. That editor kills that paper so fast. No
chance. Over. So you have to be, if you're not going to
make a revision on it, you're going to have to be awfully lucky about where you
send it the next time around. And you're really stupid if you don't.
That's very good too. And,
What key changes do you anticipate are going to occur in the publication process
over the next decade? I think we're sort of in a, in an era
where, where a lot of things are changing, and I was hoping to kind of get from you
what you think it's going to look like. Dylan is going to be in San Francisco,
later this month. Dylan Bob, not Dylan Thomas, the great
Welsh poet. And the time, they are a changing.
Oh, yeah. Change is everywhere,
And most people are caught up in it and trying to figure out what's happening.
In the publication process, the future's, I mean, predictions are hard to make
especially about the future. Of course, it is. But, it's going to
change. Yeah.
We know that for sure. Yeah.
But, second, And my view is that open access publishing
in science and medicine will become the rule, not the exception.
Right. If you gave me a ten year time frame I'd
say by ten for sure, Perhaps even earlier than that,
The, the recent rebellion by people, especially in the UK and Harvard faculty
and others, against those for profit publishers that have been charging
libraries so much money to keep their subscriptions going has shaken the
publishing industry while they've tried to ignored it for a long time.
So Open Access Publishing, which I'm pleased to have been a pioneer a long time
ago, 1999, actually early on, Before their [inaudible] was even a dream
in [inaudible] mind. And it's coming, coming, coming, coming.
Now, there are costs involved in publishing.
You have to understand that, and they're real.
But, you don't have to make a huge profit like shareholders require from some of
those publishing houses. Some are publicly held, some are privately
held but that's who they shake down. But costs will have to be, there will have
to be a way to the find money to keep the journals going because there are real
costs. The peer review process costs, editors
need to get paid, even though peer reviewers generally don't, the publishing
process. However, in medical scientific journals,
the biggest cost have always been paper, and the printing and postage issue.
And with Open Access Publishing on the internet, you don't have paper,
And there are production costs, because you have to get it up there, and there are
editing costs, but they're usually not as high as they are, in a, print publication.
So, Fortunately, if you're going for grants
now, you can ask the granting agency to fund the opportunity for Open Access
Publishing. If you're paying page cost yourself it
goes way back to the days when authors were asked to pay to a journal in order
for a journal to consider a paper, and then it was sometimes just for pictures.
I don't like authors having to pay because I always worry well, if they pay a lot
maybe there's a better chance they're going to get published and the vanity
press concept. It's there, you have to be very careful about the ethics and modern,
and the transparency of that process. It's going to be open access, and it's not
going to be a whole of six months to a year, at the national library of medicine
before people have access to it, Because that's not fair.
If public funds funded the research, the public owns the data.
And to have to pay again, to get a subscription to something, I've said is
wrong since 1999. I made that point at Harvard in 99, and
the point is the same, But now people are coming on that point of
view. That's the biggest shame.
Yeah. And with that, speed, speed, speed.
And in the process of speed, we don't want to lose quality.
Right, right. That's the big point.
And if you could change one thing about the publication process going forward,
what would it be? Make it open access?
Yeah, open access. But, not self-publishing.
Okay, still have the peer review. There are people who like the idea of self
publishing and I can understand that. Say, post publication peer review is
always the most important peer review anyway.
So, people could say, well why don't we just publish anything and let the post
publication process take it over and I think there's a place for journalist to
try that. But there should be a due process to the
reader up front. So the reader knows this is self
published, and nobody's seen it except the author.
And the author wants to have the post-publication peer review process.
Then, how do you do that in an organized manner, who, who's the owner, who's the
publisher? Or is there one?
Is, I mean, blogging. Now I predict that, that blogging.
Would be the end of the world in terms of any kind of trust in anything because, a
blogger is the author. Right.
The copy editor, the peer reviewer, The final editor, the advertiser, the
public relations director. All these things all at the same time.
And how can you trust that? I couldn't believe that would ever be
possible. And yet the market has shaken it down so
that there are bloggers you can trust. And there are bloggers you can't.
And that's from post publication peer review.
You look at something like the health care blog.
And the stuff that appears in the healthcare blog by and large, has been
written by people reviewed by nobody except the editor who does agree or
disagree or not agree to publish it. But it can be published very quickly, and
it, it stands on its own merit, with the name of the author.
If the author hasn't faked it, that's the other problem, you can fake it,
And if there's not an inner shaking down who the real author is, how do you even
know it's that person? Right, right.
They could fake the whole thing. So I but I was wrong.
You know, a lot of blogging has worked very well.
And So, I don't know. As I say the, the future's not that easy.
[laugh]. Yeah.
It's great. But it's gonna change, you know, it'll
change a lot. Yeah.
If you can give any last tips to the class again.
A lot of people trying to get published for the first few, first time, or Follow
the instructions well. [laugh]. For all is, try to choose a journal that
fits your study your paper, Trying to do what the editor wants you to
do before the editor has even asked you. [laugh] And that's the Instructions for
Authors. And then have a couple of your colleagues
or your friends. What remained your friends tell you what
they think before you actually send it in. And then wait and see.
I had the amazing good fortune. To send my first paper with three
co-authors, to the New England Journal of Medicine.
First ever, and it was accepted. Wow.
[laugh] With very little revision. Wow.
But it was a spectacular paper, based on cases.
Yeah. And the cases were remarkable cases.
And, and the editor understood that. But that's not what the average author is
gonna be likely to experience. Yeah, great.
Okay? Thank you so much, Dr.
George Lundberg for being here with us today.
Thank you. I appreciate that very much, and thank you
for bearing with us. [laugh].
The proceeding program is copyrighted by the Board of Trustees of the Leland
Stanford Junior University. Please visit us at med.stanford.edu.