Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK


What is happening to scholarship in medicine, how are career scientists responding to academic pressures, and has it affected clinical science? And, in the world of scholarly publishing, what has happened to the research paper, how we share research outcomes, and the academic dialogue? Demands on the scientific community may have altered research priorities, but journals and their editors are also buffeted by advances in communication and commercial tensions. In sharing advances in medical science within the research community and beyond, publishing the definitive paper is not that straightforward anymore.

Are you an academic or a scientist? Medical research is about seeking truth, exploring new discoveries and improving health and the general public will not see any difference between an academic and a scientist. For the researcher, however, the financial demands on universities, performance management, together with academic league tables, mean that researchers are pulled in many different directions. Gerry Carter, in his scientific blog and linked slides, highlights these tensions and wonders if being a good scientist and a good academic ever conflict. There are common goals of increasing knowledge and improving health, sharing research findings and encouraging dialogue and debate. But, for a career academic there are pressures to produce publications in high impact journals, bring in grant income and raise the profile of their academic department. The scientific process means being skeptical of ones results, seeking to replicate, interpreting carefully, answering key questions over time. But, for academic success, the pressure is to seek novel and exciting findings that generate high profile publications in high impact journals and attract additional research funding. Some might suggest that academic researchers care more about getting their research published than people reading it or, as quotes Richard Smith former editor of the BMJ, scientists are interested in funding and careers rather than the truth.

Are journals driven by communication or commercialism? Medical journals share knowledge and improve health by publishing important research findings and creating an accessible record. But, like clinical research, the reality is not quite that straightforward. It is no longer sufficient for a journal to inform, educate and create a permanent research repository as they respond to a long list of rapidly changing competing demands. Impact factor has become a completely inappropriate but seemingly unassailable quality metric. Speaking to newly appointed editors their prime aim is to increase impact factor, and some long admired journals appear to have sold their souls in pursuit of this meaningless metric. Trying to game impact factor will undoubtedly influence an editors prioritization of the type, content, and origin of research published and the educational content of a journal. As authors too seek to publish papers in high impact journals, there is increasing temptation to take short cuts or cheat and the problems of research misconduct have already been reported in the international media both in the US and Europe. Misconduct accounts for the majority of retracted scientific articles while, at the same time, universities seem slow to act.

The peer review process, itself the foundation stone of scholarly publication, is under sustained criticism. And, while we know that it may be flawed, arbirtrary, and fail to pick up weaknesses, it was particularly alarming to read recent examples of peer review fraud.

Publishing is a business and while editors see themselves as guardians of academic integrity wishing to separate the editorial process from any commerical influence, the more profit focused commerical interests within publishing may see this as obstructive and unnecessary. The relationship with the pharmaceutical industry is complex. It is difficult for journals to negotiate a path so that the research and educational content of a journal is completely independent, or may even be critical of the pharmaceutical industry, while the journal itself depends heavily on pharmaceutical support. Taking a high moral position is complicated when scholarly content sits side by side with a glossy advertisements on opposing pages. The New England Journal of Medicine has recently opted for slightly more liberal line, and not without criticism from some members of the research community. But, commerical pressures are very strong and, while some large publishing houses are successful enterprises with healthy profit margins, small publishers may struggle to survive financially.

Journals try to respond to the needs of the scientific community and the increasing emphasis on demonstrating the wider impact of their research (rather than impact factor alone) ; many journals publish metrics on the number of reads, cites and downloads, and partner with Altmetrics to give an index of wider pickup. Journals, like CMAJ, augment publication by posting videos, recording podcasts and, linking blogs. In moving towards greater transparency, some journals now publish the entire pre-publication peer review process and many encourage post publication peer review in an academic dialogue through rapid responses.

But is this sufficient? The Ebola crisis highlighted the failures of the academic and publishing process where researchers were reluctant to share their findings lest it threaten potential scholarly publication. This provoked a consultation meeting at the World Health Organization and an agreement by journal editors that public dissemination of research findings in this situation would not prejudice publication. Recently, Harlan Krumholz highlighted, in the New York Times, the delay in release of findings of a major NIH study on managing hypertension that was halted because of definitive results yet, these results would not be made public until presented at a major conference or, much later, published in a journal saying, “Its time for medical scientists to think differently about how quickly they alert the public to breakthrough knowledge”.

In a world where information is transmitted globally immediately, where social media is faster than television, and today’s newspaper is already history, the traditional model of scholarly research disseminated in peer reviewed journals seems an anachronism ripe for disruptive innovation and radical revolution.

This blog is a version of a talk delivered as part of the Bradford Hill Seminar Series at Cambridge Institute of Public Health on October 16th 2015.