Eleanor D. Lederer, MD, FASN
Citation: Kidney News 9, 6
ASN President Eleanor D. Lederer, MD, FASN, recently interviewed Raj Mehrotra, MD, FASN, the new Editor-in-Chief of the Clinical Journal of the American Society of Nephrology (CJASN) about scientific publishing and his plans for CJASN. Following are excerpts from their conversation. To listen to the full podcast, please visit http://asn.kdny.info/qpOr30bIv7Y.
DR. LEDERER:
During a recent ASN Communities chat, you were asked about your biggest surprise upon becoming Editor-in-Chief of CJASN. You responded to the effect that you realized you had no idea of the huge breadth of research going on. If someone like you—who is so energetic and keeps up with the clinical literature as well as you do—realizes you aren’t keeping up, what will happen to the rest of us, who don’t have your energy?
DR. MEHROTRA:
It’s an important question, and I take a broader view than just scientific publishing. The way we consume news and information during the past 20 years has changed dramatically. We have 24-hour cable news, Facebook, and other social media. I would argue that scientific publishing has not kept pace with how we live our lives now compared to 20 years ago and need to innovate in order to best communicate information to people with so many demands on their time.
Something I find helpful is to utilize an electronic table of contents for journals that publish things of interest to me. Even then, I am often so inundated with email that I would be wrong if I said I read things carefully every time.
CJASN has started a few more initiatives in the past few months to grab the attention of individuals who are so busy otherwise. We have started to produce podcasts. Our hope is to have podcasts for at least two articles published in CJASN every month. We also recently introduced the visual abstract, which is like a single PowerPoint slide that summarizes the key message from a paper. We hope the visual abstracts will be made available through the website and social media.
How we communicate information through social media is also very critical. There’s a way in which you and I consume information and then there are the ways those now growing up in the medical world—fellows and young faculty—consume information. We need to test our assumptions about things that could potentially be effective forms of communication that we are not presently thinking about. I hope to test those assumptions in the next year or two.
DR. LEDERER:
Young people today often use “T.L.D.R” online, meaning “too long, didn’t read.” I think this is a direct outgrowth of the phenomenon you’ve described. People are now accustomed to getting their news in teeny chunks in a way that’s relatively easy to digest. Even TV news is all little bitty two-minute blurbettes on what’s going on. And you have to wonder how many people are actually reading the two- or three-page New York Times articles that can actually be quite excellent and groundbreaking.
I think a challenge for people looking at medical literature today is that it’s designed so you can read the abstract at the top and get your little sound bites. However, if you’re really interested, you have to dig to find: How did they do this? What was the population that they were looking at? What kinds of statistics did they use to analyze it?
One of the sequelae of the new way of disseminating news and information that has gotten a lot of press lately is that we have become sort of holed-up and siloed in the types of information we want to get or are willing to listen to or look at. For the practicing nephrologist, that’s got to be a challenge as they try to keep up with everything. You and I, in academics, may focus on our chosen fields. So you know everything there is to know about peritoneal dialysis, but I don’t know as much about it. On the other hand, I probably know as much as anybody about phosphate metabolism, but that may not be an area that you are as interested in and do not read about as much. But the general nephrologist cannot do this. They see many problems and try to keep up. That’s why a journal like CJASN is important—it appeals to general practicing nephrologists. The challenge is: How can you present articles in the most effective way? How can you highlight what is most important or groundbreaking for a general nephrologist who is reading the journal to try to keep up?
DR. MEHROTRA:
I completely sympathize with the “T.L.D.R.” acronym, which you just introduced me to. In thinking about this and how I would share my vision for the journal, I’d partition it into two parts: communicating original research, and value-added features that put our knowledge in context.
Original research is very important because the information can be presented in a manner such that if another investigator wants to replicate the findings, they have all the information they need in that paper.
The value-added features are where one has to be very careful because I do not believe that there are many people who read papers that are 3000 or 5000 words, except maybe fellows who want to use review articles to help them make presentations.
We have changed direction in that regard and the phrase I like to use is “bite-sized pieces” that allow people to readily consume information, but in no more than 1500 words. That may even be too many, but at least it is moving in the right direction.
I think a lot of the information we consume, even scientific publishing, is viewed on handheld devices, not even desktops anymore, and nobody’s going to scroll all the way down an article unless they can readily consume it. The challenge for journal editors is to innovate and communicate our messages better.
DR. LEDERER:
Yes, and if you look at a journal like Science, to me it’s amazing because their articles are three pages long. That’s it. I suspect Science articles do not include a lot of the nitty-gritty details of the methods. So when you look at a Science article, it’s pretty easy to scan two or three pages as opposed to something longer in another type of journal.
JASN has relegated methods to the end of the article in a smaller font so that you can read what most people would consider the “gee whiz, this is the heart of the matter” if you are not interested or savvy in methodology.
Speaking of methodology, one of the biggest challenges, even for me, not being a clinical researcher, is that it’s very difficult to evaluate the types of statistics used today. So I wonder, do general nephrologists simply have to take for granted that journals have done a superb job of vetting the statistics used and then verifying their validity when a paper is written?
DR. MEHROTRA:
You bring up another extremely important point with regard to the various methods used in clinical research. Various organizations and groups put together checklists for what should be included, say, when you’re publishing results of a clinical trial or what should be included when you’re publishing the results of a meta-analysis.
CJASN has taken it a step forward and has endorsed and adapted those checklists. Every time an article is expected to move forward to revision, CJASN associate editors complete the checklist for the article type that is involved. For a clinical trial, we would use the CONSORT checklist. For an observational cohort study, we would use a STROBE checklist. For a meta-analysis, we would use a PRISMA checklist. These are the three we started with and now include with our first assessment of the article we send back to the author. Checklists allow us to tell authors additional information they need to include so we can standardize our way of reporting clinical research.
DR. LEDERER:
Articles from journals like CJASN are frequently used for journal clubs and training programs.
One of the questions that we always ask our fellows to address when they’re reviewing an article is: “Will this finding change your practice, and, if so, how?” I find it interesting that this specific question is never really addressed in an article. Why do you think that is? Why would authors be reluctant to step out and say “this is how we think you should change your practice”?
DR. MEHROTRA:
That’s actually the first thing we look at when we assess a paper, and I would call it “significance.” There are two ways an article could be significant. First, it could change clinical practice. I have to admit that most of the articles published do not use the research methods necessary for us to be certain that this is how clinical practice should be changed. But most papers should meet the threshold for how the finding advances our knowledge of this or that aspect of kidney disease and whether it allows us to clarify something we didn’t understand in terms of what the next clinical trial should be: Now that this study is done, how we can design a clinical trial?
DR. LEDERER:
Shifting gears, from a clinical knowledge standpoint, is there any area of general nephrology in which you feel you have really picked up some knowledge even in the relatively brief period of time that you have been Editor-in-Chief?
DR. MEHROTRA:
You know, the answer goes back to the point you raised earlier when you mentioned how there are things we love and things we don’t spend much time thinking about on a day-to-day basis. For me, that’s been glomerular diseases and transplantation.
With regard to the rare glomerular diseases, it has been amazing to see how collaborative networks have been established and how people are doing the difficult work of understanding the pathophysiology and/or treatment of rare diseases. That has been absolutely amazing.
Similarly with regard to transplantation, since the time of my fellowship I have only taken care of people after the acute phase of receiving a kidney transplant. The second area I have learned more about includes the partnerships with sophisticated transplant programs and the advances and work people are doing there, and I’m gratified to learn about that.
DR. LEDERER:
I think another thing you are pointing out is that not only do each of us have an area or a few areas where we tend to focus our attention while we ignore others, but also that everything changes so quickly. Even though we talk about nephrology sometimes as if “it’s kind of the same as it was 50 years ago…” it isn’t.
DR. MEHROTRA:
I agree. It is easy to say there hasn’t been much progress, but looking at the work people are doing and the effort they’re putting in to solve some of the problems we face is actually very humbling.
