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. >> Thank you very much for having me today. Yeah, I hope we can say something that might be useful. >> So I want to tell you a little bit about Dr. George Lundberg. He spent 17 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 Web MD. He is currently 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. And so, he has just a wealth of experience in publishing that he can share with us, so thanks again for being with us. >> Yeah, I've done it, I've done medical editing now for about 30 years full time. >> [LAUGH] So I'm going to just start at 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 moderately 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 or 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, that might be an entirely different journal to pick. >> Yeah. >> So is the authorage in the readership? Who does the author want to have read the journal? I mean the 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 is 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 of if is this the right fit for the science that was done and is it a fit for the journal? >> I think that's what one does actually from the very beginning. A paper comes in, 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 that has the most knowledge in that particular subject area to handle 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 [NOISE] 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 an area? What if the editor, is arrogant? Or maybe is in competition with that field, or knows somebody else who Is working in that field. There are all kinds of human things come in to there, which unfortunately I've seen happened too often. But the usual author ought to trust the editorial process as being in the best interest of science, medicine if it's 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. >> [LAUGH] That's a really good point. >> So, the authors, especially young authors, should view this issue of the review process, the editorial process, it is designed to keep egg of of their face. And be thankful for help in making the manuscript better. Or maybe even making it never be seen by anyone else. >> [LAUGH] That's a really good point that the viewing, the whole publication process is a way to improve your article, and improve your paper. >> For the reader and for the author. >> Yeah. >> So that's what the review process is all about. >> 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 that, if they pick a proper journal, the best journal for it, which may be the number one mistake, not picking, >> [LAUGH] Yeah, okay. >> The best journal, and being rejected at that point. 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 easy to find the instructions for authors. So many authors don't find them, and if they find them, they don't follow them. Then 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 said here, try to get the right journal, follow the instructions for authors, don't write it too long. And don't draw conclusions that go beyond the data. >> Good point. >> That's a very common problem. >> Good, good. >> Sorry, you asked for one. >> No, those are all fantastic tips. >> I gave you several, they're all vying for, >> Yeah. >> Number one. >> Yeah, great, no, those are really great. And sort of along those same lines, what can authors do to increase their chances of getting published, you know, in a higher impact journal, or even just getting published if you're starting out? >> Be humble, but don't be excessively humble. 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 all the time. So I think, as I've already said, try to figure out the right venue, where there'll be a reading audience that is what you're trying to reach, that will be sympathetic to your topic and what you're trying to say. And then follow the instructions for authors. >> [LAUGH] >> Really do. >> Yeah, that's good to hear. >> And once you've done that, and tried to write it concisely, that's pretty good. Now if you have a lot of coauthors, that's good, but it's also hard, because they all have to agree on a final product. If you don't have many coauthors, 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're really hot to trot. >> Yeah. >> But let it cool, then go back and pretend your the meanest editor, >> [LAUGH] >> In the world, and see whether you, the meanest editor in the world, really think this is the paper. And if not, see how it could be made better. And then choose your own reviewer, at least 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 to tell you. [LAUGH] >> Yeah. >> What they really think 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 it's 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 it to get that outside feedback. >> Right, right, that's real. >> And I was hoping you would give some advice, especially to young scientists. So since a lot of the class are younger scientists kind of just starting out, having their first experiences with getting, trying to get a paper published, is there some advice specifically for the younger folks in 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 anyhow. >> [LAUGH] >> But that's another side of the story. But be suitably in awe of 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 your honest, also have confidence in what you're doing, don't be afraid. But also you don't expect to hit the moon the first time. >> [LAUGH] Yeah, so one of the questions that I wanted to ask you is to give some advice, let's say you're a first time author, and you get rejected. Is there some encouraging words you can give for some author who gets the first thing they submit, get sent back as an outright rejection? >> No one likes rejection. >> Yep. >> Everyone experiences it. Well, for example, I tried to get in medical school three years in a row before I was finally accepted to medical school. >> [LAUGH] >> 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 admissions 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 the real likelihood. When you look at a journal, a high impact journal like New England Journal Jam, or the Lancet, you're looking at rejection rates for unsolicited manuscripts on the range of 95%, >> 95%, well, yeah. >> So, most likely the people who are watching the stock level they will tell you, they're 99 to 5%, that means it's hard, and it is hard. The journals that are not that hard to get into have much lesser rejection rates slowly up to [LAUGH] rejection rates in the 5, 10, or 15% range. But mostly those journals won't tell you that and mostly you don't have any good way to know. >> Right, right. >> Because there's, unfortunately, there's not a lot of transparency in the publishing process. >> Right, right, but you can assume even for a moderate impact journal that rejection rates are likely fairly high, then. >> The rejection rate's going to be a majority of papers that are submitted. >> Okay. >> In a moderate impact. >> Think it's helpful for people to know what they're getting into. >> Yeah, when you talk about impact journals, you're coming into a very nebulous area. >> Yes. >> What does it mean for impact? People like to have numbers to put on things. >> Yeah. >> Like if you're looking out in the morning then you see what kind of day is it going to be? A lot of times you see, well there's a 94% chance of rain today. On the other hand the sun is shining. What would that really mean? I'm not sure. But impact factor is something that Gene Garfield created a long time ago. >> Right. >> And he wished he hadn't because it puts a number on an article, a number on a journal, that really is not that important. But it has grown into a measuring stick for journals, for authors, 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 people read it and quote it because it was wrong? [CROSSTALK] >> It was stimulating and interesting. So, but nonetheless, there's a range of journals, in terms of the level of difficulty of getting into them, and I think it's natural for people who are naturally competitive, who want to get into journalism. >> Of course. [LAUGH] >> The hardest thing to be 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. >> Yeah. >> It was that hard to get in there, that person got there. I know that when I ran the gem of journals, which included the Archives of General Psychiatry, that journal had an acceptance rate so low, and a review process so long and tedious that it had become 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 a mystique, but there were also data to support it because everybody knew it. >> It was hard to get it, yeah. >> It happened that way because it was so hard, but that was important because Danny Freeman, the editor for a very long time, >> Commonly would have 12 to 15 peer reviewers. >> Wow, that's very unusual. >> Per manuscript. >> [LAUGH] Yeah. >> And yeah. [LAUGH] >> [LAUGH] On the flip of side, just so people who are just starting out understand. So you mentioned the rejection rates and 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 an article gets accepted in a good journal outright is if it was solicited by the editor. >> Okay, so you're usually looking at one of these rejected but resubmit, [LAUGH] kind of where you're- >> Beyond that, because you're looking at what, well no, what an author's going to get, by and large if the author's lucky, they're going to 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, it's subject matter of interest to the readers of the journal. I'm the editor speaking on that now, and it's timely. So we'll give it 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, but not often. Heavy scientific papers rarely get accepted with minor revisions. There's usually rather a lot of revision. Commentaries, viewpoints, opinion pieces, invited editorials, things like that can get accepted with very little change sometimes. But I don't think I ever wrote an editorial for Jama myself that got accepted without revision. >> [LAUGH] So that's good to know. >> Remember that. >> Yeah [LAUGH] >> I was the editor. But I was generally intelligent enough and humble enough to let somebody else look at my stuff before I published it because I want somebody else to see it. >> Yeah. >> And fortunately, I've kept egg off my face most of the time, not always. >> Right, right. So in terms of if you get one of these back where there are a lot of revisions requested of you and maybe it hasn't been rejected but with a chance of re-submission. What is an author or journal editor looking for when they get a paper back, I mean what's the, 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 do the others have to achieve? >> Well, 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 they're told to do it will be accepted like that. No, it's always subject to additional review, but it's 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 or about the article on 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 reviewers say, or has to argue effectively as to why they did not do what the reviewers said. And then that's okay. But to do this all of the authors if there are many, although hopefully there'd be one who would take the lead, 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 is different from whatever you would think, see this reference. >> Yeah. >> Or something like that. >> Very specific. >> Item by item so that the cover letter could become as long as a manuscript, right? The editor is going to look at that and see whoo, 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. >> That's a good point, yes. [LAUGH] >> [CROSSTALK] tell you. Of course sometimes authors don't. They say they did it but if you check it. >> I have reviewed papers where that's been the case, yup. >> Now the stupidest thing an author or a 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 know 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. The editor from reviewer say I already reviewed this paper for the whatever, whatever journal. And I recommend that it'd be revised it had value but there had to be a lot of changes. It looks to me like they haven't done anything. That editor kills that paper so fast, no chance. >> Okay. >> So you have to be If you're not going to make a revision on it, you're going to have to be also lucky about what you send it the next time around. You're really stupid if you do that. >> [LAUGH] That's very good tip and. >> What key changes do you anticipate are going to occur in the publication process over the next decade? I think we're sort in an era where a lot of things are changing and it's something to kind of see Get from you what you think its going to look like. >> Dylan is going to be in San Francisco later this month. Dylan Bog, not Dylan Tom. >> [LAUGH] >> And the times, they are changing, 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 futures I mean predictions are hard to make especially about the future. But it's going to change. We know that for sure. Second 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 buy ten for sure. >> Okay. >> Perhaps even earlier than that. The recent rebellion by people, especially in the UK, and the 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 ignore it for a long time. So open access publishing of which I am pleased to have been a pioneer a long time ago. >> Yes. >> 19 99 actually early on before the was even agreement [INAUDIBLE]. And that 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 and some are privately held, but that's going to shake down. But costs will have to be, there will have to be a way to find the money, to keep the journals going. Because there are real costs. The has costs, editors need to get paid, even though the peer reviewers generally don't. The publishing process. However, in medical scientific journals the biggest costs have always been paper, and the printing and postage issue. With open access publishing on the Internet you don't have paper and there are production costs because you have to get it out there. There are editing costs that are 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 that 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. The vanity press concept is the area you have to be very careful about the ethics and the transparency of that process. It's going to be open access and it's not going to be a hold of six months to a year at the National of 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 1999. The point is the same, but now people are coming around to that point of view. That's the biggest change. >> Yeah. >> With that, speed, speed, speed, and in the process of speed, we don't want to lose quality. >> Right, right. >> And that's a big point. >> [INAUDIBLE] >> [COUGH] >> And if you could change one thing about the publication process going forward, what would it be? >> Make an open access. >> Open access, yeah. >> But not self publishing. >> Okay, still have the peer review. >> There are people who like the ideal self publishing and I can understand that. Say post publication peer review is always the most important peer review anyway. >> Right. >> 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 journalists to try that, but there should be a due process to the reader upfront. 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's the owner, who's the publisher or is there one? Blogging, I predicted that blogging would be the end of the world, in terms of any kind of trust in anything. Because a blogger is the author, the copy editor, the peer reviewer, the final editor [COUGH], 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 into something like the healthcare 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 publishing it. But it can be published very quickly and then it stands on its own merit with the name of the author. If the author hasn't faked it, that's the only problem, you can fake it. And if there's not an editor shaking down who the real author is how do you even know it's that person? >> Right right. >> You fake the whole thing. But I was wrong, a lot of blogging has worked very well. And so I don't know, as I say, the future's not that easy. >> [LAUGH] Yeah, great. >> But it's going to change, and it'll change a lot. >> Yeah, and if you can give any last tips to the class again, a lot of people trying to get published for the first time. >> Follow the instructions for authors. Try to choose a journal that fits your study, your paper, try to do what the editor wants you to do before the editors even ask you, and that's the instructions for authors. >> [LAUGH] >> And then have a couple of your colleagues who are your friends, who want to remain 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] >> [LAUGH] With very little revision, but it was a spectacular paper based on cases. And the cases were remarkable cases. And the editor understood that, but that's not what the average author is going to be likely to experience. >> Great, 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.