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The findings of medical research are disseminated too slowly (economist.com)
87 points by jimsojim on March 23, 2017 | hide | past | favorite | 23 comments



No no no no....

Don't give them more money! Journals already have far too much power. They already publish research in a way that serves their own financial needs. They are too slow. They make you do all the writing, editing, formatting and figure design for free, then they charge people to read your publicly funded research. They make you put your data in an excel spreadsheet or a PDF. They fail miserably at peer review. At my institution, editors of nature journals are going around and giving seminars on how to publish in their journal - journal editors giving SEMINARS to ACTUAL SCIENTISTS. Absurdity.

All of this will sink journals. They just don't know it yet. Their strategy seems to be to become more like news outlets, publishing opinion pieces on how to fix scientific publishing, yet never actually changing what they do. The only reason it survives is because more than anybody, scientists learn to put up with all sorts of shit.


> They make you do all the writing, editing, formatting and figure design for free

Shouldn't research scientists be the ones who write? I mean, who else knows the intimate details about your experiments that need to be communicated to posterity? And, do they really make you do the formatting? My understanding is you basically just give them an easily readable pdf version of your paper... in standard double spaced 12 font arial, and when it gets accepted they are the ones who choose the pretty fonts (probably with Indesign) and revise your figures so they don't look crappy.

That said, I'll say one nice thing about the system (partly in the spirit of contrarianism, as hardly anyone has good things to say about top journals:)). If you really want to be published in a top journal, there are two routes: 1) make something really ground-breaking... and then you can even submit a crappily-formatted paper with ugly figures and you'll still get accepted -- and they'll make good figures for you! 2) have something decently good... make good figures, make sure you follow formatting guidelines to a tee and make everything as easy as possible for the editors, and then hope for the best. I think this situation is not too bad.


Obviously you write your own paper. The point is the journals profit from your work, yet they expect you to do everything for free. Then they charge your university's library a fortune so you can access your own paper. If someone wants to reuse a figure from your paper, which you made yourself, and represents data from publicly funded research on patients that donated their time and body for the betterment of society, the journal wants to charge $500.

I've realised that scientists will put up with almost anything. You have to be that way, otherwise you won't last. But when Elsevier makes billions of dollars in profit, and the person that reviews the papers for them lives in a box subsisting on instant noodles with no job security, you have to ask some questions. We don't actually need Elsevier. If they disappeared tomorrow science would march on largely unperturbed. Elsevier needs the scientists, and bless them, they have found a way to put us to work for free and sell us the product at the same time.


While I appreciate the trend towards open-access and wider dissemination, I don't think that the slowness of dissemination is one of the bigger problems in medicine.

Given that the subject deals with trying to "fix" complex, organic systems, it's worth taking time to get things right before designing interventions. It is important to realize that a flood of rapid communication often makes it harder to settle on the underlying truth (as clearly evidenced by the recent atmosphere) by rendering the search process unstable.

As some other articles (on the HN front page) have recently argued, the rush to faster publication is one of the biggest causes of research debt. And I think that is a much more important problem to solve. So, by all means let's have open-access and also more distilled dissemination. But optimizing for speed (eg: race to publish) often gets in the way of correctness.


I don't think anyone is advocating for health decisions to be based off shoddy-half baked research--some might say that is the current situation. Rather, if it takes a year from experiment completion to publication and the data is embargoed for all that time--that replication, criticism, and independent confirmation of the work is delayed for at least a year. Since this is usually on the critical path to implementing a discovery in a therapy--this publication delay does real harm to the advancement of healthcare and doesn't seem to provide a commensurate benefit in paper quality.


Right now we have research that is slow to publish, but publishing is careful, and once published we treat is as a kind of truth. You can call it a "Brittanica" approach.

Alternative is not just a faster publishing, but more feedback, and better discussion around the subject. You could call it a "Wikipedia" approach.

In the "Wikipedia" approach, you don't rely on the publisher's prestige, nor citations, as a meter of trustworthiness. Before accepting the results you review it's discussions and critique.

A similar switch happened with traditional news publishing. Years ago you had to rely on the fact that an article was published in Economist, and vetted by their good editors. Nowadays, there is a lot of independent content, and there are communities (like HN, or Reddit's AskScience), and non-profits (fact checkers, or Snopes) that point out the potential issues.


I don't think using the decentralization of news as a comparison is a good one. I agree that there are great things about new media outlets, but on the balance we are arguably worse off -- news is more polarized and political than ever. There's more great analysis and commentary online, but there's also more analysis and commentary in general.


You're right about distillation and research debt. Additionally, though, the lag from research to clinical practice is a major issue in medicine, so speed has to be a factor in any solutions. This is complex, since it's not just a question of improving throughput of publication, we need to examine issues of practitioner attitudes and capacity to change practices.

For refs, Google Paul Glasziou's research in this area.


Isn't it even worse than that, with the problem being doctors who don't bother to keep up with new practice or even resist it out of (more or less) habit?


There is a very large problem with doctors favoring what they were trained to do, and what their local colleagues do, over what's actually standard practice.

It's extremely hard to move the needle on that particular issue.


Someone said that medicine moves one doctor's grave at a time.


Loved the end of the article:

Having survived three and a half centuries, scientific journals will no doubt be around for a long time yet. With luck, though, they will return to being science’s servants, rather than its ringmasters.


The majority of journals I know provide an open-access option: you pay a few thousand dollars publication fee such that everyone else in the world can read the electronic version for free. PNAS has this option. Nature, I believe, make an article free in several months/a year if you opt to open access. A few funding bodies, such as Wellcome Trust, have requested to publish in the open access model for several years (these funding bodies pay for the publication fee as long as you can get your paper accepted). I am not sure what the Gates foundation is doing differently here.


Note that, to a lab just starting out "A few thousand dollars" is a non-trivial expenditure.


Yeah. Understand that. But journals are not charity. Someone has to pay for publication and distribution. It is either readers, authors or funding providers. Or you could get rid of the costly midman/publishers, but I am not sure an academic world with preprint servers only would be a better one.


Some countries/universities have reserved pots of money for OA fees, sadly it isn't common.

I have myself published a few papers with PhD students that should have been OA but we used the PhD students' allocated funds to send that student to a relevant conference, that's a better prospect for their career.


Yeah - this is mostly me grumbling in the direction of "Oh, I only publish in open access journals..." types who have tenure and funded R01s


Any OA publisher worth their salt offers a fee waiver program, and the expectation from Day 1 of OA has been that these costs should be baked into grant applications and funding requests. Many funding bodies and institutions take care of this for you, having OA funds and assistance available to take care of OA fees and to help direct publishing scientists to non-predatory publishers (Elsevier in particular can charge obscene OA fees, giving OA in general a bad name, which works to their benefit!)and also pick up the tab.


Article is about free access to bio/med research. Some thoughts:

Would love to see rate of adoption of new standards of evidence based medical care as a function of institutional access to top journals or simply Uptodate (the tool people actually use nowadays). Access to curated guidelines may be more clinically important than primary lit.

One reason prestigious journals are great is you get the imprimatur of success for further funding/promotion without needing to wait for citations and scientific consequence. Perhaps an opensource analytics team will over time convert the community to other metrics like reads, shares, and other h-factoresque metrics (granted all are contrived and gamable to some degree), perhaps tied to some funding consequences. Cough, ResearchGate, cough.

Regarding thread title: The small number of good medical findings are disseminated far too slowly; the large number of irreproducible, contradictory, poorly supported, and statistically misinterpreted findings are disseminated far too quickly. Couldn't resist.


For those not in the field, it's worth noting that a good deal of research is disseminated prior to publishing (or while "in press"/waiting to be published) via conferences or word of mouth.


The reach should be quit limited or not? Imo it's kind of the point to make it accessible to everyone.


Most research work is fraudulent, how does disseminating it faster address quality concerns?


It says that the fact that physicists share more their work than biological sciences, because the first ones are more computer savvy. The conspiracy theorist in me thinks that biological science papers are more forged due to Big Pharma profit motivations. Physicists have more difficult to manipulate their data.




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