Valuing The Written Word

I recently attended an interesting lecture at the Annual Meeting of the Association of American Medical Colleges in Boston. Harold E. Varmus, MD, gave the Robert G. Petersdorf Lecture, entitled Publication Practices and Academic Values. The talk addressed the increasing pressure to publish in glamour journals, both for funding and academic advancement. Dr. Varmus pointed out that many of his most significant works appeared in “lesser” journals that served the appropriate audience for the science. Discussions after the formal talk centered on judging academic achievement on that standard.

How did some scientific journals acquire biblical reputations?

Some have been around a long, long time. I have not found anyone who can remember a time when The New England Journal of Medicine was not the premier clinical research carrier.

How do we determine a journal’s worth? At the present time, the index of choice is the Impact Factor (IF). There is an excellent description of IF and its calculation on Wikipedia:

The impact factor, often abbreviated IF, is a measure reflecting the average number of citations to articles published in science and social science journals. It is frequently used as a proxy for the relative importance of a journal within its field, with journals with higher impact factors deemed to be more important than those with lower ones. The impact factor was devised by Eugene Garfield, the founder of the Institute for Scientific Information (ISI), now part of Thomson Reuters. Impact factors are calculated yearly for those journals that are indexed in Thomson Reuter's Journal Citation Reports.

Academics, especially scientists, love an objective numerical datapoint. During the 20 years or so that I have participated in these endeavors [has it really been that long?], the IF has risen dramatically in importance because it seems so objective. However, like all numbers, the IF can be gamed, and its validity has been questioned:

The impact factor refers to the average number of citations per paper, but this is not a normal distribution. It is rather a Bradford distribution, as predicted by theory. Being an arithmetic mean, the impact factor therefore is not a valid representation of this distribution and unfit for citation evaluation.^[6]

Most journals try to improve IF by providing more review articles. Reviews receive more citations than original research, thus improving the IF. Other manipulations may also inflate IF:

Journals may change the fraction of "citable items" compared to front-matter in the denominator of the IF equation. Which types of articles are considered "citable" is largely a matter of negotiation between journals and Thomson Scientific. As a result of such negotiations, impact factor variations of more than 300% have been observed.^[12] For instance, editorials in a journal are not considered to be citable items and therefore do not enter into the denominator of the impact factor. However, citations to such items will still enter into the numerator, thereby inflating the impact factor. In addition, if such items cite other articles (often even from the same journal), those citations will be counted and will increase the citation count for the cited journal. This effect is hard to evaluate, for the distinction between editorial comment and short original articles is not always obvious. "Letters to the editor" might refer to either class.

 

Several methods, not necessarily with nefarious intent, exist for a journal to cite articles in the same journal which will increase the journal's impact factor.^[13]

 

In 2007 a specialist journal with an impact factor of 0.66 published an editorial that cited all its articles from 2005 to 2006 in a protest against the absurd use of the impact factor.^[14] The large number of citations meant that the impact factor for that journal increased to 1.44. As a result of the increase, the journal was not included in the 2008 Journal Citation Report. ^[15]

The Wiki lists a number of alternatives to IF; however, complexity plagues them. PageRank algorithms (such as used by Google) cannot be explained in a simple equation. Increasing complexity may improve validity, but it zaps intuitive understanding.

Dr. Varmus plead for an end to IF insanity. He also works on open access, and has been a a major proponent of freely available online science. In 2006, Chris Surridge of Public Library of Science (PLoS) blogged on the IF and its irrelevancy to PLoS following an editorial in PLoS Medicine. In the Petersdorf lecture, Varmus bragged about reported the IF for PLoS Medicine (amusing but irrelevant, I guess).

So what is the answer? Clearly, the IF can be too easily manipulated. Other alternatives should be considered. Or, perhaps, we need to get over the idea of ranking stuff. Ranking journals and schools (that pesky US News and World Report thing) results in game-playing. We all know which ones are elite. The IF works about as well right now as the Bowl Championship Series algorithm does for college football.

In this internet-connected, computerized age, any paper in a peer-reviewed, indexed journal can readily be retrieved by interested parties. “Elite” journals increase early exposure, but those who need to see the work can easily retrieve it without personal subscriptions or press releases. Today, more than ever, the content should be the point.

Photo courtesy of PhotoXpress.

Masks, Hot or Not

“Why do you use your real name?”

Eventually most people who read my blog ask me this question. We all read other blogs written under pseudonyms, be they  a goddess or another fictional name. Many commenters also use pseudonyms. Working behind the veil of a screen name allows people to discuss things with candor; otherwise they might not feel free to open up for fear of reprisal or embarrassment.

Within my world of academic medicine, most bloggers hide their identity, at least to some degree. Some posts, although pseudonymous, include the author’s identity, or enough clues to figure it out. Others work hard to separate their real name from their blogosphere self.

Online identity is one of the first thing a new blogger decides. My own rationale for blogging came about because of my work. In starting a new magazine for the American Society of Nephrology, I needed to learn about social media and the role it could play with traditional media. The best way to learn this stuff is to jump in and do it. It did not make sense to have an anonymous online identity when I wanted these activities to compliment stuff I do offline under my real name.

Isis has posted her rules for pseudonymous blogging:

Anyone who could fire me/prevent my career advancement knows about my blog. I write with the knowledge that they may be reading it.  Some of them do.

I never, ever, ever write about my students.  Ever.

I never write about a colleague without their knowledge.  My immediate colleagues and collaborators know about my blog. 

I never write things about another scientist that I would not say to them openly and in public.

I don't divulge top secret MRU-related stuff.

These are good rules for any blogger no matter how they handle their identity, and ones to which I generally adhere. Given these rules, I feel completely comfortable being “out” on the web. Occasionally I get snarky, but not in a way that will cause irreparable harm to myself or my relationships.

I still remember the sense of freedom I felt when I turned 40. About that age I realized that other people really could not do that much to harm me. I bring that same attitude online now. Of course, I still have enough fear to give proper attribution to the photo-art supplier… cause FWDAOTI is cool, but stealing intellectual property is not.

Photo courtesy of PhotoXpress.

That “Special” Time of Year

‘Tis the season when a doctor’s fancy turns toward… re-credentialing. Not roasted turkey with family and football. Not jingle bells and candles. Just packet after packet from insurers and hospitals wanting to know all about you.

They all want the same information in different order:

• Are you still licensed?
• Are you still board certified?
• Has anyone sued you?
• Are you impaired in your ability to practice?
• Have you kept up your skills?
• Are you insured for malpractice?

Copies of your CV, your license, your DEA certificate, and your continuing medical education coursework accompany each form. You must also supply 3 to 5 peer references who are familiar with your practice. Also, your original signature (NO STAMPS) in 3 to 7 places.

Perhaps they would like a note from my kindergarten teacher? I believe she died, but a séance wouldn’t be much more work…

Repeat this process for each hospital or clinic at which you see patients. Fill out similar forms for every insurer. Then have your secretary make and keep copies (because at least one application will be lost).

As I struggle through this quagmire of paperwork, I wonder why this cumbersome process still exists. All of these parties request the same information; perhaps they could get together and come up with a single universal form. Even better, we could put that universal process form online. The amount of paper I am required to submit boggles the mind. The requirements can be interesting as well; some parties want only black ink while others specify only blue pens be used. (One year I used purple just to, perhaps, cause a bit of trouble.)

When you add up the cost in paper, time, and postage, we could put together a national online web-based process. Collecting these sorts of data is not rocket science. Of course, it would require some cooperation among competitors, but it is within reach. A bit of government guidance could make this reality! It would reduce administrative costs and reduce the hassle factor with a learning-curve less-steep than the electronic medical records funded by the stimulus plan!

Imagine filling out this stuff once… That would leave a lot more time for myself and my staff to enjoy family and football and bells and candles, not to mention actually taking care of patients and performing the rest of our academic duties.

A Dish Served Cold

I rose before the sun this morning to get to the airport. The cab ride lasted all of 15 minutes- about a third of the duration inbound to Boston. I checked into the lounge for a bite of breakfast and a leisurely blog post.

Instead I read emails that have made me angry. I hate when another professional questions my knowledge. I really hate when I provide data to validate my knowledge and I am ignored by said professional. I REALLY REALLY HATE an email showing that said “professional” still seeks an opinion that shows me up.

My plane will board soon. I usually fall asleep quickly in a moving vehicle not under my control.

Today I may will plan revenge.

More Information About GWIMS

In last evening’s post I described GWIMS, the Group on Women in Medicine and Science of the AAMC. Becoming an official group recognizes the importance of women’s participation in our academic enterprise. I now have some more “official”language about the role of GWIMS:

The GWIMS will serve as a national forum to advance women’s success in medicine and science by addressing gender equity, career advancement, awards and recognition, and recruitment and retention. Deans have been directed to designate institutional representatives who advocate for women’s advancement in leadership, education, research, clinical practice and administration to join the GWIMS. This new forum replaces the former AAMC Women Liaison Officer (WLO) network.

Each school should have one primary GWIMS representative serving as a point of contact to the AAMC. GWIMS is open to anyone who has an interest in advancing women’s success in medicine and science. If you are interested in becoming a member of the GWIMS or are a former WLO, please communicate with your dean that you wish to become a member of the GWIMS and have the dean’s office forward a comprehensive list of all those interested to the GWIMS office at gwims@aamc.org.

For more information about GWIMS, please visit www.aamc.org/gwims or call 202-828-0647.

A Group Becomes a Group

I serve lots of professional roles in my job. I see patients, try to run a lab, and edit a magazine. In another role, I design and implement development programs for our faculty to improve their skills in teaching, administration, and writing. As part of this role, I attend the meeting of the Association of American Medical Colleges (AAMC).

Today I attended an amazing gathering. In 1976 the AAMC gathered its first participants to discuss women in medicine. Over the past 30+ years women have gradually become half of all medical students. We are finally making some inroads into senior leadership positions as well. In all this time, Women in Medicine and their representatives, the Women’s Liaison Officers, have remained a lesser organization within the AAMC.

This year, we officially became a “group,” a formally recognized part of the AAMC. Moving from WIM to GWIMS (Group on Women In Medicine and Science) is a big step, and one long overdue. The additional “S” is welcome as well; many women serve in basic science departments, and their needs should also be served.

Each medical school dean appoints an official representative to GWIMS. Find out who represents your school and make your concerns known.

Someday sexism, overt and unintended, may be gone; until then, we need to pay attention to the needs of women.

What I Am Reading

I have been saving this one for a trip. A few years back my spouse handed me a tattered paperback he had just finished- Angels and Demons. I took it to the airport, and I did not close my eyes until I finished it. The mix of history, symbolism, science, and some anti-papacy undertones kept me reading into the wee hours of the morning. I then devoured The Da Vinci Code, a much weaker book that still kept me turning pages. I have been waiting since then for Dan Brown’s next efforts.

If you liked the first two novels, The Lost Symbol will provide a lot of the same. Massive conspiracies that could end civilization as we know it all come together along with Robert Langdon. The Harvard Symbologist (can you really get a degree in that?) has less than 24 hours to decode a complex mystery to save his friends and the world as we know it. Substitute the Masons for various Roman Catholic groups… you get the picture.

Sometimes I pick up sequels because I want more of the same. The Lincoln Rhyme novels provide procedural murder mysteries with a familiar cast but novel twists in each one. The Lost Symbol is too much of the same.

However, I did enjoy one aspect of this novel immensely. When I was a freshman in high school, during the year of our bicentennial, I researched a year-long report on the signers of the Declaration of Independence. What struck me, growing up in the heart of the Bible Belt, was the lack of traditional religion among this group of men. Most were deists; a creator exists but has little to do with the day-to-day issues of human beings. They believed in intellectual curiosity and seeking answers to the way the world worked, that the creator wanted us to seek these answers for ourselves.

In Angels and Demons, one early scene in the book (not included in the movie for some inexplicable reason) sticks with me. The dead physicist-priest and his adopted daughter have been using particle physics to attempt to provide scientific proof of the existence of god (sound familiar?). This hot female yoga-master physicist demonstrates the interaction of a teensy bit of anti-matter with matter, resulting in a brilliant explosion. After witnessing this feat, Robert Langton utters, “My god!” The woman replies, “Exactly.” I loved this scene because it suggests that the creator is a source of energy and initiation, not some judgmental bearded guy on some heavenly throne. Much more believable than anything I have heard in church.

The Lost Symbol entertained me through a couple of airports and plane rides, but the plot was too familiar. Robert Langdon still appeals, and there are still symbols to unravel. Freshen something up next time, please.