Abstract
From the UK to China, whether you travel west or east, doctors face the same challenge: how to get published to get on in your career. Clearly, the problem is greater in some places than others. If you are setting out on a career in academic medicine, it doesn’t seem unreasonable that you should be involved in research to help you get to the top. That’s essentially the case in the UK, although of course a published paper or two can help you sound good at any job interview. How relevant it is to your abilities as a doctor is another matter. If you’re lucky, your paper might even be on a topic that matters to patients, as we hope is the case with this month’s study on interventions to improve safety in care homes. 1
China, however, is an example of a country that has taken publication profile to a bizarre extreme. Promotion now depends on publication, at almost any stage of a medical career. The demand for publication before promotion is extending to other health professionals such as nurses. 2 Apart from creating dismay among health professionals, the policy is fuelling the rise of predatory journals and encouraging unethical publication practices. Research papers are being fabricated, duplicated and plagiarised.
The challenge of misconduct in publishing is as old as publishing itself. It was barely acknowledged until the last twenty years and still remains under recognised. The fundamental problem is that scientific journals do not have enough resources to check the veracity and originality of the work that is sent to them. Systems that now check papers on submission to journals do help but they remain imperfect and are blind to certain forms of misconduct. That leaves plenty of scope for the system to be exploited.
Hence, the publishing enterprise is reliant on trust. It is also improved by transparency. More importantly still, the peer review of a paper does not end with its publication. Post-publication review is essential to improving the science in any field and identifying flaws in individual papers. Readers should be encouraged to write letters to editors and post-electronic responses when they are concerned about the rigour or the integrity of any published work. Indeed, you might build on or respond to an argument such as the plea by Williams et al. to protect graduate entry to medical school? 3 Or you might feel strongly enough to contend the interpretations of Fontalis and colleagues in their clinical review of euthanasia and assisted dying? 4
Letter writing, for what it’s worth, seems a much more manageable, useful and enjoyable discipline to provide evidence of intellectual capacity than forcing doctors to put their names on research papers that nobody wants to read and nobody will benefit from. I guess Winston Churchill might have approved. 5