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Originality: who is to judge?
what should one recommend to colleagues who see a patient with obvious meningococcal septicaemia? Should one begin antibiotics immediately or not? Frankly, I do not know, because even the hypothesis (with some backing from animal studies8) that one perhaps should give dexamethasone to calm hectic inflammation, wait for a while, and then administer antimicrobials is far from proven in human studies. In fact, recent US guidelines do not recommend glucocorticoids for gram-negative sepsis or shock, at least in large doses.9 One may criticise comparison of the UK5and the Danish6 studies, but whatever the arguments, one issue seems clear: we do not have a ready means to distinguish the patients benefiting from prompt antimicrobial treatment from those whom we put in danger by inducing massive bacteriolysis with &bgr;-Iactams.1o Clinical studies with a new approach are urgently needed. Meanwhile, let us shift away from thinking about meningococcal disease only as meningitis,3,11emphasise the clinical significance of petechiae, and start treatment promptly, if not necessarily before hospital admission. Heikki Peltola Children’s Hospital, University of Helsinki, Helsinki, Finland
1 2
3 4
Peltola H. Meningococcal disease: still with us. Rev Infect Dis 1983; 5: 71-91. Waage A, Halstensen A, Espevik T. Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1987; 1: 355-57. Thomson APJ, Hayhurst GK. Press publicity in meningococcal disease. Arch Dis Child 1993; 69: 166-69. Kilpi T, Anttila M, Kallio MJT, Peltola H. Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet
1991: 338: 406-09. 5 6
7
8 9
Cartwright K, Strang J, Gossain S, Begg N. Early treatment of meningococcal disease. BMJ 1992; 305: 774. Sørensen HT, Møller-Petersen J, Bygum Krarup H, Pedersen H, Hansen H, Hamburger H. Early treatment of meningococcal disease. BMJ 1992; 305: 774. Begg N. Reducing mortality from meningococcal disease. Give antibiotics before admission. BMJ 1992; 305: 133-34. Friedland J, Griffin G. Tumour necrosis factor, steroids, and meningitis. Lancet 1990; 335: 300. McGowan EJ Jr, Chesney PJ, Crossley KB, LaForce FM. Guidelines for the use of systemic glucocorticosteroids in the management of selected infections. J Infect Dis 1992; 165: 1-13.
10 Editorial. A nasty shock from antibiotics? Lancet 1985; 2: 594. 11 Tarlow M, Geddes A. Meningococcal meningitis or septicaemia: for diagnostic clarity. Lancet 1992; 340: 1481.
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plea
the area of originality, name the originators, rely on peer review, and are usually competitive. Let us concentrate on the issues as they affect publication, although much of what say applies equally to the allocation of grants. What is originality? Whilst journal referees are asked to assess the originality of a submission, sometimes within loosely defined bands (originality: "real", "marginal", "lacking"), a definition is rarely provided. Is an observation original if, having been made in one cell system, it is found also in a second cell system, or shown to apply to a whole organ or animal, or found in a different species? How should we score originality if the research allows numbers to be put to older qualitative observations, if computer technology moves data along a decimal point, or if new techniques essentially confirm older observations? Does research become original if it provides new data that refute an earlier "original" finding? Is a paper still original if it comes from a second centre and confirms the initial findings of others? These decisions have no absolute basis but will rely on the character of the journal, its particular subject, and the qualities of its referees. Thereby arises a dilemma. The journal will select articles with an eye to its subscribers, choosing material that is reliable, relevant, and interesting and that gives the journal an edge over any competitor. The readers must be satisfied. The scientist, however, wants to probe, innovate, unravel; for scientists, journal readership should not be an issue. Some research, even if "truly" original, may be rejected because it is inconsistent with the agenda of a journal, or an otherwise original paper may be turned down because it is deemed "uninteresting". Readers are unlikely to find ah article interesting if it relates to a drug that has been withdrawn or to practice that has since changed. The interest criterion begins to weaken when this reasoning leads to the rejection of papers because the results are negative or relate to a subject or substance that is perceived as unfashionable. More difficult is the failure to publish because the article has no obvious journal niche; by its very nature, true originality cuts across established we
patterns.
Originality may then spawn secondary problems. The topic may now become the subject of heightened inquiry, papers follow, and if established journals cannot cope one dedicated to the topic is launched. Superficially the problem of publication seems to have been solved but in reality this may simply be a diversion. The new journal will new
seldom
attract the trust afforded to its established foreand so the articles it publishes will lack impact among those who judge research success. Editors and scientists internationally have a symbiotic relationship in which originality is a central common theme. In such a relationship it would be tempting to assume that they held the same definition of originality, and that does seem to be an underlying assumption. In practice, however, the definition will vary because it is required to serve the different agendas of publishers and science. Often the outcome of deliberations will coincide; occasionally there is conflict that may leave science undermined. We believe that the different working definitions of originality used by journal editors and scientists should be recognised. Academia should accept that definitions differ, and consider ways of relying less on journal publications as a critical measure of research success. runner
Originality: who is to judge? Academic medicine reveres originality. It is the stuff of promotion and accolade and a critical commodity in career development. But how is it measured and who is to judge? Institutions themselves seldom attempt such assessments. They note contributions to departmental development, committee function, teaching, and examining, but originality is something for outsiders to assess. In reality judgment falls to journals and grant-giving bodies, whose influence is critical since ultimately their decisions determine the outcome of the equation: no publications + no grants no promotion. We question academia’s practice of delegating responsibility in this way. The judging of articles for publication, and the assessment of projects for funding, have much in common. Both make originality a necessary criterion for acceptance, define =
510
Joe
Collier, Patrick Vallance
Clinical
Pharmacology Unit, St George’s Hospital Medical School, London,
UK
1 2
3 4
Peltola H. Meningococcal disease: still with us. Rev Infect Dis 1983; 5: 71-91. Waage A, Halstensen A, Espevik T. Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1987; 1: 355-57. Thomson APJ, Hayhurst GK. Press publicity in meningococcal disease. Arch Dis Child 1993; 69: 166-69. Kilpi T, Anttila M, Kallio MJT, Peltola H. Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet
1991: 338: 406-09. 5 6
7
8 9
Cartwright K, Strang J, Gossain S, Begg N. Early treatment of meningococcal disease. BMJ 1992; 305: 774. Sørensen HT, Møller-Petersen J, Bygum Krarup H, Pedersen H, Hansen H, Hamburger H. Early treatment of meningococcal disease. BMJ 1992; 305: 774. Begg N. Reducing mortality from meningococcal disease. Give antibiotics before admission. BMJ 1992; 305: 133-34. Friedland J, Griffin G. Tumour necrosis factor, steroids, and meningitis. Lancet 1990; 335: 300. McGowan EJ Jr, Chesney PJ, Crossley KB, LaForce FM. Guidelines for the use of systemic glucocorticosteroids in the management of selected infections. J Infect Dis 1992; 165: 1-13.
10 Editorial. A nasty shock from antibiotics? Lancet 1985; 2: 594. 11 Tarlow M, Geddes A. Meningococcal meningitis or septicaemia: for diagnostic clarity. Lancet 1992; 340: 1481.
a
plea
the area of originality, name the originators, rely on peer review, and are usually competitive. Let us concentrate on the issues as they affect publication, although much of what say applies equally to the allocation of grants. What is originality? Whilst journal referees are asked to assess the originality of a submission, sometimes within loosely defined bands (originality: "real", "marginal", "lacking"), a definition is rarely provided. Is an observation original if, having been made in one cell system, it is found also in a second cell system, or shown to apply to a whole organ or animal, or found in a different species? How should we score originality if the research allows numbers to be put to older qualitative observations, if computer technology moves data along a decimal point, or if new techniques essentially confirm older observations? Does research become original if it provides new data that refute an earlier "original" finding? Is a paper still original if it comes from a second centre and confirms the initial findings of others? These decisions have no absolute basis but will rely on the character of the journal, its particular subject, and the qualities of its referees. Thereby arises a dilemma. The journal will select articles with an eye to its subscribers, choosing material that is reliable, relevant, and interesting and that gives the journal an edge over any competitor. The readers must be satisfied. The scientist, however, wants to probe, innovate, unravel; for scientists, journal readership should not be an issue. Some research, even if "truly" original, may be rejected because it is inconsistent with the agenda of a journal, or an otherwise original paper may be turned down because it is deemed "uninteresting". Readers are unlikely to find ah article interesting if it relates to a drug that has been withdrawn or to practice that has since changed. The interest criterion begins to weaken when this reasoning leads to the rejection of papers because the results are negative or relate to a subject or substance that is perceived as unfashionable. More difficult is the failure to publish because the article has no obvious journal niche; by its very nature, true originality cuts across established we
patterns.
Originality may then spawn secondary problems. The topic may now become the subject of heightened inquiry, papers follow, and if established journals cannot cope one dedicated to the topic is launched. Superficially the problem of publication seems to have been solved but in reality this may simply be a diversion. The new journal will new
seldom
attract the trust afforded to its established foreand so the articles it publishes will lack impact among those who judge research success. Editors and scientists internationally have a symbiotic relationship in which originality is a central common theme. In such a relationship it would be tempting to assume that they held the same definition of originality, and that does seem to be an underlying assumption. In practice, however, the definition will vary because it is required to serve the different agendas of publishers and science. Often the outcome of deliberations will coincide; occasionally there is conflict that may leave science undermined. We believe that the different working definitions of originality used by journal editors and scientists should be recognised. Academia should accept that definitions differ, and consider ways of relying less on journal publications as a critical measure of research success. runner
Originality: who is to judge? Academic medicine reveres originality. It is the stuff of promotion and accolade and a critical commodity in career development. But how is it measured and who is to judge? Institutions themselves seldom attempt such assessments. They note contributions to departmental development, committee function, teaching, and examining, but originality is something for outsiders to assess. In reality judgment falls to journals and grant-giving bodies, whose influence is critical since ultimately their decisions determine the outcome of the equation: no publications + no grants no promotion. We question academia’s practice of delegating responsibility in this way. The judging of articles for publication, and the assessment of projects for funding, have much in common. Both make originality a necessary criterion for acceptance, define =
510
Joe
Collier, Patrick Vallance
Clinical
Pharmacology Unit, St George’s Hospital Medical School, London,
UK