Getting on track: how scientific journals and mainstream journalists could do a better job of communicating with the public =========================================================================================================================== * André Picard The debate surrounding fast-track publication should not be strictly an academic one. The public has a vested interest in seeing some research rushed into print: studies that reveal new or unexpected microbial or environmental threats to health, innovations that signal important advances in the treatment of serious illness, or newly uncovered serious adverse effects of specific treatments or medications that need to be revealed quickly to the public. In addition, innovations that might have an important effect on the cost of delivering health care are not without immediate interest. Admittedly, those kinds of bombshells are rare. Still, it tells us that the principal motive behind fast-tracking — of alerting the public to real dangers and opportunities — is sound. Yet, as the paper by William Ghali and colleagues in this issue (page 1137)1 makes clear, articles given accelerated publication are not necessarily more important from a scientific or clinical point of view than those handled in the usual fashion by journals. Papers are fast-tracked for a host of reasons, chief among them fierce competition among journals for interesting and controversial articles. There is also an element of keeping up with the Joneses. Once *The Lancet* cover was adorned with a red bird indicating that an article had been fast-tracked, it was not at all surprising that both the *British Medical Journal* (with an oval-wheeled bicycle symbol) and *CMAJ* with the fleet-footed (and wily) Mercury rapidly followed.2,3 And now that *Nature* has introduced online prepublication (to draw attention to 2 articles on the molecular biology of the bacteria that causes anthrax), we will soon be bombarded by articles that presumably cannot wait a few more days for a regular publication date. Among journalists in the mainstream press, however, fast-tracking is largely a nonissue. An informal survey among a number of my fellow health care reporters revealed a near-unanimous view that fast-tracking does not necessarily imply superior quality. Rather, reporters wonder why only a select few articles are expedited. Why is the whole process of publishing research in journals not speeded up in its entirety rather than selectively? And, why is more effort not expended on weeding out marginal research instead of concentrating efforts to get a few articles into print a bit earlier? Ghali and his colleagues1 make the point diplomatically by stating that “our findings call into question current publication practices. Journals in some instances are not expediting the publication or release of important articles, and in other instances are selecting relatively less important articles for expedited publication.” Journalists are, to a certain extent, puzzled by the selection criteria and methods used by medical and scientific journals. But I suspect that the head-scratching is mutual. I am often asked by health professionals how journalists and news editors decide what medical and health news to cover on a daily basis. Story ideas come from a number of sources: the political arena, the courts, news events, published reports and, of course, journals. Given the appetite for health news, there is never any shortage of topics. The challenge is not so much deciding what to cover, but what not to cover. A reporter like myself scans about 20–25 journals a week. We receive most of them under embargo, meaning that they arrive about a week before publication date. Many journals and the universities, research institutes and corporations with which researchers are affiliated also publish press releases simultaneously. From that weekly pool of a couple of hundred research articles, we will, at my paper, usually write 2–3 articles — and during a slow news week maybe double that number. Narrowing the number down is not as hard as it might seem on the surface. Regular readers of journals know that, regardless of the publication, each issue contains a lot more chaff than wheat. Above all, we look for news that has broad appeal — it generally has to be understandable to the lay public and have some relevance to their personal health, or to the broader health system. Naturally, you will see more coverage of treatments for heart disease than of new techniques in microbiology. At a paper like *The Globe and Mail*, we also pay particular attention to the work of Canadian researchers, which often would not otherwise be covered by the wire services. All media look for controversy: research that questions popular wisdom is far more likely to get coverage than a study affirming it. The article by Nancy Baxter and colleagues4 in the June 26 issue of *CMAJ* questioning the benefits of routine breast self-examination is a perfect example of an article that is both broadly relevant and highly controversial. At the same time, we try to avoid covering research breakthroughs that offer false hope. Many a scientist has “cured” cancer in a petri dish, and even in the occasional lab mouse; this type of finding is undoubtedly important but, unfortunately, readers all too often expect these miracle cures to be available to them that same day. This is not meant as a slight to health consumers, who are much more sophisticated than we tend to give them credit for; rather, our readership expects findings reported in the newspaper to be tangible, not theoretical. In addition to hard news, we scour the journals for quirky and amusing material, such as the article that revealed that Oscar winners live longer than runners-up.5 Context also matters a lot. In the post-September 11 world, interest in articles about bioterrorism and infectious agents soared. Yet, at the same time, the resources dedicated to coverage of terrorists and the war in Afghanistan also meant there was less space for health and medical news. And space allotment is always the ultimate determinant of how much we will cover. There is, unfortunately, no magical formula for determining what goes in that space. What we do in the media is a crude form of fast-tracking: we attempt to single out those particularly interesting bits of research and rush them into print. Unlike journal editors, however, we do not have the benefit of peer reviewers, or the power to send the manuscript back for revisions and clarifications. The process that journalists and news editors use in selecting which journal articles to cover is an imperfect one; it owes as much to our personal quirks as to timing and to what else is going on in the world. But, as the article by Ghali and colleagues makes clear,1 the process used for choosing which articles appear in journals in the first place — fast-tracked or otherwise — is, despite being more systematic, equally imperfect. Meaning that the lay press and the scientific press have a lot more in common than we probably care to admit. And we should both endeavour to do better, for the sake of the public that should ultimately benefit from scientific research. 𝛃 See related articles pages [1137](http://www.cmaj.ca/lookup/volpage/166/1137) and [1151](http://www.cmaj.ca/lookup/volpage/166/1151) ## Footnotes * *Competing interests:* None declared. ## References 1. 1. Ghali WA, Cornuz J, McAlister FA, Wasserfallen JB, Devereaux PJ, Naylor CD. Accelerated publication versus usual publication in 2 leading medical journals. CMAJ 2002;166(9):1137-43. Available: [www.cmaj.ca/cgi/content/full/166/9/1137](http://www.cmaj.ca/cgi/content/full/166/9/1137) [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTY2LzkvMTEzNyI7czo0OiJhdG9tIjtzOjIxOiIvY21hai8xNjYvOS8xMTUzLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 2. 2. Goldbeck-Wood S, Robinson R. *BMJ* introduces a fast track system for papers. We will offer to publish exceptional papers within four weeks. BMJ 1999;318(7184):620. [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjEyOiIzMTgvNzE4NC82MjAiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTY2LzkvMTE1My5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 3. 3. With all due haste: fast tracking at *CMAJ* [editorial]. CMAJ 2001; 164(8):1117. Available: [www.cmaj.ca/cgi/content/full/164/8/1117](http://www.cmaj.ca/cgi/content/full/164/8/1117) [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTY0LzgvMTExNyI7czo0OiJhdG9tIjtzOjIxOiIvY21hai8xNjYvOS8xMTUzLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 4. 4. Baxter N, the Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer? CMAJ 2001;164(13):1837-46. 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