My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario
My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario - Okay, I have only published 2 papers in JAMA
My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario - Okay, I have only published 2 papers in JAMA - Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine)
My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario - Okay, I have only published 2 papers in JAMA - Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine) - Paper 4 was accepted by JAMA but published in PNAS
My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario - Okay, I have only published 2 papers in JAMA - Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine) - Paper 4 was accepted by JAMA but published in PNAS - Paper 5 I burned in rage!
Attempted My Five ‘JAMA Papers’ Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario
The following presentation represents the views of the speaker at the time of the presentation. This information is meant for educational purposes, and should not replace other sources of information or your medical judgment. Learning Objectives: • Recognize hurdles to publishing the results of research projects. • Employ strategies to develop an early research career. • Set priorities for a career in research.
Definition: A Conflict of Interest may occur in situations where the personal and professional interests of individuals may have actual, potential or apparent influence over their judgment and actions. “I I have no conflicts to declare”
Outline: 5 Chapters and a Conclusion Chapter 1 - Never turn down a good lunch. Chapter 2 - Know when to hold’em. Chapter 3 - Know when to fold’em. Chapter 4 - Don’t count your chickens before they hatch. Chapter 5 - Strike while the iron is hot.
Chapter 1 - Never turn down a good lunch
Chapter 1 - Never turn down a good lunch
Chapter 1 - Never turn down a good lunch
• Published in 2011 • Core ideas included ‘Prospect Theory’ • People treat gains and loses in an asymmetric way • Point of reference for gain or loss is crucial
• Published in 2011 • Core ideas included ‘Prospect Theory’ • People treat gains and loses in an asymmetric way • Point of reference for gain or loss is crucial
Verma AA, Razak F, Detsky AS. Understanding choice: why physicians should learn prospect theory. JAMA :2014;311(6):571-572
Verma AA, Razak F, Detsky AS. Understanding choice: why physicians should learn prospect theory. JAMA :2014;311(6):571-572
Additional thought… • Never underestimate the potential of academic arbitrage
Chapter 2 - Know when to hold’em
• BMI < 16 = “Severe Thinness” or “Severe Chronic Energy Deficiency” • Though definition was more than 25 years old - no global prevalence estimate
• BMI < 16 = “Severe Thinness” or “Severe Chronic Energy Deficiency” • Though definition was more than 25 years old - no global prevalence estimate
BMI ~ 30 BMI ~ 17
Population * Estimate of Low BMI Country BMI < 16 BMI <18.5 India 47,366,237 246,070,755 Bangladesh 4,132,985 23,919,079 Pakistan 2,471,033 16,219,371 Ethiopia 1,045,533 11,993,949 Nigeria 873,524 8,613,080 Congo DR 576,923 5,006,620 Madagascar 386,369 2,914,642 Nepal 326,716 2,751,791 Kenya 263,035 2,324,468 South Africa 172,865 1,283,787 Senegal 160,801 1,200,668 Tanzania 142,644 2,391,611 Uganda 134,402 2,004,234 Cambodia 119,803 1,601,906 Burkina Faso 101,286 1,166,840 Niger 98,952 1,049,460 * Calculated from World Bank country population estimate for proportion of population age 15+ that corresponds to survey year
After 3 months of waiting, we heard from JAMA…
After 3 months of waiting, we heard from JAMA… • Very positive reviews overall • HOWEVER, Reviewer 2 said the following: “the authors do not have an expert understanding of the current work in the field of undernutrition or in the way the field has changed over time and do not lend confidence to their ability to make a call for action in this field”
After 3 months of waiting, we heard from JAMA… • Very positive reviews overall • HOWEVER, Reviewer 2 said the following: “the authors do not have an expert understanding of the current work in the field of undernutrition or in the way the field has changed over time and do not lend confidence to their ability to identify the relevant abstracts, let alone make a call for action in this field” • Paper was rejected.
So we appealed.
So we appealed. • “Our coauthors represent a fairly senior spectrum of scientists and there was uniform concern about the tone and content of comments from Reviewer 2.” • “Given the personal and antagonistic nature of comments from Reviewer 2, we strongly question whether this reviewer can provide a fully objective and scientific assessment”
Anura Kurpad SV ‘Subu’ Subramanian Art Slutsky Andreas Laupacis Lisa Berkman
JAMA agreed with our concerns • Reviewer 2 excluded • Paper sent out for additional review
JAMA agreed with our concerns • Reviewer 2 excluded • Paper sent out for additional review • Accepted for publication!
Razak F, Corsi DJ, Slutsky AS, et al. Prevalence of Body Mass Index Lower Than 16 Among Women in Low- and Middle-Income Countries. JAMA: 2015;314(20):2164-2171
Additional thoughts… • Sometimes, obvious and easy to answer questions haven’t been looked at. • There is a lot of publicly available data out there you can work on.
Additional thoughts… • Sometimes, obvious and easy to answer questions haven’t been looked at. • There is a lot of publicly available data out there you can work on. • Don’t be a jerk when you review someone’s work.
Chapter 3 - Know when to fold’em
Rational Clinical Exam - Does this patient have pulmonary hypertension? 2012 Invited to lead an RCE for JAMA
Rational Clinical Exam - Does this patient have pulmonary hypertension? 2012 Invited to lead an RCE for JAMA Update literature review (1000s of articles screened, extract data from 43 2012 articles) Submitted to JAMA 2012 - asked to do major revision expanding focus from PAH to all pulmonary hypertension 2013 - asked to do major revision including echo screening 2014 - asked to include quality review (QUADAS) 2014, 2015 Resubmit, Resubmit, Resubmit… 2015 Rejected from JAMA 2016 Try lots of other journals - Rejected, Rejected, Rejected.
Rational Clinical Exam - Does this patient have pulmonary hypertension? 2012 Invited to lead an RCE for JAMA Update literature review (1000s of articles screened, extract data from 43 2012 articles) Submitted to JAMA 2012 - asked to do major revision expanding focus from PAH to all pulmonary hypertension 2013 - asked to do major revision including echo screening 2014 - asked to include quality review (QUADAS) 2014, 2015 Resubmit, Resubmit, Resubmit… 2016 Rejected from JAMA 2016 Try lots of other journals - Rejected, Rejected, Rejected.
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