I have just put on a preprint server a paper I have been trying to get published for nine months. It has so far been impossible to get it into a peer reviewed journal. I make no guesses as to why these eight journals behaved in the ways they did. I will leave you to draw your own conclusions, and I will just set out the facts. I will say at the outset that no journal rejected it on the basis of the quality of the work.
You will see from the posted manuscript that this study was about the provision of pseudoscientific therapies in cancer departments in England. Admittedly it’s a rather unusual type of study, especially as there was no protocol, the methodology evolving in response to public concerns. Key results are:
- Over 13% of cancer departments in NHS England offer pseudoscientific therapies, eg reiki, crystal therapy, chakra balancing, reflexology, and aromatherapy.
- No NHS trust could provide any robust evidence in support of these therapies.
- No NHS trust could provide a valid business case for these therapies.
- No properly informed consent was obtained from patients offered these therapies.
I started with the highest quality and most appropriate journals. I submitted to BMJ Evidence Based Medicine on 6th September 2023. I resubmitted on 7th September, after completing some minor revisions. Within 1.5 hours I received this response:
We are sorry to say that we are unable to accept it for publication, as it did not achieve a high enough priority score to enable it to be published in BMJ Evidence-Based Medicine. We have not sent this manuscript for external peer review as in our experience this is unlikely to alter the chances of ultimate acceptance. We are keen to provide authors with a prompt decision to allow them to submit elsewhere without unnecessary delay.
The paper was automatically transferred the same day to BMJ Supportive and Palliative Care. After two months with nothing more than an auto-reply, I withdrew the article on 7th November. I would have expected at least an editor to have been assigned in this time.
The next journal selected was The International Journal of Quality in Health Care, published by Oxford University Press. This required quite a lot of revision, and the revised manuscript was submitted on 29th November. A response was received on 27th January 2024:
Many thanks for this paper. It has raised discussion among the editorial team. We find that it is outside of the scope of the International Journal for Quality in Healthcare.
During the submission process, over two months, I was required to complete several rounds of revision. I have to ask why the matter of the journal’s scope was not raised before I committed to all this work.
The next journal looked interesting. It is called Cureus, and appears to have a very clever online submission system. I submitted to Cureus on 30th January 2024. There followed several rounds of confusing emails from the editorial assistant, who kept introducing new formatting requirements. Eventually I was told that the manuscript could not be accepted without chargeable editing services being applied. I had hitherto completed every revision requested, and was now being asked for US$400. I withdrew the submission on 6th February 2024.
Hey ho, off to the next one. I submitted to Public Understanding of Science on 20th February, and got this response the next day:
We are very sorry to say that we do not consider your manuscript for publication in Public Understanding of Science. Your study is certainly interesting but since it investigates the quality of health care, it does not match our scope. Please see our aims and scope: https://journals.sagepub.com/aims-scope/PUS. We want to emphasize that our desk rejection is not based on an assessment of the manuscript’s quality but only on its lack of fit with our scope. A journal on health care systems such as “Health Services Insights” (https://journals.sagepub.com/home/hisa) may be more appropriate for your manuscript.
Nothing wrong with that response, and I had a look at Health Services Insights. But their article processing charge (APC) is $2000. I should explain that most journals operate in one of two modes. If they are open access, which means that there is no charge for reading their content, they then charge for publishing. If there is no APC they put articles behind a paywall. OK, journals are businesses and have to earn a living, but this selects against people like me who are not paid by an institution and work on a voluntary basis. But moving on…
I started submitting to Palliative Medicine on 7th March 2024, but ran up against a road block that is increasingly common. More and more journals now require authors to confirm that they have completed a publication checklist appropriate to their study. These checklists are often very long and onerous to complete. My problem is that there is no appropriate checklist for my type of work. I asked the editorial office for advice, and this is what I got from the editor in chief:
I am sorry you would find the checklist onerous- it is a relatively standard requirement for most journals and we find that it has a positive influence on the quality of submissions. I suspect any survey type checklist would probably suffice for your study. That said, I can see the abstract you have already submitted within the system. I doubt that this paper is a good match for Palliative Medicine. It seems rather UK centric for an international journal, and not focused particularly on the practice of palliative care? I acknowledge that complementary therapies are often offered to palliative care patients, but this does not seem to be the focus of this paper? If you do choose to submit this paper, we will let you know quickly if we are interested in it.
Clearly it was not worth the effort to complete this submission, so I withdrew it. The next one was Health Science Journal. I submitted on 9th June, within six days the paper was accepted, and I was then told about the APC of 2300 euros. Seems a bit quick for peer review.
The last journal submission, on 23rd May 2024, was probably the oddest. The Indian Journal of Medical Ethics is highly respected, and as the lack of informed consent identified by my study is a major issue, it seemed an appropriate journal. Here is their initial response:
- The manuscript has almost no literature review that refers to pre-existing work on pseudoscientific practices within modern healthcare systems. For example, a study like this could have referred to Sabah Siddiqui’s work on the dawa-dua programme ( https://pure.manchester.ac.uk/ws/portalfiles/portal/188957891/FULL_TEXT.PDF). There has also been some discussion around “integrative medicine” that claims to bring together traditional (read: often pseudoscientific) medicine with modern medicine ( https://www.sciencedirect.com/science/article/abs/pii/S1479666X17301695). This study ideally should have located itself in the context of these discussions.
- Further, the paper is analytically quite thin. Despite the author providing us with excerpts from the Trust’s text on complementary therapies, the paper does not engage adequately with these excerpts, other than repetitive (and perhaps, misguided) uses of the word “healing”.
- Another important concern is that this paper critiques pseudoscientific interventions without investigating potential cause for their prevalence. Who are the people that are seeking these complementary therapies? Why? Something that Siddiqui’s work on dawa-dua tells us is that there is a certain entanglement between how people see the therapeutic effects of alternative and modern medicine systems. Even if the author does not have the data to comment on this, engaging with literature would help the author make reasonable speculations, nuance their discussion and identify more rigorously the points for future investigation.
Please resubmit the manuscript with a thorough literature review before we could send it out for peer review.
Someone seems to have missed the point here. Let’s take the three points in order:
- The first of the documents linked here is an unpublished PhD thesis about a Muslim shrine in the Indian State of Gujarat. I have not been able to establish whether the PhD was ever awarded. Try as I might, I fail to see the relevance of this to the National Health Service in England. The second paper linked here is quite interesting, but my research question was not about integrative health, it simply asked about the extent of pseudoscientific therapies, and how these were justified in the NHS.
- I could have analysed all of the statements from the trusts’ governance documents, but this would have made the paper impossibly long. I already had to do a lot of reworking to meet this journal’s word count limit.
- The research question did not ask about demand for pseudoscientific treatments. I was specifically interested in the conflict between the well publicised NHS policy of evidence based clinical practice, and the provision of therapies which lacked any credible evidence.
I did engage with the journal editor in chief, with whom some of my colleagues at HealthSense have worked. The problem seems to be a cultural one. In India pseudoscience is so prevalent that a paper about it, even in another country, seems irrelevant. Also, there seemed to be some sensitivity about the UK’s “imperial past”. So I decided to withdraw the paper.
I am by no means a full-time academic, and never have been. But for people whose job is getting papers published, it must be a nightmare. For a start, a lot of journals use the platform Manuscript Central, but there is not much that’s central about it. I had to create a new account for every journal. Then of course, they all have different requirements for formatting, references, word count, tables and figures etc, despite international “standards”. One major problem was that much of my source information consisted of lists of papers which NHS trusts were using as evidence for therapies. Part of the research question was to assess this evidence, meaning that I had to read all the papers and say something about them. So they had to be listed in the references, which then exceeded the maximum number of references for most journals. Some journal editors seemed unable to understand this, and just insisted on the standard being observed. Much the same applied to the tables. I created tables which summarised the studies the trusts were citing, but these made the tables too big for some journals to accept. The version I have posted on MedRxiv was reworked to suit the Indian Journal of Medical Ethics, so the tables are brutally summarised. If anyone is interested in more detail there are other versions available on request.
Nobody pays me to do this work. I only do it because I care about the truth. If you do too, let me know. It will make it worthwhile.
Filed under: Alternative medicine, cancer, Evidence-based medicine, Journals, Uncategorized | Tagged: Alternative medicine, call-for-papers, CAM, cancer, news, peer-review, publishing, research | 2 Comments »
Majikthyse 