On this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes Dr. Susan Galandiuk, a medical journal editor. Dr. Galandiuk discusses the process of researching, writing, editing, and publishing studies in medical review journals, and offers suggestions for evaluating medical information in the internet age.
How the Peer Review Process Expands Medical Science
Dr. Galandiuk is editor-in-chief of “Diseases of the Colon and Rectum” and a professor in the Department of Surgery at the University of Louisville. She says that her journal, and most of the highest valued medical journals in the U.S. and abroad, are based on the concept of peer review. Peer-reviewed journals date back to 1665, according to Galandiuk.
“What that means is that for scientific publications, when a journal receives an article, it is reviewed by the editor, and the editor decides who they want to review the article to check on whether it’s worthy of publication,” she says. In most cases, the editor will select three experts in the subject matter discussed in the article.
Galandiuk says that these experts evaluate the article based on how it compares with prior studies on the subject matter and also with their own knowledge. “They will then write up reviews of that article and send their reviews to the editor, who will then look at all of the reviews that are sent in, and then decide whether or not that article should be published,” she explains.
Some articles are rejected after review, but if the editor decides that an article indeed is worthy, he/she will send the reviews to the article’s author for revisions. That process can be extended through several revisions, and the overall time period for this process can last for several months, Galandiuk says.
This time-tested peer review process is the standard for medical journals, Galandiuk says, and it doesn’t matter if they are traditional print journals or if they exist online. She notes, however, that the advent of online publishing has enabled more articles and journals to be created that are not peer-reviewed and therefore contain information that has not been subjected to rigorous examination.
“For example, there are what are called pre-prints, which basically means that anybody can take their work and put it online without anyone having reviewed the quality of the work,” she says. In recent years, several drug companies that have conducted studies on their new medications but not subjected their findings to peer reviews have put the studies online as pre-prints. “It gets their work into the public forum much easier, without any of this careful review and vetting by experts,” she says.
Discerning Accurate Medical Information in the Internet Age
“It’s always important to look at the source of where an article is coming from – if it’s coming from a respected journal, that is one way to determine the veracity of the information,” Galandiuk says. “Nowadays, there are more than 30,000 scientific journals, and unfortunately, they are not all of equal quality. So if you want to get an article published, it’s fairly easy to do so – but again, quality publishing is different from any type of publishing.”
Since the medical science field is so competitive, Galandiuk says that journal editors must be especially vigilant in adhering to their own high standards at all times. She recalls a famous case dating back to 1998, when The Lancet, one of the most respected medical journals in the world, published an article linking measles vaccinations and autism in children; the publication’s editors eventually retracted the article after it was revealed that its author was financially supported by a group formed to sue vaccine makers.
“By that time, a lot of damage was already done,” Galandiuk says. Furthermore, she notes that instances of scientific fraud have risen roughly tenfold since The Lancet article was published. Galandiuk notes that the growth of mass media into a 24-hour business focused on breaking news has affected medical research to an extent.
Some media outlets may simplify a study’s findings, while others, in the pursuit of ratings, will promote encouraging research that has dubious academic support over more rigorous work that may have negative consequences for a particular drug or therapy. Galandiuk says that public health is put at risk when journalists fail to do the legwork necessary to accurately report medical news.
“There are sites where media can go to get subject matter experts that hopefully will give them truthful information,” she says. “Many journals will also write press releases if they have a newsworthy topic, to give a true picture of their findings so they won’t be misinterpreted by the media. So I think there’s an effort to make things transparent. ... There’s been a big movement in medical research also to provide lay summaries of articles to make things understandable to an average person.”
Journal editors have a responsibility to discern bias in studies and to remove as much of it as possible, Galandiuk says. One example is funding bias, where a pharmaceutical company’s or manufacturer’s financial support of research influences how results are reported. Galandiuk says that a group called the Equator Network comprised of medical researchers and editors has created a checklist of standard practices for peer-reviewed studies that should be followed by any individual or group that is undertaking research.
Advice for Patients: Check with Your Doctor
Galandiuk recommends that when patients seek out medical information online, they only visit websites operated by reputable, established organizations – those operated by the American Cancer Society or Mayo Clinic are two good examples. Information from personal blogs should generally be regarded with skepticism, even if it is presented with good intentions.
Galandiuk adds that patients should critically examine statistics presented in commercials and by media outlets. She observes that a lot of global statistics cited for diseases or treatments may be too broad. “They don’t consider co-morbidities or other things that are wrong in the patient, where in the disease process somebody is,” she observes. “There are so many things that determine treatment response, such as different drugs. You can’t generalize things.”
To get a better handle on statistics, Galandiuk recommends that people find out how many patients were evaluated in the study involving the medical treatment in question, if the study was a randomized control trial with groups of patients separated by treatment vs. placebo, and how long patients were observed in the study.
“For example, many studies for cancer drugs consider (patients’) having a response is living a month longer,” she notes. “To me, that’s really not a significant response. Living a month longer is not a real good marker of an effective treatment.”
First and foremost, Galandiuk says that patients who have read or watched media coverage, accessed websites, and delved into statistics about a condition they have should discuss their findings with their physician and consider their advice. She says that most medications have both benefits and side effects, and that it’s the physician’s responsibility to inform the patient about those benefits and risks in order to make an informed decision about whether they should take a new drug.
Galandiuk also acknowledges that even peer-reviewed research studies that announce major findings may subsequently become obsolete to a degree if new medical discoveries are made. “That’s how we learn,” she says. “And that’s how medicine has always changed: we improve and increase our knowledge.”
