medRxiv: the pre-print server for medicine

Pre-print servers are a place to place share your academic work before actual peer review and subsequent publication. They are not so new completely new to academia, as many different disciplines have adopted pre-print servers to quickly share ideas and keep the academic discussion going. Many have praised the informal peer-review that you get when you post on pre-print servers, but I primarily like the speed.

But medicine is not one of those disciplines. Up until recently, the medical community had to use bioRxiv, a pre-print server for biology. Very unsatisfactory; as the fields are just too far apart, and the idiosyncrasies of the medical sciences bring some extra requirements. (e.g. ethical approval, trial registration, etc.). So here comes medRxiv, from the makers of bioRxiv with support of the BMJ. Let’s take a moment to listen to the people behind medRxiv to explain the concept themselves.

source: https://www.medrxiv.org/content/about-medrxiv

I love it. I am not sure whether it will be adopted by the community at the same space as some other disciplines have, but doing nothing will never be part of the way forward. Critical participation is the only way.

So, that’s what I did. I wanted to be part of this new thing and convinced with co-authors for using the pre-print concept. I focussed my efforts on the paper in which we describe the BeLOVe study. This is a big cohort we are currently setting up, and in a way, is therefore well-suited for pre-print servers. The pre-print servers allow us to describe without restrictions in word count, appendices or tables and graphs to describe what we want to the level of detail of our choice. The speediness is also welcome, as we want to inform the world on our effects while we are still in the pilot phase and are still able to tweak the design here or there. And that is actually what happened: after being online for a couple of days, our pre-print already sparked some ideas by others.

Now we have to see how much effort it took us, and how much benefit w drew from this extra effort. It would be great if all journals would permit pre-prints (not all do…) and if submitting to a journal would just be a “one click’ kind of effort after jumping through the hoops for the medRxiv.

This is not my first pre-print. For example, the paper that I co-authored on the timely publication of trials from Germany was posted on biorXiv. But being the guy who actually uploads the manuscript is a whole different feeling.

REWARD | EQUATOR Conference 2020 in Berlin

https://www.reward-equator-conference-2020.com

Almost 5 years ago something interesting happened in Edinburgh. REWARD and EQUATOR teamed up and organized a joint conference on “Increasing value and reducing waste in biomedical research “. Over the last five years, that topic has dominated Meta-research and research improvement activities all over the world. Now 5 years later, it is again time for another REWARD and EQUATOR conference, this time in Berlin. And I have the honor to serve on the local organizing committee.

My role is so small, that the LOC is currently not even mentioned on the website. But the website does show some other names, promising a great event! it starts with the theme. which is “Challenges and opportunities for Improvement for Ethics Committees and Regulators, Publishers, Institutions and Researchers, Funders – and Methods for measuring and testing Interventions”. That is not a sexy title like 5 years ago, but it shows that the field has outgrown the alarmistic phase and is now looking for real and lasting changes for the better – a move I can only encourage. See you in Berlin?

https://www.reward-equator-conference-2020.com

Results dissemination from clinical trials conducted at German university medical centers was delayed and incomplete.

My interests are broader than stroke, as you can see my tweets as well as my publications. I am interested in how the medical scientific enterprise works – and more importantly how it can be improved. The latest paper looks at both.

The paper, with the relatively boring title “Results dissemination from clinical trials conducted at German university medical centres was delayed and incomplete.” is a collaboration with QUEST, and carried by DS and his team. The short form of the title might just as well have been “RCT don’t get published, and even if they do it is often too late.”

Now, this is not a new finding, in the sense that older publications also showed high rates of non-publishing. Newer activities in this field, such as the trial trackers for the FDAA and the EU, confirm this idea. The cool thing about these newer trackers is that they rely on continuous data collection through bots that crawl all over the interwebs to look for new trials. This upside thas a couple of downsides though: with constant being updated, these trackers do not work that well as a benchmarking tool. Second, they might miss some obscure type of publication which might lead to underreporting of reporting. Third, to keep the trackers simple they tend to only use one definition as what counts as “timely publication” even though the field, nor the guidelines, are conclusive.

So our project is something different. To get a good benchmark, we looked at whether trials executed by/at German University medical centers were published in a timely fashion. We collected the data automatically as far as we could, but also did a complete double check by hand to ensure we didn’t skip publications (hint, we did, hand search is important, potentially because of the language thing). Then we put all the data in a database, made a shiny app so that readers themselves can decide what definitions and subsets they are interested in. The bottomline, on average only ~50% of trials get published within two years after their formal end. That is too little and too slow.

shiny app

This is a cool publication because it provides a solid benchmark that truly captures the current state. Now, it is up to us, and the community to improve our reporting. We should track progress in the upcoming years by automated trackers, and in 5 years or so do the whole manual tracking once more. But that is not the only reason why it was so inspiring to work on the projects; it was the diverse team of researchers from many different groups that made the work fun to do. The discussions we had on the right methodology were complex and even led to an ancillary paper by DS and his group. But the way this publication was published in the most open way possible (open data, preprint, etc) was also a good experience.

The paper is here on Pubmed, the project page on OSF can be found here and the preprint is on bioRxiv, and let us not forget the shiny app where you can check out the results yourself. Kudos go out to DS and SW who really took the lead in this project.

Joining the PLOS Biology editorial board

I am happy and honored that I can share that I am going to be part of the PLOS Biology editorial board. PLOS Biology has a special model for their editorial duties, with the core of the work being done by in-house staff editors – all scientist turned professional science communicators/publishers. They are supported by the academic editors – scientists who are active in their field and can help the in-house editors with insight/insider knowledge. I will join the team of academic editors.

When the staff editors asked me to join the editorial board, it quickly became clear that they invited because I might be able to contribute to the Meta-research section in the journal. After all, next to some of my peer review reports I wrote for the journal, I published a paper on missing mice, the idea behind sequential designs in preclinical research, and more recently about the role of exact replication.

Next to the meta-research manuscripts that need evaluation, I am also looking forward to just working with the professional and smart editorial office. The staff editors already teased a bit that a couple of new innovations are coming up. So, next to helping meta-research forward, I am looking forward to help shape and evaluate these experiments in scholarly publishing.

FVIII, Protein C and the Risk of Arterial Thrombosis: More than the Sum of Its Parts.

maxresdefault
source: https://www.youtube.com/watch?v=jGMRLLySc4w 

Peer review is not a pissing contest. Peer reviewing is not about findings the smallest of errors and delay publication because of it. Peer review is not about being right. Peer review is not about rewriting the paper under review. Peer review is not about asking for yet another experiment.

 

Peer review is about making sure that the conclusions presented in the paper are justified by the data presented and peer review is about helping the authors get the best report on what they did.

At least that what I try to remind myself of when I write my peer review report. So what happened when I wrote a peer review about a paper presenting data on the two hemostatic factors protein C and FVIII in relation to arterial thrombosis. These two proteins are known to have a direct interaction with each other. But does this also translate into the situation where a combination of the two risk factors of the “have both, get extra risk for free”?

There are two approaches to test so-called interaction: statistical and biological. The authors presented one approach, while I thought the other approach was better suited to analyze and interpret the data. Did that result in an academic battle of arguments, or perhaps a peer review deadlock? No, the authors were quite civil to entertain my rambling thoughts and comments with additional analyses and results, but convinced me in the end that their approach have more merit in this particular situation. The editor of thrombosis and hemostasis saw this all going down and agreed with my suggestion that an accompanying editorial on this topic to help the readers understand what actually happened during the peer review process. The nice thing about this is that the editor asked me to that editorial, which can be found here, the paper by Zakai et al can be found here.

All this learned me a thing or two about peer review: Cordial peer review is always better (duh!) than a peer review street brawl, and that sharing aspects from the peer review process could help readers understand the paper in more detail. Open peer review, especially the parts where peer review is not anonymous and reports are open to readers after publication, is a way to foster both practices. In the meantime, this editorial will have to do.

 

Associate editor at BMC Thrombosis Journal

source: https://goo.gl/CS2XtJ
source: https://goo.gl/CS2XtJ

In the week just before Christmas, HtC approached me by asking whether or not I would like to join the editorial board of BMC Thrombosis Journal as an Associate Editor. the aims and scope of the journal, taken from their website:

“Thrombosis Journal  is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis.Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.”

I talked to HtC, someone at BMC, as well as some of my friends and colleagues whether or not this would be a wise thing to do. Here is an overview of the points that came up:

Experience: Thrombosis is the field where I grew up in as a researcher. I know the basics, and have some extensive knowledge on specific parts of the field. But with my move to Germany, I started to focus on stroke, so one might wonder why not use your time to work with a stroke related journal. My answer is that the field of thrombosis is a stroke related field and that my position in both worlds is a good opportunity to learn from both fields. Sure, there will be topics that I have less knowledge off, but here is where an associate editor should rely on expert reviewers and fellow editors.

This new position will also provide me with a bunch of new experiences in itself: for example, sitting on the other side of the table in a peer review process might help me to better understand a rejection of one of my own papers. Bottom line is that I think that I both bring and gain relevant experiences in this new position.

Time: These things cost time. A lot. Especially when you need to learn the skills needed for the job, like me. But learning these skills as an associate editor is an integral part of the science apparatus, and I am sure that the time that I invest will help me develop as a scientist. Also, the time that I need to spend is not necessary the type of time that I currently lack, i.e. writing time. For writing and doing research myself I need decent blocks of time to dive in and focus  — 4+ hours if possible. The time I need to perform my associate editor tasks is more fragmented: find peer reviewers, read their comments and make a final judgement are relative fragmented activities and I am sure that as soon as I get the hang of it I can squeeze those activities within shorter slots of time. Perhaps a nice way to fill those otherwise lost 30 minutes between two meetings?

Open science: Thrombosis journal is part of the Biomed central family. As such, it is an 100% OA journal. It is not that I am an open science fanboy or sceptic, but I am very curious how OA is developing and working with an OA journal will help me to understand what OA can and cannot deliver.

Going over these points, I am convinced that I can contribute to the journal with my experience in the fields of coagulation, stroke and research methodology. Also, I think that the time that it will take to learn the skills needed are an investment that in the end will help me to grow as a researcher. So, I replied HtC with a positive answer. Expect email requesting for a peer review report soon!

The paradox of the BMI paradox

2016-10-19-17_52_02-physbe-talk-bs-pdf-adobe-reader

I had the honor to be invited to the PHYSBE research group in Gothenburg, Sweden. I got to talk about the paradox of the BMI paradox. In the announcement abstract I wrote:

“The paradox of the BMI paradox”
Many fields have their own so-called “paradox”, where a risk factor in certain
instances suddenly seems to be protective. A good example is the BMI paradox,
where high BMI in some studies seems to be protective of mortality. I will
argue that these paradoxes can be explained by a form of selection bias. But I
will also discuss that these paradoxes have provided researchers with much
more than just an erroneous conclusion on the causal link between BMI and
mortality.

I first address the problem of BMI as an exposure. Easy stuff. But then we come to index even bias, or collider stratification bias. and how selections do matter in a recurrence research paradox -like PFO & stroke- or a health status research like BMI- and can introduce confounding into the equation.

I see that the confounding might not be enough to explain all that is observed in observational research, so I continued looking for other reasons there are these strong feelings on these paradoxes. Do they exist, or don’t they?I found that the two sides tend to “talk in two worlds”. One side talks about causal research and asks what we can learn from the biological systems that might play a role, whereas others think with their clinical  POV and start to talk about RCTs and the need for weight control programs in patients. But there is huge difference in study design, RQ and interpretation of results between the studies that they cite and interpret. Perhaps part of the paradox can be explained by this misunderstanding.

But the cool thing about the paradox is that through complicated topics, new hypothesis , interesting findings and strong feelings about the existence of paradoxes, I think that the we can all agree: the field of obesity research has won in the end. and with winning i mean that the methods are now better described, better discussed and better applied. New hypothesis are being generated and confirmed or refuted. All in all, the field makes progress not despite, but because the paradox. A paradox that doesn’t even exist. How is that for a paradox?

All in all an interesting day, and i think i made some friends in Gothenburg. Perhaps we can do some cool science together!

Slides can be found here.