Interview with Trish Groves

Two MiRoR research fellows, Van Nguyen Thu (University Paris Descartes, France) and Ketevan Glonti (University of Split, Croatia) had the opportunity to interview Trish Groves, Director of Academic Outreach and Advocacy for BMJ, Editor in Chief of the online journal BMJ Open, and Honorary Deputy Editor of The BMJ.

Open peer review, data sharing, research misconduct, journal impact factors, patient involvement, are among the topics covered in this inspiring interview. The transcript and the audio recording are available below.

You started training in medicine and in psychiatry, before joining The BMJ. What led you to join the BMJ?

Like a lot of things, it was a bit of an accident. I didn’t think “I want to go and work at a medical journal”. I was actually looking in the BMJ for my next post in psychiatry. There was an advertisement from the BMJ saying, ‘Why don’t you come here for a year to learn about peer review about research and importantly about journalism debate and general aspects of editing?’ I thought: ‘Wow, that’s only a year! That looks really interesting and I had already got some experience with writing’. So I thought: ‘Well, I will apply. I won’t have much chance’. And then genuinely to my surprise I got offered the job. So that was a one-year internship and I thought I would go back to psychiatry after a year. But as the year went on, it became clear that actually this was the beginning of an internship program and there was the possibility of staying on. We still run it. It is a bit different now. It is not openly advertised. We do it now in partnership with the Department of Health where leadership trainees have the chance to come and do their posts at the BMJ, but it is still an internship.

We had a look at your job BMJ profile and it looks like you have a lot of different positions. You are the director of academic outreach and advocacy for BMJ, Editor-in-Chief of BMJ Open, and honorary Deputy Editor of The BMJ. So how does a typical work day look like?

I am almost never at the office. I haven’t had a desk at the BMJ headquarters in London for about five years. And wonderfully the BMJ has always been a really flexible organization which has been very open minded and very keen to promote diversity. I was at the BMJ full-time for just a few years and then I had a break to have two children. In between and after that I came back to the BMJ part-time and was able to do a lot of work from home, which was brilliant. So the BMJ has a great culture on recognizing that you can work from anywhere and that what we do is an international endeavour.

Until about four, five years ago, I was the head of the research team at the BMJ and the Deputy Editor. My team of research editors were all over the world. We work entirely globally and you can do it from anywhere if you have a decent internet connection. My favourite day would be meeting authors of research or meeting people who are doing their very best to try and make research less wasteful, high quality. So, people like you. But also, something like being in Rwanda and doing a two-day workshop with the fantastic researchers there and their local faculty, on how to develop great research questions that are truly relevant and high priority to Rwanda, making sure that the methodologies are as good as they can be in the setting with the resources available, and helping them consider publishing perhaps in their own local journal, which is growing fast. So a lot of what we do is not about just trying to get great papers into our journals, it is about genuinely trying to build the capabilities and to some extent the capacity for good health research.

Both the BMJ and BMJ Open are using the open peer review process. So why is this the case? What led to the decision employing this process?

Back in the mid-nineties, perhaps it was even earlier than that, the BMJ just decided we were going to ask reviewers to sign their reports to put their names and addresses and their competing interests on their review. This is because it just seemed crazy that people should be judged by someone they don’t know. There were arguments against this kind of openness. So, we tested it in a randomized control trial. It showed that reviews were of the same quality. One thing improved was the tone. When I first went to the BMJ in 1989, everything was on paper. The peer review reports came in as written documents. They often included unnecessary, unwarranted, unprofessional insults about the authors or their work. Our trials show that the tone was much more collegial, much more constructive and positive when people had to sign their reviews. We then moved on to a study looking at the idea that – once the paper has been peer reviewed and accepted and is published – then why not publish the peer review reports next to it, along with the original submitted version of the report of the paper and the authors’ responses to all of the comments they received from the editors and the reviewers. So this is called a pre-publication history. When we launched BMJ Open in 2011, for us it was a no brainer that we would make the journal as open as possible in all ways including open peer review. Now that there are organizations such as Publons, they can actually put the reviews there with the DOI, making them citable and making sure that they can therefore get due credit for their work.

The BMJ requires authors of trials to make anonymized data available on request. However, a recent research showed that data availability was not optimal, even in journals with strong policies on data sharing. What is the role of the journal in these cases?

There has been a lot of debate particularly about clinical trials. I just want to make it clear that all these initiatives are about sharing the individual participant data (IPD) which has been de-identified and that is the data from clinical trials. There are good reasons for that because when people enter a clinical trial, they are actively, altruistically joining a study where they might be an extra benefit or a risk depending on which group they were randomized to. You take people in to actively do stuff to them in order to answer a research question. Trials are expensive and difficult to do. Therefore, it is imperative that we get as much information as possible out of those trials. We don’t think it is okay for a paper of 3000 words in a top journal to be the only output from a trial.

We started at the BMJ back in 2009 saying that all authors who have any kind of research paper must include a data sharing statement on their paper, to be explicit and make the authors think about it. After a few years, we introduced our own policy asking authors of clinical trials to promise, on submission of their trial, that they would share the IPD on reasonable request. So if the authors refuse when somebody asks for the dataset, at the very least we will expect the people requesting access to send us a e-letter to the paper. We then get the authors along to defend themselves. We wanted to provide a forum for debate.

What is nice is that we are now shifting to a world where this happens upfront and funders are willing to fund the proper preparation and deposition of an anonymized dataset. And meanwhile, we are getting places where it is possible to share data safely. There is the development of platforms where researchers have to put in a proposal for a secondary study with a proper research question, a proper design that is assessed by an independent peer review committee, and then they are given access if the proposal seems valid. The International Committee of Medical Journal Editors (ICMJE) has over the years developed the uniform requirements for biomedical manuscripts and they have come up with a data sharing policy which has now kicked in. So from next year, any trial submitted to those journals – including the New England Journal of Medicine, the Lancet, BMJ, and PLOS Medicine and so on – will have to have registered and have a data sharing plan on the clinical trial registry upfront. And then when they submit the paper they will have to comply with their plan or say why they didn’t.

What do you think about questionable research practices? How have the views about questionable research practices have changed over time, if at all?

For years we thought that research misconduct only meant certain things. We thought it meant doing unethical studies. But then we thought it meant the three things: fraud, fabrication and plagiarism. Most attention was paid to fraud and plagiarism. Plagiarism is common: the internet makes it more possible, but actually it also makes it more detectable. Lots of journals use anti plagiarism software, so we are sort of on the case. Fraud is terrible when it happens. It is probably more common than we think, but generally nobody dies. Fabrication, we used to think was sort of part of fraud. But no, the biggest shift is we have realized that data manipulation or fabrication are absolutely rife and embedded in the research culture. Even researchers in the very best funded research institutions around the world think it is okay not to report outcomes. In Ben Goldacre’s project where they looked at clinical trials published in the top five medical journals and compared the outcomes that were reported in published papers with the outcomes that were on the clinical trial registries and the protocols, they found a lot of switching of outcomes with no explanation. We now know that what hasn’t been recognized as misconduct is terribly common – that kills patients because that skews the evidence base and leads to the wrong clinical practice guidelines, the wrong systematic reviews, the wrong drug policies.

How does BMJ & BMJ Open deal with QRP? What is the role of the journal?

Over the years, we have tried very hard to prevent this through advocacy, but also by encouraging methodological research and encouraging articles on methodology and reporting in a section we have in the BMJ. The EQUATOR Network has been absolutely vital to this and we are very pleased to have been able to support those initiatives in lots of ways. We have actually provided a little bit of financial support over the years. But also importantly, we provided a lot of editorial time. Many of us have been invited to take part in the Delphi exercises, the face to face workshops, and the reporting in final papers of such reporting guidelines. And we use reporting guidelines upfront. It is embedded in our peer review process. For clinical trials, people have to submit the registration details which we check carefully when we are appraising a submitted paper. We also ask for the protocol, the version of the protocol that was used to run the study. Importantly though, we also have very active post publication peer review, which is an essential tool for highlighting and trying to fix any questionable research practices. Readers carefully read our papers and then send us rapid responses (e-letters). It allows debate and allows the authors to respond.

Currently the journal impact factor is frequently used as a surrogate measure of the quality of the individual research articles and to assess the individual scientist’s contributions. Do you think that’s the journal impact factor should have that main role in the research evaluations?

A simple answer is no, and we are involved in quite a lot of initiatives to try and develop real measures of impact. Now you might think as a journal publisher, why would we do that? We should be trying to defend our turf because our impact factors are quite good at our journals. We know it remains at the moment important to a lot of our authors. We want authors to send their best work to us and we want to provide them with the best service we can. But absolutely we will be pretty glad when impact factor is dead. The mission of the BMJ (the publishing group) is a healthier world – to get a healthy world – and we genuinely mean it. If for individual outputs but also institutional outputs, universities and so on are looking at the real impact of research that has to be better for health than some not great metric. We are working hard on how we might be able to contribute to the various movements such as the Declaration on Research Assessment – DORA, the Leiden manifesto, and the Research Excellence Framework in the UK, which is used to assess universities. It looks like China is probably going to introduce something similar for its international world leading universities. It looks like they won’t take impact factor as a major key performance indicator, which is really interesting because China up until now has very much used impact factor as its main metric. So the world is changing and we want to be part of that change.

Within the MiRoR project we focus on reducing waste in research. Where do you see journals contributing to reduce research waste?

We try at the BMJ to contribute in various different ways. We have contributed to the REWARD Alliance initiative which was set up after the publication of the important Lancet series in 2014. Importantly, the e-learning program that we have built, Research to Publication, absolutely addresses the waste and research agenda all the way through, from good research questions to fill evidence gaps shown by systematic reviews, making sure that questions are relevant to patients, to the public, to society, and then crucially, using the best possible methods in given circumstances, which might vary. If you are in a very rural part of a low income country, your ability to use certain methods might be restricted, but you do your very best and you discuss properly these limitations in your paper.

So importantly we include patients in the peer review process at the BMJ and we will soon be doing so at BMJ Open whenever possible. That is for any paper having a clinical research question, we try very hard to include patients in the peer review process. We have a fantastic international patient advisory panel and several hundred patient reviewers now on our database. We haven’t managed to get patient reviews for every eligible study but we are working hard to improve that. We have developed lots of resources to support patient reviewers. We are trying to help health practitioners and researchers to partner with patients. Across the BMJ we have coproduction of our education articles whenever possible. So that means that patients are involved in helping to develop and write the education articles we publish for doctors. By the way, we are quite keen to not call it patient peer review because we think it confuses things and in some ways dilutes its importance. So we call it patient review. It is a small point, but I think it is quite important.

We also try to give a lot of emphasis to methodological and statistical reviewing in the peer review process, making sure that reporting is as good as it can be, supported by the use of reporting guidelines such as the various CONSORT extensions and so on. Last week a consultation has happened across the EU, an online consultation called EnTIRE, which is building a platform for research integrity across Europe. There is another EU wide project which I have been involved on behalf of BMJ, which is the Responsible Research and Innovation project, including the building of a really lovely big online toolkit – the RRI toolkit. A toolkit providing all kinds of resources for people to try and ensure that research is of value and that it is addressing questions that matter to people and society.

How do you see the future of scientific journals?

That is a very, very big question and we have done lot of work on this over the years. We just published on BMJ’s website four scenarios for the future of scientific research looking at 2030, which of course are seen through the lens of scholarly publishing. Things that are happening are very interesting developments such as the rise of open research platforms that kind of cut out publishers completely. On these platforms, researchers can publish everything, with appropriate limitations expressed. It will be peer reviewed, but it won’t be selective. They don’t have to pay a journal to publish in open research platforms, and nobody has to pay to read it. Wellcome Open Research is the first example of that. We also have the Gates Foundation. The EU is just about to put out a detailed tender on a platform like that, for all EU funded research across all disciplines. The African Academy of Sciences has also launched one of these platforms. So that is a really interesting development. We are intrigued by that and obviously to some extent threatened by it, but we hope that we could also help and get involved in. If things like impact factor become less important, what are journals going to do to please authors? There is the whole piece of work around how we can be better for authors and that includes things like making it easier for them to submit and trying to make it less burdensome for authors.

We now also have a basic science journal called BMJ Open Science, which was launched very recently with an extremely sharp focus on methodology and open science practices and reporting, and addressing all the concerns about the failure of basic science to reproduce. If you are talking about the future of scientific journals, then I hope that the future for basic science journals is that they will actually develop appropriate epidemiological and reporting processes to make sure that science is as robust and as reproducible as possible.

Do you think that citizen science can contribute to the peer review process?

Citizens science means lots of different things. So it might mean: here are some pathology samples. We put them online, can you please spot the cancer cells? There is that sort of fascinating crowdsourcing that goes on and has been shown in research studies to be as effective as pathologists looking at the slides. This is the ‘Many Eyes’ approach to citizen science, which is wonderful. I am not sure where that fits in with medicine, but clearly there are all sorts of possible paths where that might take us. There have been studies of crowdsourced peer review and this actually has proved pretty difficult. Nature tried a sort of community peer review some years ago. Not surprisingly, the world doesn’t work like that. People are busy and already it is difficult enough to fit peer review into a professional and academic career or clinical career. The reality is that that kind of crowdsourced peer review doesn’t tend to happen upfront. But it does. We think it works post-publication and as I said our BMJ Rapid Responses have been amazing. That is partly because we have put a lot of effort and resource into doing it well, into making it easy to do and into pre moderating every rapid response. I think that has made a big difference.

What could be the future career path for young researchers who are interested in scientific publishing?

I think the very first place to start with is peer review. I would urge anybody who is an early career researcher to somehow find the time and develop the skills to be a peer reviewer. I think it is absolutely vital that as a young researcher, you learn how to do it. It is a way of really contributing to the scientific endeavour. You learn a lot from it and increasingly you will get credit for it because of open peer review and initiatives like Publons. You should absolutely put it on your CV or resume and as you learn and as you grow, I hope that you bring in younger colleagues as well, and you help them to do it. It is vitally important. So that is the best place to start. After that, there aren’t many jobs like mine. Many of our editors are part time by the way. There are some internships and opportunities to work either full or part time, so it is worth looking at places like the Lancet, BMJ, PLOS, BMC, and so on, but frankly not many. Many clinicians and scientists will find that they won’t get as much money in publishing as they would if they stayed in their own career, so that might be a consideration as well. It depends, but in many cases there are many opportunities to work part time as editors. Most of our journals are specialist journals where the editor works one or two days a week and might do that for three to five years. They have editorial boards, assistant editors and so on. So there are many opportunities to join journals as a very part time thing, but that is a really important contribution.

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