This is an academic presentation first given in October 2005 at the TNC group, Cardiff. It deals with how to maximise research in the NHS job.

1. Facts they daren’t tell you about research
Alex Mitchell alex.mitchell@leicspart.nhs.uk
Consultant in Liaison Psychiatry, Leicester General Hospital
Alex Mitchell alex.mitchell@leicspart.nhs.uk
Consultant in Liaison Psychiatry, Leicester General Hospital TNC Cardiff October 2005TNC Cardiff October 2005

2. ContentsContents
• Research, who is interested?
• Types of research
• Who is Doing Research?
• Research Tips & the publication game
• Research Examples

3. What is Research?
• Any scientific activity that
leads to a publication
Audit
Surveys
Reviews
Case Reports
Case Series
Letters
Editorials (opinion pieces)
And
Data collection!

4. Where is the Money?Where is the Money?
• DOH R&D (2002) = 74.9 million
• NHS R&D (2004) = 500 million
Of which 20% spent on scientific projects
• Industry £2,700m
• MRC £ 300m
• Charities £ 420m
• HEFCE £ 140m
Cost of bringing new drug to market = 500 million (= annual profit)
Cost of waiting list initiative for UK = 500 million

5. Is Academic Medicine the Answer?Is Academic Medicine the Answer?
• 31 July 2004, there were 3113 FTE clinical academics in all specialties
• 494 clinical lecturers (down 17% on 2003)
• 1500 Readers / SnR Lecturers (down 11% on 2000)
• 1146 Professors (up 10% on 2000)
• 302 SnR academics in Psychiatry
• 40 lecturers in Psychiatry
• (< 20% under 46 years old <5% female)

6. Research OutputResearch Output
• How much is typical?
• How much is expected?

7. Who Is Doing Research – Low Level?Who Is Doing Research – Low Level?
• WHO TOTAL RATE
SHO 0 papers 0
SpR 1+ paper / 3 years 1/3 paper / yr
Consultant NHS 5+ papers / 10 years ½ paper / yr / PA
Lecturer 10+ papers / 3 years 3 papers / yr
SnR Lecturer 30+ papers / 5 years 6 papers / yr

8. Who Is Doing Research – High Level?Who Is Doing Research – High Level?
• WHO TOTAL RATE
Professor 100+ papers /10 years 1 paper/month
Highly Cited Prof 500+ / 15 years 0.5 paper /week
Nemeroff CB. 1362 / 20 years 1.3 papers/week
Meltzer, HY. 1450 / 20 years 1.4 papers/week

9. Ok.. How???Ok.. How???

10. Peer Review ProblemsPeer Review Problems
Problems with authorsProblems with authors
Conflicts of interestConflicts of interest

11. Tips for Ambitious AcademicTips for Ambitious Academic
• Submit smallest publishable unit
• Get others to write
• Write on things you have an interest in
• Fill in the gaps

12. Problems with AuthorsProblems with Authors
• Multiple publication
• Ghost authorship
• Non-contributory
authors
• Conflicts of Interest
• Fraud / Plagarism

13. Plagarism in Psychiatry?Plagarism in Psychiatry?
• Case of RP…….. Retraction by Elsevier October 2005
'Why the media refuses to obey' by Prof RP published in Vol
9.... This media commentary has been retracted because a
very substantial percentage of the wording of the
commentary consists of material reproduced with
permission or acknowledgement from the following
previously published sources. 'The man who shocked the
world', an article written by Prof Thomas Blass......and
published by Psychology Today....; Prof Blass's
informational website, www.stanleymilgram.com and Prof
B's biography of Stanley Milgram 'The man who shocked the
world....'. Wiley Interfact Ltd sincerely regrets what occurred.

14. How Many Authors?How Many Authors?
• Deep Impact: Observations from a Worldwide Earth-Based Campaign
K. J. Meech, N. Ageorges, M. F. A'Hearn, C. Arpigny, A. Ates, J. Aycock, S. Bagnulo, J. Bailey, R.
Barber, L. Barrera, R. Barrena, J. M. Bauer, M. J. S. Belton, F. Bensch, B. Bhattacharya, N. Biver,
G. Blake, D. Bockelée-Morvan, H. Boehnhardt, B. P. Bonev, T. Bonev, M. W. Buie, M. G. Burton,
H. M. Butner, R. Cabanac, R. Campbell, H. Campins, M. T. Capria, T. Carroll, F. Chaffee, S. B.
Charnley, R. Cleis, A. Coates, A. Cochran, P. Colom, A. Conrad, I. M. Coulson, J. Crovisier, J.
deBuizer, R. Dekany, J. de Léon, N. Dello Russo, A. Delsanti, M. DiSanti, J. Drummond, L.
Dundon, P. B. Etzel, T. L. Farnham, P. Feldman, Y. R. Fernández, M. D. Filipovic, S. Fisher, A.
Fitzsimmons, D. Fong, R. Fugate, H. Fujiwara, T. Fujiyoshi, R. Furusho, T. Fuse, E. Gibb, O.
Groussin, S. Gulkis, M. Gurwell, E. Hadamcik, O. Hainaut, D. Harker, D. Harrington, M. Harwit,
S. Hasegawa, C. W. Hergenrother, P. Hirst, K. Hodapp, M. Honda, E. S. Howell, D. Hutsemékers,
D. Iono, W.-H. Ip, W. Jackson, E. Jehin, Z. J. Jiang, G. H. Jones, P. A. Jones, T. Kadono, U. W.
Kamath, H. U. Käufl, T. Kasuga, H. Kawakita, M. S. Kelley, F. Kerber, M. Kidger, D. Kinoshita, M.
Knight, L. Lara, S. M. Larson, S. Lederer, C.-F. Lee, A. C. Levasseur-Regourd, J. Y. Li, Q.-S. Li, J.
Licandro, Z.-Y. Lin, C. M. Lisse, G. LoCurto, A. J. Lovell, S. C. Lowry, J. Lyke, D. Lynch, J. Ma, K.
Magee-Sauer, G. Maheswar, J. Manfroid, O. Marco, P. Martin, G. Melnick, S. Miller, T. Miyata, G.
H. Moriarty-Schieven, N. Moskovitz, B. E. A. Mueller, M. J. Mumma, S. Muneer, D. A. Neufeld, T.
Ootsubo, D. Osip, S. K. Pandea, E. Pantin, R. Paterno-Mahler, B. Patten, B. E. Penprase, A. Peck,
G. Petitas, N. Pinilla-Alonso, J. Pittichova, E. Pompei, T. P. Prabhu, C. Qi, R. Rao, H. Rauer, H.
Reitsema, S. D. Rodgers, P. Rodriguez, R. Ruane, G. Ruch, W. Rujopakarn, D. K. Sahu, S. Sako,
I. Sakon, N. Samarasinha, J. M. Sarkissian, I. Saviane, M. Schirmer, P. Schultz, R. Schulz, P.
Seitzer, T. Sekiguchi, F. Selman, M. Serra-Ricart, R. Sharp, R. L. Snell, C. Snodgrass, T. Stallard,
G. Stecklein, C. Sterken, J. A. Stüwe, S. Sugita, M. Sumner, N. Suntzeff, R. Swaters, S.
Takakuwa, N. Takato, J. Thomas-Osip, E. Thompson, A. T. Tokunaga, G. P. Tozzi, H. Tran, M.
Troy, C. Trujillo, J. Van Cleve, R. Vasundhara, R. Vazquez, F. Vilas, G. Villanueva, K. von Braun,
P. Vora, R. J. Wainscoat, K. Walsh, J. Watanabe, H. A. Weaver, W. Weaver, M. Weiler, P. R.
Weissman, W. F. Welsh, D. Wilner, S. Wolk, M. Womack, D. Wooden, L. M. Woodney, C.
Woodward, Z.-Y. Wu, J.-H. Wu, T. Yamashita, B. Yang, Y.-B. Yang, S. Yokogawa, A. C. Zook, A.
Zauderer, X. Zhao, X. Zhou, and J.-M. Zucconi
Science 14 October 2005: 265-269

15. Ghost AuthorshipGhost Authorship
• An Inquiry by the UK House of Commons Health Select
Committee into the Influence of the Pharmaceutical
Industry October 2004
50% of therapeutics articles may be ghost written
• Flanagin A et al (1998) Prevalence of Articles With
Honorary Authors and Ghost Authors in Peer-Reviewed
Medical Journals JAMA 280:222-224
Of 809 articles
19% had evidence of honorary authors
11% had evidence of ghost authors
2% had evidence of both

16. 3 Research Scandals in 10 years3 Research Scandals in 10 years
• Jan Hendrik Schön (born 1970) is a German physicist who briefly rose to
prominence after a series of apparent breakthroughs On October 31, 2002,
Science withdrew 8 papers written by Schön. On March 5, 2003, Nature
withdrew 7 papers written by Schön.
• 1997-1998 Friedhelm Herrmann, professor of medicine at Ulm University,
and fellow cancer researcher, Marion Brach, had forged and invented data
contained in 47 scientific articles in 19 journals. Only 2 retracted!
• Eric Poehlman, formerly of the Université de Montréal, Canada, leading
obesity research with > 200 papers. He was accused of scientific
misconduct and on March 17, 2005 pleaded guilty to the charges,
acknowledging falsifying 17 grant applications to the National Institutes of
Health and fabricating data in 10 of his papers. In 2003 Ann Int Med
retracts 1 article

17. Retractions in Medical Journals 1966 to 1977
0
10
20
30
40
50
60
70
80
90
100
Error Misconduct No replication Not Stated

18. International Committee of Medical Journal EditorsInternational Committee of Medical Journal Editors
• Authorship credit should be based only on ALL OF 1, 2, & 3
• 1) substantial contributions to conception and design, or
acquisition of data, or analysis and interpretation of data
• 2) drafting the article or revising it critically for important
intellectual content; and
• 3) final approval of the version to be published.
• Acquisition of funding, the collection of data, or general
supervision of the research group, by themselves, do not
justify authorship.

19. Fraud and COPEFraud and COPE

20. Redundant submission/publication 40
Authorship 20
Falsification of data 16
No informed consent 11
Unethical research 13
No ethics cttee approval 11
Fabrication 11
Editorial misconduct 7
Plagiarism 4
Undeclared competing interest 5
Breach of confidentiality 3
Clinical miscoduct 2
Attack on whistleblowers 2
Reviewer misconduct 2
Deception 1
Failure to publish 1
Ethical questions 3

21. Problems with JournalsProblems with Journals
• Multiple publication
• Ghost authorship
• Conflicts of Interest
• Failure to withdraw or notify others
• Quality of peer review

23. Open vs Closed Peer Review?Open vs Closed Peer Review?
• McNutt RA, Evans AT, Fletcher RH, Fletcher SW. The effects of blinding on the
quality of peer review. JAMA 1990; 263: 1371-1376
• Godlee F, Gale C, Martyn C. Effect on the quality of peer review of blinding
reviewers and asking them to sign their reports: a randomized controlled trial.
JAMA 1998; 280: 237-240
• Egger M, Wood L, von Elm E, Wood A, Shlomo YB, May M. Are reviewers
influenced by citations of their own work? Evidence from the International
Journal of Epidemiology [abstract]. Proceedings of the 5th international
congress on peer review and biomedical publication. Chicago, September 2005.

24. COPE StudiesCOPE Studies
• Deliberately inserted 8 errors(method, analysis and
interpretation) into an accepted paper
• sent it to 400 reviewers - 221 responded
• mean number of weaknesses found was 2
• only 10% identified 4 or more
• 16% didn’t detect any ( Godlee,F et al JAMA,1998,280,237)

25. Walsh et al (2000) BJPsychiatr 176(1)47-51
• 408 manuscripts assigned to
reviewers who agreed were
randomised to signed or unsigned
groups.
• 245 reviewers (76%) agreed to sign
their name.
• Signed reviews were of 5% higher
quality, more courteous and took
longer to complete than unsigned
reviews.
• They were more likely to recommend
publication.

26. van Rooyen BMJ 1999;318:23-27van Rooyen BMJ 1999;318:23-27
• 125 eligible papers were sent to two reviewers who were
randomised to have their identity revealed to the authors or to
remain anonymous.
•
identified were 12% more likely than anonymous (35% v
23%) to decline to review the paper.
• There was no significant difference in quality
• no significant difference in the recommendation regarding
publication or time taken to review the paper.

27. Jefferson JAMA 2002Jefferson JAMA 2002
9 studies considered the effects of concealing
reviewer/author identity.
4 studies suggested that concealing reviewer or author
identity affected review quality (mostly positively)
1 study suggested that a statistical checklist can improve
report quality, but another failed to find an effect of
publishing another checklist.
1 study found no evidence that training referees improves
performance and another showed increased interrater
reliability
2 studies of how journals communicate with reviewers did
not demonstrate any effect on review quality. One study
failed to show reviewer bias
1 nonrandomized study compared the quality of articles
published in peer-reviewed vs other journals.
2 studies showed that editorial processes make articles
more readable and improve the quality of reporting

28. Why So Many Problems?Why So Many Problems?

29. Wilson suspected the results of the new medicine
were not good, but felt obliged to give it a go

30. What Makes a Good Peer Reviewer?What Makes a Good Peer Reviewer?
• A reviewer was less than 40 years old
• From a top academic institution
• Well known to the editor choosing the reviewer
• Author blinded to the identity of the manuscript's authors
• Then the probability of good review was 87% vs 7%
Evans AT, McNutt RA, Fletcher SW, Fletcher RH. The characteristics of peer reviewers who
produce good-quality reviews. J Gen Intern Med. 1993 Aug;8(8):422-8

31. Possible SolutionsPossible Solutions
• In 1976 Dublin physician J B Healy wrote to the Lancet:
It seems to me that we should for an experimental period
of a year, declare a moratorium on the appending of
authors' names and of the names of hospitals to
articles in medical journals.
If the dissemination of information is the reason why
papers are submitted for publication, there will be no
falling-off in the numbers offered … But if far less
material is offered to the journals, we shall have
unmasked ourselves.
Healy JB. Why do you write?. Lancet 1976; 1: 204.

32. Future of Academic Scrutiny?Future of Academic Scrutiny?
AnonymousAnonymousDeclaredFuture
DeclaredPartial Anony.Partially declaredCurrent
DeclaredDeclaredHiddenPast
Paper in printAuthor (Draft)
identity
Peer Identity

33. My Story!My Story!
• 19th February Paper Released
Dean Fergusson et al Association between suicide attempts and selective
serotonin reuptake inhibitors: systematic review of randomised controlled trials
• 20th February Error Noted
odds of suicide attempts in SSRIs vs others is 1.94 => 1.54 (0.85-2.8)
odds for non-fatal attempts was 2.25 => 1.89 (0.96 –3.73)
odds of completed suicide vs tricyclics 7.27 => 1.1 (0.29-4.1)
• 1 – 4th March 2005 Author Denies, Refuses to Correct
. Others agree (seehttp://bmj.bmjjournals.com/cgi/eletters/330/7488/396)
Author disagrees
• 19th March 2005 BMJ Issues Correction Not Retraction
The authors of this paper, Dean Fergusson and colleagues (BMJ 2005;330:396-9, 19 Feb ),
have notified us of some incorrect values in the Results section (fourth paragraph of print
version and sixth paragraph of full version). The odds ratio of fatal suicide attempts for
selective serotonin reuptake inhibitors compared with tricyclic antidepressants should be
1.08 not 7.27 as reported. They state that this does not affect the main conclusions or the
main message of the article
• 22nd March 2005 Author Correct 1 of 3 calculations

34. About ResearchAbout Research
Funding issuesFunding issues
About ResearchAbout Research

35. Example 1 – Psychiatr Bull Oct 05 (Type Edit)Example 1 – Psychiatr Bull Oct 05 (Type Edit)
• Time to Submit: 2 months
• Rejections: 1 (Br J Psych)
• Revisions: Nil
• Delay to Print: 10 months
• Co-author Contribution: 20%
• Quality of content: 40%
• Impact: 10%
• Income: Nil Cost: Low Value: Med

36. Example 2 – Br J Ca Nov 04 (Type: Data)Example 2 – Br J Ca Nov 04 (Type: Data)
• Time to Submit: 12 weeks
• Rejections: 1 (BMJ)
• Revisions: 2
• Delay to Print: 6 months
• Co-author Contribution: 30%
• Quality of content: 40%
• Impact: 30%
• Income: Nil Cost: Med Value: Med

37. Example 3 – Lancet Neurol Jul 05 (Type: Review)Example 3 – Lancet Neurol Jul 05 (Type: Review)
• Time to Submit: 3 weeks
• Rejections: 0 (invited)
• Revisions: 1 (minor)
• Delay to Print: 6 months
• Co-author Contribution: 100%
• Quality of content: 70%
• Impact: 60%
• Income: Nil Cost: Low Value: High

38. Example 4 – Am J Psychiatr (Type: Syst. Rev)Example 4 – Am J Psychiatr (Type: Syst. Rev)
• Time to Submit: 11 weeks
• Rejections: 0
• Revisions: 1
• Delay to Print: 6 months
• Co-author Contribution: 80%
• Quality of content: 80%
• Impact: 60%
• Income: Nil Cost: Med Value: High

39. Example 1 – ?? Dec 05 (Type: Meta-Analy)Example 1 – ?? Dec 05 (Type: Meta-Analy)
• Time to Submit: 18 months
• Rejections: 5 (Lancet, BMJ, Biol
Psychiatr)
• Revisions: Nil
• Delay to Print: 10 months
• Co-author Contribution: 20%
• Quality of content: 40%
• Impact: 10%
• Income: Nil Cost: Low Value: Med

40. Where to submitWhere to submit
What to submitWhat to submit
When to submitWhen to submit

42. How Many?How Many?
• Hospital Specialist
• 75 journals in psychiatry
• + 50 in neurology
• + 50 in medicine
• + 25 in misc. fields
2400 issues per year
6.5 journals per day
65 titles per day

43. Alex J Mitchell and Hari Subramaniam
Liaison Psychiatry and Old Age Psychiatry, Leicester General Hospital, Leicester (UK) alex.mitchell@leicspart.nhs.uk
AIM A number of studies show that depression in old age has poor prognosis. However, an equal body of evidence shows that the same is true of depression in middle age. The prognosis of one group (older people)
with the other group (younger people) has rarely been compared in a rigorous way. Further, it is not know if chronological age (ie age at recruitment) or age at first episode onset is an important predictor of prognosis.
METHODS We sought to identify and review studies that have directly compared the
prognosis of depression of patients stratified by either chronological age or age of onset (or
ideally both). The most important issue is whether patients in late-life received similar
treatment to those in mid-life; in an inception cohort study. Our systematic review identified
34 publications, but we excluded 11 studies for methodological reasons leaving 23 reports
from 22 studies (see Mitchell & Subramaniam (2005).
Mitchell AJ. Subramaniam H. (2005) Prognosis of Depression in Old Age Compared to Middle Age - A Systematic Review of Comparative Studies. Am J Psychiatry (in press)
Subramaniam H, Mitchell AJ. (2005) The Prognosis of Depression in Late Life vs Mid-Life - Implications for the Treatment of Older Adults. Int Psychogeriatr. (in press)
Is Chronological Age or Age of Onset Critical for the Prognosis of Depression?
A Systematic Review
RESULTS From these we identified only 4 reports (of 3 studies) that recruited older and
younger patients at the same time into one study with a fixed treatment protocol. We also
found that many of the studies (naturalistic and inception) have been underpowered. Only 5
studies examined age of first onset in relation to remission and 3 studies in relation to relapse
(table). Only 4 studies have used both measures in the same cohort. Results can be
summarized as follows:
Age of First Episode Onset
Adverse effect on relapse (Brodaty, 1993) or no effect (Reynolds et al, 1999)
Adverse effect on remission (Conwell et al, 1989; Alexopolous al, 1996) or
Better treatment response (Reynolds et al 1998)
Chronological Age
Higher chance of relapse during follow up (2 studies)
Inferior treatment response (2 studies)
A better response (3 studies)
No difference (2 studies)
CONCLUSIONS A first onset of depression in late life without comorbidity may have a
preferentially good outcome perhaps because of a short illness duration but more commonly, a
late onset is associated with a higher rate of medical comorbidity and hence an inferior
treatment response. Older chronological age also has a variable significance depending on
previous history and medical comorbidity. Both measures inform the prediction of prognosis of
depression independently but are dependent on other risk factors.
2005 American Psychiatric Association Annual Meeting (Atlanta, May 21-26, 2005)
Psychosomatic Medicine: Integrating Psychiatry and Medicine
Author(Year)
Reference
Age of
Onset
Age
at
Entry
Measures of Outcome
Diagnosis of Depression
Sample Size
Subgroup size
Methodology
Setting (if known)
Finding/Comment
Studies Examining Remission
Conwell et al (1989) Yes No Failure of Remission (chronic course)
Residual symptoms
DSMIII Criteria
94 elderly patients
n=24 aged 17-41
n=23 aged 42-54
n=23 aged 55-64
n=24 aged 65-81
Naturalistic Mixed Study
5 year retrospective review with 18
months follow up
1. No differences detected in remission between those aged over
65 and those younger
2. There was little clinical difference between groups although
the older groups were more symptomatic on discharge (p<0.04)
Musseti et al (1989) Yes Yes Remission
DSM III R criteria
400 consecutive
patients
n=217 aged < 40
n=141 aged 40-59
n=42 aged ≥60
Naturalistic Mixed Study
Cross sectional assessment of
referrals to a tertiary Institute in
Italy
1. Remission rate similar in both subgroups (Cut-off = 65 years)
Alexopoulos GS et al
(1996)
Yes Yes Time to Remission
Diagnosis by RDC
86 patients
n=63 aged ≥ 63
n=23 aged < 63
Naturalistic Mixed Study
Follow up for 18.2 months
Secondary care
1. Rate of remission similar in older and younger patients (Cut-
off = 63 years)
2. In older patients, age and age of onset predicted slower
recovery
3. In those over 65 years probability of recovery at 2 years was
64% for late onset and 90% for early onset patients of same
current age
3. In younger patients younger age predicted longer time to
recovery
Philibert et al (1997) Yes No Remission rate
Mortality rate
DSMIII criteria
192 subjects
n=42 aged < 40
n=47 aged 40-59
n=53 aged 60-69
n=50 aged ≥ 70
Naturalistic Mixed Study
7 year follow up
Secondary care
1. Older age of onset linked with higher risk of mortality
2. Age of onset linked not with remission of depression
3. Patients with late onset depression were more likely to have
physical illness
Reynolds et al (1998) Yes No Time to remission
Relapse rates
SADS-L
187 patients
n=129 early onset
n= 58 late onset
Inception cohort study
Open then randomized
Nortriptyline and/or IPT
maintenance treatment in
Secondary care
1. No difference in remission, recovery or relapse during the
first year of maintenance treatment between the groups Cut-off
= 60 years)
2. Early onset patients take longer to remission than late onset
ones.
Studies Examining Relapse / Recurrence
Brodaty (1993) Yes Yes Relapse Rate
DSM III (APA, 1980) Mj depression
242 consecutive
referrals
n=61 aged ≥ 60
n=181 < aged 60
Naturalistic Mixed Study
1 years and 2-4 years outcome
Tertiary clinic
1. No differences were apparent at 1 year
2. Early onset (1st depression < 60) had a worse prognosis than
those with late onset patients who had less relapses
3. Among the elderly depressed, prior history of recurrent
depression was more likely to be associated with a poor
outcome than a first episode of depression
4. Physical illness did not affect recovery in the elderly
Reynolds et al (1998) Yes No Time to remission
Relapse rates
SADS-L
187 patients
n=129 early onset
n= 58 late onset
Inception cohort study
Open then randomized
Nortriptyline and/or IPT
maintenance treatment in
Secondary care
1. No difference in remission, recovery or relapse during the
first year of maintenance treatment between the groups Cut-off
= 60 years)
2. Early onset patients take longer to remission than late onset
ones.
Reynolds et al (1999) Yes Yes Recurrence rates
SADS-L
107 patients
n=69 aged 60-69
n=38 aged ≥ 70
Inception cohort study
Open then randomized nortriptyline
and/or IPT maintenance treatment
in
Secondary care
1. No differences according to age of first onset (Cut-off = 70
years)
2. Older patients at study entry had a higher chance of relapse
during follow up.

44. Case Reports – 20th CenturyCase Reports – 20th Century
1984
1975
1969
1968
1964
1963
1930
1928
1921
1920
1913
1912
1911
1910
Kosoka from the Yokohama City University, Japan proposed that cortical Lewy bodies were a specific cause of dementia
Warrington reported what she termed “selective impairment of semantic memory” later referred to as semantic dementia
Graham and Oppenheimer united olivopontocerebellar atrophy, Shy-Drager syndrome and striatonigral degeneration with the term multiple system atrophy
Rebitz and colleagues described corticobasal degeneration
Hakim described normal pressure hydrocephalus whlst working at the Massachusetts General Hospital
Drs John C. Steele (neurology resident) and J. Clifford Richardson (Chief of Neurology) at Toronto General Hospital; and Jerzy Olszewski, Professor of
Neuropathology at the Banting Institute described progressive supranuclear palsy
German pathologist Theodor Fahr (1877-1945) described Fahr’s disease
Martland described dementia pugilistica
Garman neurologist Alfons Maria Jakob (1884-1931) described a similar case of Creutzfeldt-Jakob disease
German neuropathologist Hans Gerhard Creutzfeldt (1885-1964) described a case of what is now thought to be Creutzfeldt-Jakob disease
Santiago Ramon y Cajal (1852-1934) developed gold chloride-mercury stain to show astrocytes
British neurologist Samuel Alexander Kinnier Wilson (1878-1937) fully described Wilson’s disease in a doctoral thesis
Alois Alzheimer (1864-1915) describes the histological findings of pick bodies and pick cells associated Pick’s disease
Kraeplin introduced the term 'Alzheimer's disease' after his student’s early descriptions

45. ARCH GEN PSYCHIAT
AM J PSYCHIAT
BIOL PSYCHIAT
MOL PSYCHIATR
NEUROPSYCHOPHARMACOL
BRIT J PSYCHIAT
J CLIN PSYCHIAT
J CLIN PSYCHOPHARM
SLEEP
J AM ACAD CHILD PSY
INT J NEUROPSYCHOPH
PSYCHOPHARMACOLOGY
PSYCHOSOM MED
AM J GERIAT PSYCHIAT
SCHIZOPHRENIA BULL
SCHIZOPHR RES
Where Should I Aim?Where Should I Aim?
1 in 10+
1 in 3+

46. BMJ Manuscript Processing
Hand written
Silly mistakes
Wrong journal
5000 scanned by 1
editor
2500 sent
for review
1000 Immediately
rejected
6000 received per
year
Poorly written
Obvious flaws
Too Obscure
2500
Rejected by editor
1000 Rejected by
reviewer / editor
Methodological concerns
Not interesting
100 accepted400 rejected500 discussed
1500 sent to hanging
committees
100 accepted400 rejected500 discussed
100 accepted400 rejected500 discussed
Rate
= 1 in 20
300 accepted per year
(6 per week + 2 short
reports)

47. A comment on medical journals from Drummond Rennie,
deputy editor (west), JAMA
A comment on medical journals from Drummond Rennie,
deputy editor (west), JAMA
There seems to be no study too
fragmented, no hypothesis too
trivial, no literature citation too
biased or too egotistical, no
design too warped, no
methodology too bungled, no
presentation of results too
inaccurate, too obscure, and too
contradictory, no analysis too self
serving, no argument too circular,
no conclusions too trifling or too
unjustified, and no grammar and
syntax too offensive for a paper
to end up in print.

48. Advice?Advice?
• How can young researchers increase their chances of
getting their paper published?
• By learning to write (columns, letters, editorials, reviews
and articles) about topical subjects in an innovative style:
and, after 3 years without success, they should take Mark
Twain's advice and return to sawing wood.
Greg Wilkinson The British Journal of Psychiatry (2003) 182: 465-466