Author : Brad Johnston Category : Podcast
Tags : Clinical Nutrition, Evidence Based Medicine, Nutrition Science
And that’s the first step in what happens in a journal, the papers arrive at the editor’s office and they get assigned to someone who’s going to handle them. Now, this is a crucial step because one can almost determine the fate of a manuscript by the editor to whom it’s assigned.
Hey, folks, welcome to another episode of Methodology Matters, a podcast on evidence based nutrition. I am very happy to be here today with Dr. Johnston, whom I like to call Brad, because I feel like at this point we’re on a first name basis. What do you think, Brad?
Of course, 100 percent. It always makes me kind of uncomfortable when I hear people use doctor in front of my name.
Well, good. I get uncomfortable when people use doctor in front of my name, too. But for a very different reason, today we’re talking about a really interesting guy, Dr. Dennis Bier. We’re going to hear your interview with him later in the episode.
But I’d love for you to kind of provide some context to me and the audience about just who he is and why we chose him. It’s really great stuff that we’re going to hear.
Yeah, sure. So Dr. Bier is a very interesting guy who’s got a great reputation in the field of nutrition in terms of being very well known, having been the editor in chief of the American Journal of Clinical Nutrition for almost 12 years.
Yeah, but what really strikes me about Dr. Beer is he’s very much a critical thinker.
Number one, he’s got a number two, he’s got a sense of humor. Yeah, he does. Yeah. He’s a real character.
My sense is he’s not trying to be anybody that he’s not. Yeah.
He’s kind of unapologetic, very data driven, but I would say not ideological in his interpretation of the world or of data. Interesting. So, yeah, a lot of really interesting characteristics.
Yeah. Yeah. Hearing the two of you talk, it sounds like he’s very focused on the evidence and not afraid to be critical. He’s been in the field for so long, it seems kind of like a rarity for someone with that kind of a reputation to to not be ideological and to be sort of open to change as he is. Would you say that’s correct?
I would say that’s definitely correct. It’s very easy to develop. And he talks about this allegiance bias. When you’re in a particular field for a long period of time and you make friends and you start to build maybe parts of your career around certain findings. Yeah, you can start to believe that something is true when in fact, there still may be uncertainty around some of some of the findings that you may have been involved in discovering or pulmigating.
Yeah, gotcha. Why don’t you tell me and our listeners a little bit more about the specifics of Dr. Bier’s background and then we’ll talk a little bit about his time at the AJCN.
Yeah, so he’s a doctor. Bier’s a medical doctor. He’s a professor of pediatrics, director of the Children’s Nutrition Research Center at Baylor College of Medicine. He’s a member of the National Academy of Medicine. He’s a former president of the American Society for Nutrition.
He’s won many awards from various societies and universities, including the American Society for Nutrition, the American Academy of Pediatrics, the National Institute of Health and Washington University School of Medicine.
And as the editor in chief up until recently of the AJCN American Journal of Clinical Nutrition for almost 12 years, he kind of led really the highest impact factor journal in the field of nutrition for a long period of time. Yeah, and so he was really at the forefront of what was happening in nutrition for over a decade, which is why he’s got some stories and he’s got the perspective that I think will be helpful for the audience.
Yeah, I love that you brought up his perspective. So now, Brad, tell me a little bit about why the AJCN is important. You know, I think we keep talking about it as kind of a leading research journal, but what does that actually mean? And does it have a link to evidence based medicine?
Yeah, that’s a good question. If a journal is positioned to be kind of the leading journal in its field, which AJCN is, it’s, you know, for people in the field of nutrition, it’s important to publish in that journal. If you publish there, that’s an endorsement of your work. Yeah. The AJCN is very, very influential in terms of really what the field is thinking about and doing and what people are doing with their patients that have illness or that are trying to prevent illness.
How does it link to evidence based medicine or principles? Well, if it’s in the AJCN the kind of the presupposition is that must be evidence based. It must be good evidence. It must be well done. So there is a link there, it’s loose, I mean, the philosophy of evidence based medicine or nutrition is a very different concept than what a journal is all about. But there’s yeah, it’s certainly linked.
Yeah, that makes sense. That makes a lot of sense. So one thing that I’d like to touch on that you and Dr. Bier go over a little bit is sort of you know, he focuses on the data rather than his own ideologies and his own bias. But, you know, we’re almost fighting human nature while we’re doing that. So here you have this, the AJCN as this top journal and part of what you guys talk about is kind of the hazards of expertise.
How do you let’s say you’re an associate editor for the AJCN and your work has all been about how, like, you know, I don’t know, a low carb diet is great for heart health. And then suddenly somebody submits a paper that says the opposite. How do you as a scientist, as an editor, that conundrum you’ve got to legions bias. You’ve got expertise, bias. But what if the science is sound?
Yeah, great question.
Well, you know, the interview with Denny, he talks a lot about what he did in his years with the AJCN. And he, I’ll use a quote from him when he says, “One can almost determine the fate of a manuscript by the editor to whom it’s assigned”. Yeah. Which I thought was really well articulated and is kind of scary, if that’s true. And I think it’s fair to say that it can often be true. And that speaks to the hazards of experts.
And as we talk about that, it reminds me of the grandfather of evidence based medicine, Dr. Dave Sackett, who was one of the individuals who was very influential that Dr. Gordon Guy talked about. He was one of Dr. Guy’s mentors and kind of started the field by kind of pushing the idea of critical appraisal of the health sciences literature and using that literature at the bedside. Dave Sackett was a very interesting person in that he used to joke about having had many careers, I think he talked about something like nine or 10 careers.
Yeah. At one point he retired from compliance therapeutics. So the evidence around how people do if they comply versus don’t comply. And in the year 2000, he wrote a short article in the British Medical Journal called The Sins of Expertness and a Proposal for Redemption. And he basically talks about how experts get in the way of new thought and new perspective and new data. Yeah, which, you know, is kind of a fun paper to read. But it also has a feeling of truth to it.
Yeah. And oh, by the way, this two thousand article that we’re talking about was when he announced his retirement from evidence based medicine and Dennie doctor, Dr. Bier talks about how journals work sometimes and how if you really have an allegiance bias.
Yeah. And you’re in a powerful position, you can really influence what ends up in a particular journal. Yeah. And the same goes for you can influence what gets funded and what doesn’t get funded. And you can influence the general popular opinion through social media, you know. Yeah. In the paper in Sackett’s, 2000 paper he joked about when he was an expert in the compliance of therapeutics. Because he felt like he was always given the last word in meetings.
Through scientific journals, through granting agencies. If he was on if he was a peer reviewer or so experts are very powerful and they’re useful, but sometimes they can be a real menace.
Yeah, that’s really interesting. Well, part of what I love about the content that we’ve got with Dr. Bier is that he knows the old adage. Like the first step is acknowledging the problem. Right. And so here you have Dr. Bier. And I think it probably speaks to how long he was at the Journal. You have Dr. Bier, who sort of likes, OK, well, it’s perfectly natural for these people. You know, if you’re working as an associate editor for the American Journal of Clinical Nutrition, chances are you’ve done some research.
You may have published some papers. You know, you mentioned to me that Dr. Bier himself has published over three hundred plus papers or something like that. So, you know, how do you do then? Sort of objectively picking good science for this journal, and it sounds like Dr. Behar put some strategies into place to sort of offer some better transparency because he acknowledged that expertise can be a hazard.
Yeah, he talks about a few strategies, I think more strategies around the transparency of what’s happening at the Journal. So I think one of the strategies he talks about is that all editors or associate editors have access to all titles and abstracts that are submitted. Yeah. And if they want to see something, they can request it. So that way you forgo the opportunity of, let’s say, an editor and chief cherry picking what associate editor of a particular paper goes to.
Yeah, yeah. He talks, he talks a little bit about this. So yeah, it’s a really fun interview.
Yeah. Yeah. That’s great. Well I think useful, useful to anyone that wants kind of a closer look at the veil behind how this is published.
Right. You know, you have mentioned to me a number of times in this podcast that sort of part of evidence based medicine is like using and I love this phrase, the totality of evidence. Right. And so it’s important to understand, even when we’re thinking about the totality of evidence, where that evidence comes from. You know, for me, who has no real scientific background, just your average person on the street. Right. Like I see an article like, oh, there is a study that came out and I might know, like, oh, the New England Journal of Medicine or the American Journal of Clinical Nutrition.
I’ve heard of that. I’m sure it means it’s important. Right. And so you just sort of assume that the methodology is good or that it’s information that’s important and that and therefore is true. Right. But it sounds like the actual truth of the situation with methodology and research is that it’s a little more nuanced than that.
Yeah, I would say much more nuanced.
Now we’re going to hear from Dr. Bier in two episodes coming up. But this first one is really more centered around his time at the Journal and and sort of his approach to science and kind of I think for me, provides like a nice view of not just the AJCN, but in general how scientific journals work and sort of the I dont want to say to, the under belly, but more like the nuts and bolts, you know a little bit how the sausage is made.
Yeah, yeah, exactly.
Well, without further ado, here is part one of our interview with Dr. Dennis Bier.
Welcome, Dr. Dennis Bier to the Methodology Matters podcast, so I have to say, I’m very excited to have you on the show today, Dennis, given your extensive experience in the field, both in research, clinical practice and in many different leadership positions, as you’ve as I’ve gathered, you’ve been doing this for over 50 years. So it’s fair to say you do have extensive experience. So thank you for being here. So we’re going to take some time to discuss the quality of nutrition science, particularly with respect to applied nutrition science.
So let’s jump into the questions that I have for you. So speaking of the American Journal of Clinical Nutrition, having been at the head for almost 12 years, and you know, again, as a reminder, it is the leading journal for original research in the field of nutrition. Can you tell us about a typical day? What did a typical day look like for you as an editor in chief?
So that’s an interesting question, because listeners, if they’re not familiar with us, have to know that there are some journals like the big weekly Science of Nature and JAMA, where the editors are full time employees of the Journal and they spend all their days on the work of the journal.
The vast bulk of the journals in biology, at least, and I think in most other areas of science are edited by people who have a day job and in their own science.
So they are doing research or related policy things or whatever in their own field. So they squeeze in the journal, work with some journals. That’s not too bad because they don’t have a lot of activity. And with other journals, that amounts to an immense amount of time. And I think that it’s really hard to get editors whose bosses and whose systems will give them the time to actually do the job properly. So it becomes not only a night job, but a night and weekend and every other job.
In my case, I have a variety of scientific research activities and things that go on in my center. And the thing about big journals like the AJCN who get a lot of papers every year is that they come in every day. There aren’t any weekends or holidays. There’s always something coming in that has to be dealt with, either new manuscripts or manuscripts that have been revised and resubmitted, editorial decisions and stuff. So it’s a kind of job where you have to try as hard as you can to do some work on the journal every day, no matter what else is going crazy around you.
Right? So you just have to try to get to that.
There are several things that you just need to move along because new papers are submitted. They have to be assigned to an editor. They have to go out for review, etc. And you know, if you don’t do that, they start to pile up as much as humanly possible. You get to assigning new papers when they come in. And that’s the first step in what happens in a journal.
The papers arrive at the editor’s office and they get assigned to someone who’s going to handle them. Now, smaller journals and maybe just the editor and his friend bigg journals. It’s a group of associate editors or some title equivalent to that. And this is a crucial step because one can almost determine the fate of a manuscript by the editor to whom it’s assigned, because as the editor in chief, you know, their biases. So, for example, if they don’t believe in.
Some magic bullet nutrients. And you get a paper on that, you can be pretty sure it’s not going to make it through the review process. So there are great allegiances, biases to certain kinds of diets, dietary recommendations, et cetera.
Well, so this is a big problem, though, like how do you manage that? The job of a scientist is to be open minded, regardless of what one’s presuppositions are.
Right? There are different levels of that. Right. One way is to obviously assign it to the people who have the least biases or to gain, but they may not be the experts in the field. When people get to be real experts in a field, they have accumulated a lot of allegiance biases. No matter what they say, they they wouldn’t call them allegiance biases. They would call them evidence based actions because they now know so much about the field that they can dismiss certain kinds of evidence because they don’t believe it’s really evidence anymore.
This is a significant problem. And one of the jobs of the editor in chief is to make sure that’s minimized by spreading these things around.
And the other aspect of it is to make sure that when the editor chooses referees, they choose people known to be as unbiased as they can be. But they’re human beings and no human being is unbiased. And this is a really critical issue because, again, there are referees who have built their entire careers on certain principles of their science and whatever their field is. And if those pillars come tumbling down, their entire careers come tumbling down.
So they’re not terribly anxious to decide on the side of things that make their careers come down. And there’s someone famous quote which said, and I can’t remember, this is not a scientist. He said it’s always hard to get people to make a decision if their jobs depend on it.
It’s very hard. So the same is true here. I mean, journals, I’m sure, have dozens of ways of dealing with trying to minimize this. And some of that has changed in my lifetime. So I was the editor of pediatric research back in the ’88, ’89 or so. At that time, we didn’t have the Internet and routine email and stuff. So the editors had to be in one place or nearby so they could get together and meet with a paper copy.
So they had some regular intervals. They all got together. This is what happens, by the way, in the big weeklies, they’re all working in the same building. OK, so you had to get together and it was at these face to face meetings where you could argue positions and identify biases and stuff like this that you wanted to minimize. With everything being done electronically today, one doesn’t get together the way one used to, although there are obviously zoom meetings and other things that you do.
But in my limited experience it’s not the same as getting together every day, and if it’s a small journal, there’s no reason to get together regularly because there’s only a few people involved. If it’s a big journal, it’s maybe a journal where the editors are full time employees. But in the middle, there are many different sized journals where the communication issue becomes really important.
And we did institute policies in the AJCN which you try to minimize the potential of a single editor with biases making a decision that other editors don’t agree with. So, for example, the editors would receive the titles of the papers receipt that the Journal got so that if they saw one, they were interested and they could ask to see it and maybe make comments on it. Things that and some journals make sure that all the editors have to sign off on a decision, things of this nature, and they’re all meant to try to eliminate personal bias.
So anyway the papers come in and they are assigned, then someone has to find the referees. At smaller journals it’s the same person, same editor in big journals.
It’s an associate or assistant editor. And the hardest thing to do when a new paper comes in is to find the referees. Number one the hardest thing to do.
Yeah, I bet. Yeah. I’ve got experience as an associate editor for sure.
Most journals require two external referees. In the AJCN, it took us on the average of six point, something invite’s to get to and in many cases it was 12 invites. It’s difficult enough to identify unbiased experts. And then get them to agree to actually review the manuscript in a timely fashion, right, in a timely fashion. That’s the single rate-limiting step at the beginning. And it’s really important to try to get that. So what I advise young people, some journals allow you to suggest referees in the past, if before the Internet, if an author suggested a referee, the editor would have to spend two days in the library finding out who this person was and what they did, whatever.
Well, today, it’s several keystrokes away.
So if you send the names of suggestive referees, the editor can, if the editor doesn’t know them already, can determine in a matter of two minutes whether this person is an expert in the field and has anything to do with the paper that came in.
And if one suggests the best experts in the field, the editor says this is a person who really wants to compete at the highest level, and in fact, well theres a good chance the editor is going to choose those people because they are the experts in the field. But from my perspective, you gain points for that if you suggest someone who’s never published a paper in this field. The editor says it must be the person’s brother in law, I mean, or somebody they were fellows with in the past.
They don’t really want to compete in this field because this person has published nothing in this field. And that, in my mind, gets you real negative votes. And not only that, once the editor sees that they’re not going to pick that person anyway, it’s a method’s issue because the principles of how you do this at the beginning can determine the fate of a manuscript.
Thanks for listening, if you’d like to hear more episodes of methodology matters, please head over to MethodologyMatters.podbeam.com, or you can find us on Spotify and on Google podcasts.
And if you’d like to learn more about Dr. Dennis Bier, you can find his faculty profile at Baylor College of Medicine’s website linked in the show notes for this episode below.
Thanks for tuning in. We’ll see you on the next episode of Methodology Matters, a podcast on evidence based nutrition.