There is no doubt that scientific scholarly communication worldwide is not in great health. Some of the most important international journals, and Nature among them, are grappling with what should be done to resolve some clear distortions in the scholarly communication ecosystem (1).
The pressure to publish as many findings as possible in order to be cited as much as possible ends up influencing researchers’ decisions, their perceptions and their judgment. Mostly, the results of this pressure are perceived only “unconsciously” within the scientific community. However, scientists are often encouraged to explore procedures that support the initial hypotheses to be verified, rather than to rigorously limit the effects of any bias and carefully filter any false positives (2).
Clearly, institutional incentives emphasize the pressure to publish only statistically significant findings, more likely to be cited, and induce an unconscious resistance to using rigorous methods to confirm and publish these findings independently from the presence of positive results (3). In the literature, in fact, there is a clear tendency to present more and more frequently results that are positive, and to progressively reduce publications that contain negative results (4).
Undoubtedly big randomized double-blind controlled studies represent an incredible source of information and have been the basis of a very large part of what we know about pharmacological treatments. However, it is not clear how viable they will be in the future because of their cost, but also because of the complexity of the methods that need to be employed in order to gain adequate evidence in line with the most recent scientific developments.
Personalized medicine is now revolutionizing the field of clinical trials and their potential applications, although conducting studies on a very selective group of patients can bring a new series of problems. Many authors argue that personalized medicine now requires a shift away from big randomized controlled studies, and from the centrality of statistical evidence, and towards smaller trials that combine the use of statistical tools with accurate laboratory analysis (5).
There are some limitations here too, and some considerations need to be made on the reliability of the results. The trial needs to be organized in order to facilitate its ultimate scientific aim, obtain significant and evidence-based outcomes that can be employed by the wider medical community (6).
As personalized medicine becomes the norm, there needs to be a growing interaction between the different actors in the research environment, starting from researchers themselves, and moving on to editors and academic publishers. When assessing research projects, institutions need to start thinking of new ways to evaluate their outcomes.
Even if the journal you are reading right now, the Giornale Italiano di Nefrologia (GIN), is not directly involved in the issues we have been covering here, it is of course affected by the discussion happening in and about top scientific journals. The GIN aims at both summarizing the current knowledge in the field of Italian nephrology and at suggesting new reflections; it constantly tries to reach all corners of nephrology and all professions that intersect it. For this very reason, this journal cannot ignore what goes on in the scientific community, while always aware of the need to monitor the quality of scientific outputs. Exactly because it is immune from the incentive mechanisms we have already seen (7, 8), the GIN can gather contributions greatly relevant to clinical practice, but also intercept the most innovative ideas and developments in clinical research. It can be a space free from any interferences, to strengthen and consolidate knowledge and professional know-how.
In addition to being an agile tool to stay updated and to openly discuss any issues pertinent to Italian nephrology, in the utmost respect for other people’s opinions, this journal wants to also build a common vision so that any nephrologist can feel part of a strong community, whatever context they work in.
The GIN already features several sections, hosting contributions on a specific topic, that are curated by many great authors and are destined to be developed further in the future. It is my hope that, in addition to investing on “cultural synthesis”, the journal of the Italian Society of Nephrology (SIN) can become the perfect place to critically discuss the newest data in the literature, with methodological rigour and with a focus on clinical practice. I hope the journal will also be an arena to showcase unresolved or complex clinical cases, appealing more and more to contributors from all sides and helping nephrologists stay updated, innovate and concretely develop new skills. Finally, but importantly, I wish the journal to be open to residents, fellows and to junior doctors, who are always ready to challenge themselves and invest in their future.
Bibliography:
- Else H. Radical open-access plan could spell end to journal subscriptions. Nature. 2018; 561:17-18.
- Lindner MD. Clinical attrition due to biased preclinical assessments of potential efficacy. Pharmacol Ther. 2007; 115(1):148±75.
- Begley CG, Ellis LM. Drug development: Raise standards for preclinical cancer research. 2012; 483(7391):531±3
- Lindner MD, Torralba KD, Khan NA (2018) Scientific productivity: An exploratory study of metrics and incentives. PLoS ONE. 2018; 13(4):e0195321
- Sharma MR, Schilsky RL. Role of randomized phase III trials in an era of effective targeted therapies. Nat Rev Clin Oncol. 2012; 9(4):208–14.
- Nardini C. The ethics of clinical trials. eCancer Medical Science 2014; 8:387.
- Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Otero Gonzalez A, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W and Stel V on behalf of the European CKD Burden Consortium. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrol Dial Transplant. 2015; 30 (Suppl 4): iv6–iv16.
- Santoro A, Gibertoni D, Rucci P et al. The PIRP project (Prevenzione Insufficienza Renale Progressiva): how to integrate hospital and community maintenance treatment for chronic kidney disease. J Nephrol, 2019.