El blog MED-MEDL es un órgano de comunicación internacional donde se dan cita los historiadores de la medicina de todo tipo, desde filólogos y bibliotecarios a veterinarios, médicos e incluso algún informático. está moderado por Monica Green, catedrática de historia de la ciencia en la Universidad de Arizona. De vez en cuando se cruzan asuntos que mueven a la reflexión. Entre otros, este que añado a continuación, donde los historiadores critican, con razón, la a menudo escasa calidad de los trabajos de historia que se publican, sin embargo, en revistas muy prestigiosas.
Creo que nos debe mover a la reflexión.
Subject: medical history is a serious subject of study. De Alessandra Foscati
Dear all,
A little question. Why do serious medical periodicals, with impact factor and peer review, often permit the pubblication of articles of history of medicine that are so naive (to use an euphemistic expression)? Is there for these kind of articles a serious peer review by historians?
I don’t think so.
I think it is a behaviour that doesn’t be of use to historians who try to study seriously medical history.
As I see, it is often in use to create, by physicians, an article starting from a picture to arrive immediately to conclusions connected to current medical knowledge. Or starting from the tale of a miracle, using a casual source without to date it or to use any philological interpretations, and so on.
I have just read a very recent example in Journal of Vascular Surgery.
Even if the periodical is dedicated to the medicine, I think that also the part regarding medical history (if it is interesting for the periodical) deserves to be seriously written and controlled.
Sorry for my outburst
Alessandra
Del viernes 8 de Julio:
Dear Alessandra and MEDMED-L Colleagues,
You have articulated a widespread and rampant problem, Alessandra. The fiction of “peer review” is that any journal’s editors will identify the proper “peers” to review any piece of work they publish. But with interdisciplinary work, the inherent problem is that editors (a) don’t recognize which disciplines are necessarily involved in a given piece of work, and (b) do not know how to identify the “experts” in those other fields in order to solicit expert opinion on the work in question. In my opinion, interdisciplinary work needs to be assessed by three referees, not just two as is common. This is a problem not simply in clinical medical fields, but also in the emerging field of “archaeogenetics,” which likewise makes large claims about the past without engaging with historians knowledgeable about the time or place being discussed.
The problem with such “amateurish” work being published in medical journals is compounded by the indexing systems commonly used in biology and medicine, which normally do not even attempt to survey literature published in Humanities journals. PubMed, which is perhaps the most widely used indexing system, does not normally index work that does not appear in medical journals. I actually did a count of my own work in PubMed a couple of years ago. Of over 100 publications I had at the time, only 3 showed up in PubMed. So medical history truly is invisible to researchers (and editors) working solely within the bounds of the biomedical sciences.
The only thing we can do is (a) write to the editors of such journals when they publish egregious work as you have described and (b) send some of our own work sometimes to medical journals. If it gets published, then all the works it cites gets “recognized” at some level in the biomedical citation universe, increasing the chances that it will be noticed and cited by others.
In short, we need to keep making our presence known as professional historians, and keep making the importance of our work as skilled interpreters of the past visible and apparent to others who attempt to assess the relevance of past ideas and practices to the present day.
Using social media is also another way to get the word out, since (sometimes) it creates the opportunity for dialogue outside or beyond the normal (cloistered) channels of communication within specialized disciplines.
Just as a heads-up, Lori Jones and Richard Nevell have an important piece coming out soon in Lancet Infectious Diseases that will deconstruct the wildly inappropriate uses of “medical” images in biomedical and popular accounts about disease in the past. Making as many people as possible aware of this prestigious publication will help tremendously in increasing the visibility of our work.
Good luck!
Monica
—
Monica Green. Professor of History. School of Historical, Philosophical, and Religious Studies
Box 874302. 975 S Myrtle Ave. Arizona State University. Tempe, AZ 85287-4302. U.S.A.
Dear Monica,
the Lancet is not very good in this respect either. In this paper:
Herodotus, the Scythes and hookworm infection<http://librarysearch.rhul.ac.uk/primo_library/libweb/action/display.do?frbrVersion=7&tabs=detailsTab&ct=display&fn=search&doc=TN_sciversesciencedirect_elsevierS0140-6736%2806%2968652-2&indx=2&recIds=TN_sciversesciencedirect_elsevierS0140-6736%2806%2968652-2&recIdxs=1&elementId=1&renderMode=poppedOut&displayMode=full&frbrVersion=7&frbg=&&dscnt=0&scp.scps=scope%3A%2844ROY%29%2C44ROY_EbscoLocal%2Cprimo_central_multiple_fe&tb=t&mode=Basic&vid=44ROY_VU2&srt=rank&tab=tab1&dum=true&vl%28freeText0%29=lancet%20herodotus&dstmp=1467985331746>, Crubézy, Eric ; Magnaval, Jean-François ; Francfort, Henry-Paul ; Ludes, Bertrand ; Larrouy, Georges The Lancet, 2006, Vol.367(9521), pp.1520-1520 [Peer Reviewed Journal]
the following sentence can be found:
“According to the Greek historian Herodotus (ca 484 BC–ca 425 BC), their burial grounds were far away from their places of habitation.” with reference to the Scyths.
No Herodotus translation is mentioned in the bibliography, and the authors don’t provide a reference where Herodotus supposedly says this. I looked and I couldn’t find the passage. This is inaccurate at best.
I am just quoting this here to highlight how bad the situation actually is. Even this established medical journal didn’t think it was worth to run this by a historian or Classicist.
We need to create a platform where both science and humanities can meet and exchange expertise. At present, we live in separate worlds.
Best wishes, Barbara Zipser.
Ironically, this is likely to be more of a problem as multiple experts try
to extract more aspects of information from a single set of data (which
personally I think is a good thing).
To give one example – There is a wonderful paper on breads in archeology
which is written by several carpologists and other experts. But the paper
contains an erroneous assumption about the use of yeast (vs sourdough) in
French bread (and as a result makes no effort to identify which method was used
in the breads in question). Checking the footnote, this is based on work
by a respected bread expert who, however, has passed on an unexamined myth
of the French bread trade.
In a complex paper, it may be asking a bit much to ask the writers (or any
peer reviewers) to closely examine the basis of a statement from one of the
rare experts on an ancillary subject. But in this case this little slip of
misinformation had a material effect.
I also think it’s useful to bear in mind in regard to medieval history in
general that a lot of people assume they know things they’ve never actually
bothered to research – that all the water was bad, that people drank great
amounts of beer and wine, that the meat was often bad, etc. And yes I’ve
seen such statements from bona fide academics. I’ve even had one such person
say that, in effect, sometimes one just has to assume things which can’t
be documented (probably true in a handful of cases, but nowhere near so many
as this implied). So the moment someone goes from hard physical evidence
to “historical” accounts they may not even think to check their own
assumptions.
Jim Chevallier
_www.chezjim.com_ (http://www.chezjim.com/)
Alexandra asked why this happens. For those writing in medical journals the stakes are very low if they make a serious error about historical matters from some time ago, such as the examples cited, so they are unlikely to feel it necessary to check, let alone cite a reference.
On the other hand, if authors misstate recent work in the field bearing on current practice, this may have serious consequences for patients. And additionally, they, the editors and the readers are likely to quickly hear from other workers in the field objecting to the fact that i) their work, or pertinent work by others has not been cited, or ii) work cited has been cited incorrectly and misleadingly.
And for “ acts” cited without citation, while an editor might not insist on a reference to a a claim attributed to Herodotus for instance, s/he would do so for one referring to current practice.
Monica wrote:
“The only thing we can do is (a) write to the editors of such journals when they publish egregious work as you have described and (b) send some of our own work sometimes to medical journals.”
I agree entirely and add re (a) I would also write to the authors themselves, as tactfully as i could, in hopes it may convince them not to repeat their “whoppers’ in some future article.
The rationale she mentioned for (b) was that “If it gets published, then all the works it cites gets “recognized” at some level in the biomedical citation universe, increasing the chances that it will be noticed and cited by others.”
And it may help sensitize editors, readers, and future authors in clinical fields who read the journal to a historical perspective.
It would be fun to collect somewhere historical “whoppers” of this type mentioned.
Of course, it goes the other way too. What about trained historians who misstate or misunderstand the science (including medicine( about which they write? I am aware of two egregious examples in medical genetics. One arose from application of social-political bias of the zeitgeist of the time. The other from just lack of knowledge.
All this is simply to reaffirm the “subject” of Alexexandra’s email.
Ernest B. Hook, M.D., F.A.C.M.G.. Professor, emeritus. School of Public Health. University of California. Berkeley CA 94720-7360. USA
Dear Alessandra
As someone trained as a doctor, medial historian and palaeopathologist, this is a situation that has been causing me concern for some years. It came to a head a decade ago when I noted that there were at least 10 different published theories as to how people died from crucifixion in Roman times. This was because the physicians writing in clinical journals never read the original sources describing how crucifixion was performed, and their evidence came from quoting other articles by physicians on the same topic. That prompted me to write:
Maslen, M., Mitchell, P.D. (2006) Medical theories on the cause of death in crucifixion. Journal of the Royal Society of Medicine 99: 185-8.
I then wrote an article arguing that if people are going to try and investigate disease in the last using written sources or art, they really need a team of people who understand how to use written texts or art as well as those who understand disease:
Mitchell, P.D. (2011) Retrospective diagnosis, and the use of historical texts for investigating disease in the past. International Journal of Paleopathology 1: 81-88.
I think if others on the MedMed list also write such articles to give their viewpoint, especially if we try and publish them in medical journals read by physicians, this may eventually lead to change.
I entirely agree with Monica’s view earlier that it is not just authors who need to change but also clinical journal editors, who need to go the extra mile and invite the right reviewers with the right expertise to ensure quality control for articles using historical sources.
However, it also falls on medical historians to agree to review such articles when invited. I am associate editor for several journals and sometimes find it quite a challenge to get a suitable expert to accept to review such articles. Some medical historians will agree to review an article for a medical history journal but not for a medical journal, as they anticipate the latter will be less scholarly and so not worthy of their time. If they do that, then the clinical authors never learn from feedback from the medical historians, they continue to write articles that do not use the original sources properly, and this perpetuates the problem.
Best wishes
Dr Piers Mitchell. Department of Archaeology and Anthropology-.University of Cambridge
The Henry Wellcome Building. Fitzwilliam Street. Cambridge CB2 1QH
http://www.bioanth.cam.ac.uk/pm.html
Del 10 de Julio.
I have been surprised that more historical pieces haven’t been published in Emerging Infectious Diseases. I don’t know how hard it is to get something
accepted, but they do publish “historical perspectives”, it gets indexed in pubmed and it is open access. Several of the early plague aDNA pieces were
published there, but also more traditional history of medicine reviews that relate in some way to current EID. Scan through a few issues online and you
will see a while variety of historically important organisms being discussed.
I should also mention that since Emerging Infectious Diseases is operated by the CDC, its free to publish open access there.
Michelle Ziegler.
Hello all,
I’ve been following this discussion eagerly. As a shameless bit of self promotion I (a medieval historian and literary scholar by training)
recently collaborated with a consultant neurologist about tremor conditions in the work of medieval scribes, to publish the following piece in *Brain *(a
highly respected neurological journal)
*.*
Thorpe, Deborah E., and Jane E. Alty. “What type of tremor did the medieval
‘Tremulous Hand of Worcester’have?.” *Brain* (2015) [
http://dx.doi.org/10.1093/brain/awv232]
This collaboration has been rewarding and, I think, productive and effective. We are continuing to work together, and have a short
collaborative piece accepted for another Neurological journal, expanding our collaboration to include an experienced Latinist and historian and have
other articles in the works. I agree entirely with Piers that a multidisciplinary team is often the way forward with this. I have learned
so much through working closely with a neurologist on my project, and I hope that has worked the other way too.
Deborah Thorpe
Dear all,
I have been using Piers’ article (Mitchell, P.D. (2011) Retrospective diagnosis, and the use of historical texts for investigating disease in the past. International Journal of Paleopathology 1: 81-88) in an upper-level undergraduate course in medieval medicine for several years. It is virtually the first reading that they complete. The course is made up of senior undergraduate students, most of whom are students in biology or biochemistry, and a few of whom are humanities or social science majors. The article is excellent as an undergraduate reading because of its straightforward presentation. Afterward, I ask the students to justify which of his “pitfalls” for using retrospective diagnosis seem to them to be most important. A large majority of the biology students, many of whom have had no college-level history, cite the difficulties of translation as the most important pitfall, which brings home to me that they have never been taught that there are philological components to medieval texts. The history majors, on the other hand, aren’t surprised by the translation issues, but tend to choose as the worst pitfall the copying of previous medical authorities. If they have not done much medieval studies, it shocks them deeply to learn that medieval medical authors weren’t always “original” when they described medical events.
It strikes me that their responses are perhaps representative of the messages we have to get out to the larger public as well as to writers in medical journals.
Best to all,
Belle Tuten
Long Professor of History, Juniata College
Del 12 de julio.
Dear Monica,
the key problem remains peer review. The editors of medical journals don’t know how to find qualified reviewers. The quality of your contribution doesn’t matter, if it is assessed by someone who doesn’t know what they are doing.
And the quality that does get through is quite shocking. I actually used the Lancet article I referenced below in my first year teaching, as an example on how *not* to write an essay.
I am not blaming the scientists. I don’t know how to read a CT scan, and I wouldn’t be able to identify a parasitic worm under a microscope either, and nobody would expect me to do so. We can’t expect them to be familiar with our methodology, and, even though we tend to forget about this, the material we work with is highly complex. Most Classicists, no matter how well trained they are, wouldn’t be able to handle the manuscripts that I currently have on my desk.
Piers, and some other scholars on this list, who have a background in both humanities and medicine, are an exception. In most cases, it is not feasible for a physician to complete a humanities degree as well, both in means of provision of history of medicine training and in means of time/finances/tuition fees.
The key to resolving the situation is establishing contact. If it is easy to just run something by someone and ask for advice, this will have a positive impact on all sorts of aspects of medical research.
A first step could be to integrate compulsory history of medicine/science courses at science faculties. Personally, I also give poster presentations at science open days at my college – a small step, but at least everybody knows I am there, and the students or prospective students can have a look.
Best wishes,
Barbara Zipser
Del 15 de Julio.
Dear Alessandra, Barbara, and list members,
Sorry to join the debate a bit late. The discussion led me to check whether the article I reviewed (and recommended to reject) in December 2014 had eventually been published. And there it was. (http://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=225299). Actually, the whole volume is devoted to the heroic account of great men, medical discoveries and scientific progress, half way between medical profession advertising, political propaganda and what E. Renan stated in 1883: “for reassurance on the future, they appeal to the past” (trans. by S. P. Ragep and F. Wallis). Despite the journal’s title, articles rather follow the structure or style of papers in biomedical journals, but more to the point, for the most part, authors are physicians.
At least this journal’s editor didn’t include my name as reviewer, as was the case with the Journal of the Royal Society of Medicine some time earlier. I was informed that the reviewer’s name would be included in the publication, but as in the so-called informed consent, relevant information that one takes for granted or cannot imagine was omitted. So, my name appears implicitly approving its contents and supporting its scientific quality regardless of my critical comments advising to reject it. I was never granted the opportunity to give my opinion on the revised version (in which only very minor changes had been made, mainly to avoid problems of plagiarism). Nevertheless, the least one would expect from a true peer-reviewed scientific journal was a second review of the re-worked paper by another reviewer.
Alessandra’s question well deserves a thorough research by historians, for it is a rather complex issue. In addition to some of the reasons mentioned in the AAMH-Clio Project and in this list, to a large extent physicians don’t want to hear or see anything about the history of medicine which has been published over the last 40 years or so (the one which would actually “reveal contingency and fallibility of knowledge, foster humility, complement bioethics, instill humanity and improve history-taking” in the profession, quoting JHMAS 2014, “Making the case…”). With few exceptions, they indulge themselves in the iatrocentric and complacent version of the history of their profession. And they do it to the extent of quoting recent historical research while at the same time systematically ignoring the findings it contains.
Although it is an overarching problem which applies to all disciplines of knowledge, academic ethics and the bibliography employed by authors of historical papers in biomedical journals (and journals of medical humanities) are worth of dissection, although for the most part unethical conducts pass inadverted unless one is familiar with the corresponding bibliography or is the actual source of inspiration.
In tune with the 1001 Inventions Exhibition, papers devoted to medieval Islamic medicine are particularly inclined to bizarre, acritical, and overenthusiastic interpretations even in presumably respected biomedical journals such as the International Journal of Cardiology. So there (I mean, only in the article’s title) we can find al-Razi and Avicenna describing for the first time the aortic regurgitation, the aortic stenosis, and similar pathological entities, or performing modern clinical trials and practicing Evidence-Based Medicine. Incidentally, it took me a long while to find a particular reference, for it was buried in a total of 177 articles. Just in one issue. Just in one medical specialty. Isn’t it too much biomedical research?
According to what I am observing in biomedical journals, I subscribe the statement by Dr. Marcia Angels, former editor of The New England Journal of Medicine for 20 years: “It is simply no longer possible to believe much of clinical research published”.
Cristina Álvarez Millán
Dept. of Medieval Studies
UNED
Estoy muy de acuerdo.
Cambiar el concepto que de nosotros tiene la profesión es una tarea a la que nos tenemos que dedicar todos.
Debemos recordar que la historia ES UNA CIENCIA y como tal tiene un método que debemos mantener a toda costa.
Os mando un abrazo.
Dr. Caparrós
Buenísimo, tocayo, me ha encantado. Cuarto y mitad de rigor a la hora de leer, entender y citar clásicos e historiadores es tan importante como a la de leer, entender y citar al último citogenético o taxonomista microbiano de moda. Gracias mil y otros tantos abrazos
Estimados
Un debate de especial interés. Por poner un contrapunto. Aunque estoy de acuerdo que debemos procurar mantener el rigor a la hora de elaborar nuestros trabajos científicos (se nos presupone como en la mili), creo que no es menos cierto que no deberíamos caer en el puritanismo del método y desdeñar trabajos que desde el ámbito aficionado, aporta nuevas fuentes, recuperación de la memoria local o en nuestro caso de una profesión y que van construyendo microhistoria. El aficionado que escribe en la mayoría de los casos, lo hace desde su esfuerzo personal, con la mejor intención y sin más animo que querer aportar algo nuevo, o satisfacer su propia curiosidad. Desde mi punto de vista, pienso que es fundamental incentivar este tipo de trabajos “aficionados”, que no hacen sino enriquecer el conocimiento. Creo que todos coincidiremos, que hay dignos trabajos de este tipo que nos han aportado más que tediosos mamotretos, y quien diga que no que tire la primera piedra. 🙂
Será luego el espíritu crítico del método científico del mundo más académico, quien contrastando fuentes, ponga en mayor o menor valor estas aportaciones. El problema yace aquí. El blog pone de manifiesto la falta de rigor que algunas publicaciones tienen en este sentido. Pero aquí el problema no es del que escribe, sino del editor que lo publica.
Saúdos dende o Finis Terrae
Diego Conde
Personalmente, estoy de acuerdo con lo que Diego expone. Si bien creo que podemos aspirar ya a un cierto periodo de madurez en lo que a la HV se refiere. Creo que ya ha pasado el tiempo de admitir casi cualquier aportación en los congresos, con la mirada puesta en crear afición. Es momento de ser, no más selectivos, sino selectivos, con la finalidad de elevar el nivel general de la disciplina. Ya hay un grupo de gente que trabaja bien, y lo hace bien. Es tiempo de relegar los intentos loables, vacíos de contenido, mal realizados o inservibles.
Por lo que se refiere a este hilo que seguimos, creo que lo que se evidencia es, por una parte, la desigual consideración de un trabajo de historia en una revista científica especializada, y por otra parte la desidia en valorar adecuadamente dichos trabajos. y se apunta a que la causa principal es la incapacidad de los referees habituales para juzgar campos ajenos. Por ello se apunta a la colaboración interdisciplinar para atajar el problema. Saludos.
“En la recta final de un historiador de la medicina”. Así titulaba Pedro Laín Entralgo la conferencia de clausura de un Congreso Nacional de Historia de la Medicina en Zaragoza poco antes de su muerte. En la misma hablaba de que siempre se había considerado un “amateur”, en en sentido francófono del término, como “amante” o “amador” de la disciplina que enseñaba, que, por cierto, él introdujo en España. Luego, estimo, hay que tener cuidado cuando oponemos el término “amateur” usado con displicencia ante algunos trabajos, al de “profesional” como el colmo del saber.
Un poco de modestia no nos viene nada de mal a todos. Los profesionales de la Veterinaria, como los de la Farmacia, cuando nos hemos adentrado en el campo de la historia de nuestras respectivas disciplinas, hemos empezado de aprendices, y poco a poco algunos llegan a oficiales y los menos a maestros.
Es cierto, y se ve perfectamente en nuestros congresos, que algunas comunicaciones dejan que desear. ¿Sabéis qué pienso cuando las oigo? Pues en como serían las mías cuando empezaba.
De todas formas, pronto se ve quien ama de verdad la historia de la ciencia en cualquiera de sus variantes profesionales. La continuidad en el esfuerzo mejora siempre los resultados y eso se nota congreso tras congreso.
Voy ahora a la inclusión de artículos mediocres en las revistas científicas. Responsables: Consejo de redacción. A veces nos ponemos estupendos y rechazamos artículos de autores desconocidos que luego vemos que valen la pena. Otras, como la firma tiene prestigio, dejamos pasar bobadas.
No es fácil acertar siempre. Por mi parte, en la duda no me importa reconocer que abro la mano. Prefiero pecar de manga ancha que de criterios rígidos. El tiempo pone las cosas en su sitio, y para mi, hoy por hoy, la “profesionalización” en historia de la ciencia no es ninguna garantía de nada frente al “amateurismo”.
José María de Jaime Lorén
Yo también arriesgo mi opinión.
Este debate es muy bueno.
Tengo que reconocer que todos los comentarios son excelentes y con diferentes perspectivas lo que los hace más interesantes.
En plan salomónico creo que todavía los historiadores de las Ciencias Veterinarias tenemos que hallar un baricentro, o un ortocentro, para atraer a nuevos investigadores. Ese punto intermedio no invalida los trabajos de los noveles. Por otro lado conviene reconocer los buenos trabajos, y también a las personas que los firman pues el conjunto servirá de emulación y notable estímulo para los menos expertos a los que hay que ayudar. Recordemos “Primun non nocere” y no molestar ni asustar al que noblemente se acerca; acojamos con cariño a los que se sienten atraídos, tiempo habrá de pulir la obra con la ayuda de los más expertos. Yo he tenido buenos maestros que me han guiado y dado buenos consejos.
Estoy muy de acuerdo con el Dr. de Jaime Lorén: yo también tiemblo cuando leo alguno de mis trabajos pasados. Incluso en la actualidad me separo, sin querer, del camino de perfección, camino al que debo retornar sin dilación.
Al fin y al cabo la historia de nuestra profesión es la historia de nuestros historiadores (a los que hay que vigilar, y a mí el primero, por las posibles derivas).
Todo trabajo es perfectible, siempre que hallemos el crisol adecuado y bebamos en las fuentes primarias.
Os mando un saludo.
Dr. Caparrós