Para la reflexión (sigamos el hilo de la conversación)

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