“We have to be the change we want to see… increasing preprint engagement requires a system-wide change in how we value publications and commencing a dialogue that we can all be a part of.”
As part of Clinician’s Corner we would like practicing clinicians to share their opinions and experiences on preprint usage within the clinical community. In this post, we speak to Dr Karin Purshouse, an ECAT Clinical Lecturer in Medical Oncology and PhD Fellow at the University of Edinburgh.
When did you first become an advocate of open access science, and why?
I first became interested in open access when I was a medical student back in 2011. On meeting Nicky Shockey, Director of the Right to Research Coalition (R2RC), I first became aware of open access and the issues surrounding research publishing. Since then, it has been an ongoing journey over the last decade, as I qualified as a doctor and continued my training as a clinician scientist. The conversation surrounding open access has really come to the fore in the last few months as a result of the COVID-19 pandemic.
How have preprints impacted your clinical practice during the COVID-19 pandemic? Do you actively read preprints?
I think the pandemic has really demonstrated the importance of preprints to the clinical community in a way that hasn’t been seen before, because the need for immediate data-sharing has never been more pressing. Much of the key data which has influenced clinical practice during the COVID-19 outbreak has been originally posted as a preprint prior to peer-reviewed journal publication. For example, a large prospective study of children admitted to hospital with COVID-19, and the RECOVERY trial, which amongst other things has shown that the corticosteroid dexamethasone is important for treating patients at a certain stage of the illness, were all initially presented as preprints [1,2]. I think this has been a real watershed moment for the clinical community who perhaps may have not been aware of preprints previously and now understand more about their purpose and roles in disseminating findings as quickly as possible.
How are preprints perceived among your peers – are there concerns that preprints have not gone through the peer review process?
I think this is the main challenge in advancing adoption of preprints. Many people in the clinical community were unaware of preprints and to an extent this has been a learning process. Clinical academics I think have concerns both that data are not peer reviewed, and that people are not aware of this. My counter to that is that preprint servers, such as medRxiv, have clear banner statements that preprints are not peer reviewed. I would also argue that preprints offer the opportunity for open, dynamic real-time peer review and to make a paper better than it already was, which is what most proponents of preprints would say is a key purpose of them.
For example, data can be read by anyone in the clinical community and reviewed from the perspective of how it applies to their particular patient in front of them. Problems can be identified and fed back to the authors before the final publication is presented, whilst at the same time making key advances available for people to action as quickly as possible. Whilst there are concerns, I don’t think the evidence is there to say that there is more of a danger from preprints than journal publications in terms of accuracy and quality. We have seen during the pandemic major findings in major journals that have turned out to be incorrect even after the peer review process. Of course it is important for any publication to be read critically, and that should be true whether reading a peer-reviewed article or not.
In addition, for clinicians there is an argument that preprints have a particular power. Whilst academics often have a component of their funding put aside for open access publishing, clinicians are often not funded in the same way unless they have specific academic funding, often doing clinical academic work in their own time or as part of their clinical work without formal funding for open access. Preprints therefore offer a unique opportunity to share information generated as part of their clinical working practice for free, and that can be read for free. I don’t think many in the clinical community previously realised that there was a way of sharing information without having to essentially choose between paying to make it open access or accept your paper will be behind a paywall.
What are your hopes for preprint use in the future? Do you think the uptake of preprints will continue beyond the pandemic?
I am very optimistic – the pandemic has opened what preprints are to a community that was largely unaware. Although there are debates regarding quality control and peer review, the last few months have opened up this dialogue about how we share our latest data, and I think it can only be welcomed that we start having that discussion.
What do you think is needed to increase preprint engagement in the clinical community?
I think the challenge facing all clinicians, similarly to full-time scientists and academics, is that huge value is placed on publications and research outputs in job applications and continuing professional development. Because of this, I think there needs to be a way of incorporating preprint publications into that process. For example, often publications are only counted if they have a PubMed ID (and preprints don’t currently have that  ); I think that is something that needs to evolve, and if this was achieved, in the UK at least, it would be hugely powerful.
It is exciting that we now have a generation of scientists and junior academics that have grown up with open access as the norm – and that has to continue. We have to be the change we want to see. Something I often say to clinicians who ask this question, is that we can try and do this in simple ways. For example, when we are involved in our first publication, we can ask the question ‘can it be published in a preprint server?’ and at least start the conversation. It is really hard when you are a junior researcher to put your head above the parapet and voice what you think, but at least it forces people to think. In summary, I think increasing preprint engagement requires a system-wide change in how we value publications and commencing a dialogue that we can all be a part of.
- Swann et al. Clinical characteristics of children and young people hospitalised with covid-19 in the United Kingdom: prospective multicentre observational cohort study. medRxiv 2020.07.14.20153320; doi: https://doi.org/10.1101/2020.07.14.20153320
- Horby et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report. medRxiv 2020.06.22.20137273; doi: https://doi.org/10.1101/2020.06.22.20137273
- In June 2020 the National Library of Medicine (NLM) launched the National Institutes of Health (NIH) Preprint Pilot, during which NIH-funded preprints will be made available via PubMed Central (https://www.ncbi.nlm.nih.gov/pmc/about/nihpreprints/). The first phase of the project aims to increase the discoverability of preprints through NIH’s iSearch COVID-19 portfolio, a curated source of publications and preprints related to COVID-19 and SARS-CoV-2 virus research (https://icite.od.nih.gov/covid19/search/).