The commentaries in ACP Journal Club: What are they for? Can you help out?
ACP J Club. 1992 July-Aug;117:A17. doi:10.7326/ACPJC-1992-117-1-A17
Related Content in the Archives
• Editorial: Scientific evidence and expert opinion in ACP Journal Club: commentary on commentaries
Many readers have expressed appreciation for the commentaries that accompany each abstract in ACP Journal Club. Because readers may have views of the value of commentaries that differ from ours, we provide our perspective here. Commentaries are the least standardized part of ACP Journal Club and have provided many of its high and a few of its low points. We continue to recruit new commentators and hope that some of our readers will be willing to take on this role.
As indicated in the Purpose and Procedure section of each issue, the function of the commentary is "to provide a brief, highly expert comment on the context of each article, its methods, and clinical applications that its findings warrant." The success of a commentary in achieving these goals is influenced by several factors, including our ability to match the expertise of a commentator to the topic of an investigation, the commentator's understanding of the context and methods of the study and the clinical implications of its findings, and the commentator's skill in communicating this understanding.
Most of the experts on our review panel were chosen by the editor and had to meet the following criteria: 1) be engaged in clinical practice in internal medicine or one of its subspecialties or related fields (e.g., clinical pharmacology); 2) possess a working knowledge of the basic principles of critical appraisal of the medical literature, clinical epidemiology, or both; 3) be able to write clearly; 4) be willing to respond quickly (usually within 1 week) to requests for review of our structured abstracts for accuracy and to provide commentaries for articles of relevance to the commentator's stated areas of expertise.
Most of our commentators meet all these criteria, but some experts with nonclinical degrees are asked to comment if the subject matter is particularly suited to their research. Also, we may ask a surgeon, for example, to comment on a surgical issue of importance to internists. If we know of someone who, although not currently on our commentator list, is expert on the topic of an article, we will approach him or her (especially if no one on our roster has comparable expertise). Finally, we ask some authors of articles chosen for ACP Journal Club to become commentators on articles by others in future issues, especially if we have had difficulty finding a commentator for their article. We note with gratitude that many of our commentators volunteer because they support our objectives and want to help.
The commentator's tasks
When an article makes the grade for inclusion in ACP Journal Club, we consult our list of commentators to find the person best qualified to write a commentary for it. Once selected to do the honors for an article (honor has to suffice, for no one gets paid!), commentators have a number of tasks. First, they must read the entire article and ensure the accuracy, completeness, and clarity of the abstract prepared by an ACP Journal Club research staff member and reviewed by one of our associate editors. Special emphasis is placed on the appropriateness of the conclusion in the abstract, ensuring that it does not stray beyond the evidence presented in the article, no matter how logical such an extension may seem. Second, the commentator must prepare a commentary of no more than 300 words, covering 3 key issues: the context of the study in view of what other investigations or reviews have shown; any important methodologic issues that must be borne in mind when attempting to interpret the evidence from the investigation or review; and any practice recommendations that are supported by the study (and other studies addressing the same question). Third, the abstract and commentary are sent to the author of the original article. Authors often provide valuable feedback, and commentators may revise the style or content of their commentaries accordingly.
The art and science of preparing a commentary
Although the creation of a commentary may seem straightforward, leading to a standard product, often it is not. Some studies are so definitive that their application in clinical practice is obvious. The commentator can cheer from the sidelines of the abstract of such studies, but in doing so may seem to be adding little other than reassurance to the reader that no subtle flaw undermines its results. Other commentators feel, however, that they must earn their keep and try to find inconsequential flaws in strong studies. We avoid this by asking commentators to discuss only those methodologic problems that seriously compromise the article's conclusions. Although the result can be a bland comment, we prefer this evil to high-sounding but trivial critiques of evidence that speaks for itself.
Other studies have important flaws that limit clinical application. If the commentator picks these up, the authors of the article may cry "foul." Occasionally, it has taken us many versions to arrive at a wording that informs readers about the study's limitations without traumatizing its authors. Alternatively, we have given the author a (brief) chance for rebuttal. Although this can make for good theater, it takes up precious journal space, and the format of 1 page per abstract and commentary precludes the extensive airing of views.
As yet, no author has deterred us from publishing an abstract of a study, although one did explore the possibility. We think there are at least 3 reasons why authors cooperate, even when there is some criticism of their work. First, we do not choose studies with fatal scientific flaws, so none is condemned. Second, we take pains to make the abstract an accurate, fair depiction of the author's published article. Finally, when authors disagree with commentaries, we try to acknowledge their conflicting views.
Recruiting commentators—the hitch and the pitch
When we began the first issue of ACP Journal Club, the ranks of commentators were thin in some areas. As a result, our matching process was sometimes an adventure for all concerned. Now we have fleshed out the ranks and know our commentators better, and our matches of article content and commentators' interests have improved. Nonetheless, we still need more commentators, both in general internal medicine and in the subspecialties because of the high volume of some topics (for example, studies of cardiovascular disorders) and the lack of expert commentators for less common topics. For most commentators, the load is only 1 or 2 articles per year (we have more than 200 commentators and abstract slightly fewer than 200 articles annually).
The commentators for ACP Journal Club provide a valuable service for readers. Readers who meet our criteria (see Selecting commentators above) and want to help out are cordially invited to join our team by completing the form on the following page and sending it to us. Nominations of others are also welcome—send us the names and addresses of people you would like to see writing commentaries, and we will approach them.
Identification to be placed at the end of your published commentary:
Name and degrees: _________________________________________
Primary institution: ________________________________________
City and state: _____________________________________________
Year of qualification in internal medicine: ______________________
Complete mailing address:
______________________ Zip Code: ___________________________
Phone: Business ( _______ ) _______ - ____________ (ext. ___________ )
Home ( _______ ) _______ - ______________
FAX: ( _______ ) ________ - ____________
Is your main clinical activity in __General Internal Medicine? __ Specialty? (specify) _____________________________________________
What specific diseases and conditions (aspects of these) are you expert in and willing to comment upon (e.g., diagnosis of alcoholism; adverse GI effects of NSAIDs; hypertension in elderly patients)?
Which of the following are your areas of expertise and interest?
__ Clinical Pharmacology
__ Critical Care
__ Emergency Care
__ Family Practice
__ Infectious Disease
__ Nuclear Medicine
__ Occupational Medicine
__ Palliative Care
__ Physical Medicine and Rehabilitation
__ Primary Care
__ Public Health
__ Respiratory Medicine
__ Travel Medicine
__ Tropical Medicine
__ Alternative Medicine
__ Ambulatory Care
__ Clinical Measurement
__ Clinical Trials
__ Decision Analysis
__ Diagnostic Test Evaluation
__ Health Care Delivery
__ Health Promotion
__ Home Care
__ Hospice Care
__ Medical Informatics
__ Outcome Assessment
__ Patient Education
__ Perioperative Care
__ Preoperative Assessment
__ Prevention and Control
__ Quality of Life
__ Technology Assessment
__ Prognosis/Natural History
__ Quality Improvement
Other relevant information _________________________________________________________________________________________________
MAIL or FAX to: R.B. Haynes, MD, 3H7 HSC, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5 (FAX: 905-546-0401)