Preventive Medicine 67 (2014) 311–312
Contents lists available at ScienceDirect
Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed
Editorial
Striving for excellence while adapting to change: Redefining our mission of serving the preventive medicine community
As we prepared for the launch of a new journal, Preventive Medicine Reports (PMR), we asked Professor Olli S. Miettinen to write candidly and provocatively on what he thought was the mission of preventive medicine. Actually, we could have left these adverbs out in our invitation to him; a ‘candid and provocative Miettinen’ is a tautology. Miettinen's writings exude candor and elicit intellectual discomfort. The latter comes from his erudite and probing narrative with its ostensive revisionism of what many readers of Preventive Medicine consider as concepts and principles written in stone. As Preventive Medicine and its offshoot scholarly companion PMR begin to be published in parallel at the end of the summer of 2014 it is only fitting that we begin our own assessment of the editorial vision we want to impart to both journals. Professor Miettinen's body of work and public persona are uniquely impressive. The epidemiology and biostatistics toolbox and how it produces the knowledge base used in preventive medicine have been the focus of Miettinen's attention for nearly 50 years. His scholarly work from the late 1960s and culminating with the publication of ‘Theoretical Epidemiology’, his 1985 textbook (Miettinen, 1985), brought together the theory and underlying mathematics that gave birth to what became known as modern epidemiology (Morabia, 2004). Miettinen is credited with having developed the mathematical underpinnings for the notion of incidence density sampling, which underscored the soundness of the case–control study as a sampling strategy within an underlying cohort and provided a unified framework for risk ratio estimation (Miettinen, 1976). He provided a cogent formulation for our understanding of confounding and effect modification (Miettinen, 1972, 1974a) and developed a handy by-product of the risk ratio, the population attributable risk (Miettinen, 1974b), a measure of great value to policymakers in setting empirically valid targets for disease prevention and control. The latter four contributions and others related to study design, selection of controls, statistical comparison of rates, and a variety of estimation problems are classics that have greatly inspired subsequent thinking by other giants of epidemiologic theory and methods. Over time his writings became more complex and acquired a tinge of feistiness, as he exhibited displeasure with what he viewed as inappropriate understanding of fundamental principles. Miettinen coined many terms and concepts himself and is opposed to much of the mainstream lexicon of epidemiologists. His insistence on the need for precise technical language comes from his broad epistemological vision of how epidemiology, statistics, medicine, and the scientific method are related in general (Miettinen, 2011a).
DOI of original article: http://dx.doi.org/10.1016/j.ypmed.2014.07.022.
http://dx.doi.org/10.1016/j.ypmed.2014.07.021 0091-7435/© 2014 Elsevier Inc. All rights reserved.
Perhaps, Miettinen's most controversial pursuit is his stance against the medical establishment in what he believes is its enthusiastic and uncritical acceptance of evidence-based medicine and of the randomized controlled trial (RCT) as a tyrannical driver of all medical knowledge (Miettinen, 2011b). He likely started his rebellious beliefs on that topic as an investigator in the Early Lung Cancer Action Project, an observational study of computed tomography screening for lung cancer in which he and his colleagues proposed that the improvement in cure rates from screening relative to the expectation based on the array of risk characteristics of patients should serve as the scientific foundation for evidence of screening efficacy (Henschke et al., 1994). His challenges to the systematic reviews of RCTs of the value of mammography in breast cancer screening are also extremely insightful, provocative, and witty (Miettinen et al., 2002, 2003). Readers may not agree with his avant-garde views and dogmatic posturing ex-cathedra but they will likely be impressed by how well-articulated he advances his nearly utopian logic. Miettinen's guest commentary in this issue of Preventive Medicine (Miettinen, 2014) sets the keynote for what this Editorial Office intends to bring to our journal's readers as backdrop for our mission statement. We recently changed the aims and scope for Preventive Medicine to emphasize our recent trend to offer a collection of articles that are of broader appeal to readers. Our new aims and scope are now stated more ambitiously: “Founded in 1972 by Ernst Wynder, Preventive Medicine is an international scholarly journal that provides prompt publication of original articles on the science and practice of disease prevention, health promotion, and public health policymaking. Preventive Medicine aims to reward innovation. It will favor insightful observational studies, thoughtful explorations of health data, unsuspected new angles for existing hypotheses, robust randomized controlled trials, and impartial systematic reviews. Preventive Medicine's ultimate goal is to publish research that will have an impact on the work of practitioners of disease prevention and health promotion, as well as of related disciplines.” We no longer include in our aims a long list of themes that are of interest to us because we do not believe that Preventive Medicine authors need to be reminded of what specialty or subspecialty topics appeal to their own community. Preventive Medicine is an elite journal, which reflects on the relatively high impact that our papers enjoy in the preventive medicine and public health communities. This reputation comes from being selective and we are becoming ever more so because of the journal's increasing popularity. In 2013 we exceeded
312
Editorial
for the first time 1000 new submissions and we are well on our way to pass the 1200 submissions threshold in 2014, if the present rate is maintained. With the same yearly volume of 12 issues, we inevitably saw our rejection rate increase. Priority, relevance, and novelty became key factors in how we favored manuscripts for publication. To do so, our Montreal editorial office is aided by a stellar team of two associate editors, 39 editorial board members, and nearly 1000 independent reviewers who assess the validity and soundness of the science that flows through Preventive Medicine's submission pipeline. As we strive to attain the high bar set by our revised aims and scope we have gradually become a more general medical journal. Most papers submitted to Preventive Medicine are of good quality, methodologically sound, and advance technically valid conclusions that deserve to be placed in the public domain without delay. Unfortunately, we can only publish a fraction of what we receive. A majority among the ones receiving our rejection letters represent contributions that appeal to only a subset of practitioners, are of niche interest, may be better suited to a specialty journal, or represent confirmatory research. We frequently agonize over decisions to publish papers. With PMR working in cooperation with Preventive Medicine as the latter's nascent sister journal, we will no longer pass up on the opportunity to publish reports of sound science submitted to us. PMR will be entirely open access and maintained by the same publisher, Elsevier. As such and as expected by Miettinen (2014), Preventive Medicine and PMR will jointly provide a most suitable and credible home to the building blocks of the knowledge base that advance the mission of preventive medicine and health promotion. References Henschke, C.I., Miettinen, O.S., Yankelevitz, D.F.,Libby, D.M.,Smith, J.P., 1994. Radiographic screening for cancer. Proposed paradigm for requisite research. Clin Imaging. 18 (1), 16–20.
Miettinen, O.S., 1972. Components of the crude risk ratio. Am J Epidemiol 96 (2), 168–172. Miettinen, O., 1974a. Confounding and effect-modification. Am J Epidemiol 100 (5), 350–353. Miettinen, O.S., 1974b. Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol 99 (5), 325–332. Miettinen, O., 1976. Estimability and estimation in case-referent studies. Am J Epidemiol 103 (2), 226–235. Miettinen, O.S., 1985. Theoretical Epidemiology. Principles of Occurrence Research in Medicine. Wiley, New York. Miettinen, O.S., 2011a. Epidemiological Research: Terms and Concepts. Springer, Dordrecht, pp. 1–175. Miettinen, O.S., 2011b. Up From Clinical Epidemiology & EBM. Springer, Dordrech, pp. 1–173. Miettinen, O.S., 2014. Reflections on preventive medicine. Prev. Med 67, 313–315. Miettinen, O.S., Henschke, C.I., Pasmantier, M.W., Smith, J.P., Libby, D.M., Yankelevitz, D.F., 2002. Mammographic screening: no reliable supporting evidence? Lancet 359 (9304), 404–405. Miettinen, O.S.,Yankelevitz, D.F.,Henschke, C.I., 2003. Evaluation of screening for a cancer: annotated catechism of the Gold Standard creed. J Eval Clin Pract 9 (2), 145–150. Morabia, A. (Ed.), 2004. A History of Epidemiologic Methods and Concepts. Birkhäuser Verlag, Boston (405 pp.).
Eduardo L. Franco⁎ Gayle A. Shinder Joseph E. Tota Sandra D. Isidean Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada ⁎ Corresponding author at: Department of Oncology, McGill University, 546 Pine Avenue West, Montreal, QC, Canada H2W1S6. E-mail address: [email protected] (E.L. Franco).
Contents lists available at ScienceDirect
Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed
Editorial
Striving for excellence while adapting to change: Redefining our mission of serving the preventive medicine community
As we prepared for the launch of a new journal, Preventive Medicine Reports (PMR), we asked Professor Olli S. Miettinen to write candidly and provocatively on what he thought was the mission of preventive medicine. Actually, we could have left these adverbs out in our invitation to him; a ‘candid and provocative Miettinen’ is a tautology. Miettinen's writings exude candor and elicit intellectual discomfort. The latter comes from his erudite and probing narrative with its ostensive revisionism of what many readers of Preventive Medicine consider as concepts and principles written in stone. As Preventive Medicine and its offshoot scholarly companion PMR begin to be published in parallel at the end of the summer of 2014 it is only fitting that we begin our own assessment of the editorial vision we want to impart to both journals. Professor Miettinen's body of work and public persona are uniquely impressive. The epidemiology and biostatistics toolbox and how it produces the knowledge base used in preventive medicine have been the focus of Miettinen's attention for nearly 50 years. His scholarly work from the late 1960s and culminating with the publication of ‘Theoretical Epidemiology’, his 1985 textbook (Miettinen, 1985), brought together the theory and underlying mathematics that gave birth to what became known as modern epidemiology (Morabia, 2004). Miettinen is credited with having developed the mathematical underpinnings for the notion of incidence density sampling, which underscored the soundness of the case–control study as a sampling strategy within an underlying cohort and provided a unified framework for risk ratio estimation (Miettinen, 1976). He provided a cogent formulation for our understanding of confounding and effect modification (Miettinen, 1972, 1974a) and developed a handy by-product of the risk ratio, the population attributable risk (Miettinen, 1974b), a measure of great value to policymakers in setting empirically valid targets for disease prevention and control. The latter four contributions and others related to study design, selection of controls, statistical comparison of rates, and a variety of estimation problems are classics that have greatly inspired subsequent thinking by other giants of epidemiologic theory and methods. Over time his writings became more complex and acquired a tinge of feistiness, as he exhibited displeasure with what he viewed as inappropriate understanding of fundamental principles. Miettinen coined many terms and concepts himself and is opposed to much of the mainstream lexicon of epidemiologists. His insistence on the need for precise technical language comes from his broad epistemological vision of how epidemiology, statistics, medicine, and the scientific method are related in general (Miettinen, 2011a).
DOI of original article: http://dx.doi.org/10.1016/j.ypmed.2014.07.022.
http://dx.doi.org/10.1016/j.ypmed.2014.07.021 0091-7435/© 2014 Elsevier Inc. All rights reserved.
Perhaps, Miettinen's most controversial pursuit is his stance against the medical establishment in what he believes is its enthusiastic and uncritical acceptance of evidence-based medicine and of the randomized controlled trial (RCT) as a tyrannical driver of all medical knowledge (Miettinen, 2011b). He likely started his rebellious beliefs on that topic as an investigator in the Early Lung Cancer Action Project, an observational study of computed tomography screening for lung cancer in which he and his colleagues proposed that the improvement in cure rates from screening relative to the expectation based on the array of risk characteristics of patients should serve as the scientific foundation for evidence of screening efficacy (Henschke et al., 1994). His challenges to the systematic reviews of RCTs of the value of mammography in breast cancer screening are also extremely insightful, provocative, and witty (Miettinen et al., 2002, 2003). Readers may not agree with his avant-garde views and dogmatic posturing ex-cathedra but they will likely be impressed by how well-articulated he advances his nearly utopian logic. Miettinen's guest commentary in this issue of Preventive Medicine (Miettinen, 2014) sets the keynote for what this Editorial Office intends to bring to our journal's readers as backdrop for our mission statement. We recently changed the aims and scope for Preventive Medicine to emphasize our recent trend to offer a collection of articles that are of broader appeal to readers. Our new aims and scope are now stated more ambitiously: “Founded in 1972 by Ernst Wynder, Preventive Medicine is an international scholarly journal that provides prompt publication of original articles on the science and practice of disease prevention, health promotion, and public health policymaking. Preventive Medicine aims to reward innovation. It will favor insightful observational studies, thoughtful explorations of health data, unsuspected new angles for existing hypotheses, robust randomized controlled trials, and impartial systematic reviews. Preventive Medicine's ultimate goal is to publish research that will have an impact on the work of practitioners of disease prevention and health promotion, as well as of related disciplines.” We no longer include in our aims a long list of themes that are of interest to us because we do not believe that Preventive Medicine authors need to be reminded of what specialty or subspecialty topics appeal to their own community. Preventive Medicine is an elite journal, which reflects on the relatively high impact that our papers enjoy in the preventive medicine and public health communities. This reputation comes from being selective and we are becoming ever more so because of the journal's increasing popularity. In 2013 we exceeded
312
Editorial
for the first time 1000 new submissions and we are well on our way to pass the 1200 submissions threshold in 2014, if the present rate is maintained. With the same yearly volume of 12 issues, we inevitably saw our rejection rate increase. Priority, relevance, and novelty became key factors in how we favored manuscripts for publication. To do so, our Montreal editorial office is aided by a stellar team of two associate editors, 39 editorial board members, and nearly 1000 independent reviewers who assess the validity and soundness of the science that flows through Preventive Medicine's submission pipeline. As we strive to attain the high bar set by our revised aims and scope we have gradually become a more general medical journal. Most papers submitted to Preventive Medicine are of good quality, methodologically sound, and advance technically valid conclusions that deserve to be placed in the public domain without delay. Unfortunately, we can only publish a fraction of what we receive. A majority among the ones receiving our rejection letters represent contributions that appeal to only a subset of practitioners, are of niche interest, may be better suited to a specialty journal, or represent confirmatory research. We frequently agonize over decisions to publish papers. With PMR working in cooperation with Preventive Medicine as the latter's nascent sister journal, we will no longer pass up on the opportunity to publish reports of sound science submitted to us. PMR will be entirely open access and maintained by the same publisher, Elsevier. As such and as expected by Miettinen (2014), Preventive Medicine and PMR will jointly provide a most suitable and credible home to the building blocks of the knowledge base that advance the mission of preventive medicine and health promotion. References Henschke, C.I., Miettinen, O.S., Yankelevitz, D.F.,Libby, D.M.,Smith, J.P., 1994. Radiographic screening for cancer. Proposed paradigm for requisite research. Clin Imaging. 18 (1), 16–20.
Miettinen, O.S., 1972. Components of the crude risk ratio. Am J Epidemiol 96 (2), 168–172. Miettinen, O., 1974a. Confounding and effect-modification. Am J Epidemiol 100 (5), 350–353. Miettinen, O.S., 1974b. Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol 99 (5), 325–332. Miettinen, O., 1976. Estimability and estimation in case-referent studies. Am J Epidemiol 103 (2), 226–235. Miettinen, O.S., 1985. Theoretical Epidemiology. Principles of Occurrence Research in Medicine. Wiley, New York. Miettinen, O.S., 2011a. Epidemiological Research: Terms and Concepts. Springer, Dordrecht, pp. 1–175. Miettinen, O.S., 2011b. Up From Clinical Epidemiology & EBM. Springer, Dordrech, pp. 1–173. Miettinen, O.S., 2014. Reflections on preventive medicine. Prev. Med 67, 313–315. Miettinen, O.S., Henschke, C.I., Pasmantier, M.W., Smith, J.P., Libby, D.M., Yankelevitz, D.F., 2002. Mammographic screening: no reliable supporting evidence? Lancet 359 (9304), 404–405. Miettinen, O.S.,Yankelevitz, D.F.,Henschke, C.I., 2003. Evaluation of screening for a cancer: annotated catechism of the Gold Standard creed. J Eval Clin Pract 9 (2), 145–150. Morabia, A. (Ed.), 2004. A History of Epidemiologic Methods and Concepts. Birkhäuser Verlag, Boston (405 pp.).
Eduardo L. Franco⁎ Gayle A. Shinder Joseph E. Tota Sandra D. Isidean Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada ⁎ Corresponding author at: Department of Oncology, McGill University, 546 Pine Avenue West, Montreal, QC, Canada H2W1S6. E-mail address: [email protected] (E.L. Franco).
