Interview with Prof Norbert Lameire

Prof N. Lameire Renal Division Department of Medicine University Hospital Ghent Ghent, Belgium

Prof Zoccali: You are now Editor-in-Chief of NDT. Thanks to the successful efforts of your immediate predecessors Profs Ritz and Drueke, the journal has personality and is very much liked by European nephrologists. Perhaps not having given excessive importance to the Impact Factor has allowed the journal to maintain freshness. What are your plans for the journal?

Prof Lameire: As pointed out in the last Editorial Report edited by Tilman Drueke, the readership of NDT has steadily expanded over the last few years, as shown by increasing subscription rates. Another marker of success is the progressive rise in “hit” rates that have been documented during the time the journal has been accessible on the Internet. Furthermore, NDT has become the leading European journal in the field of nephrology in terms of ‘Impact Factor'. Tilman and Eberhard are to a large extent to be credited and congratulated for these recent achievements. Some academics, and not the least deans of medical faculties, are obsessed with things called “impact factors” that measure how often papers in a journal are cited. Other people make assumptions about the quality of journals, based on a range of items like peer review, whether they have heard of it or not, where it is published, or whatever. An impact factor for a journal attempts to provide a measurment of how frequently papers published in a journal are cited in the scientific literature. It is derived by dividing the number of citations in any one year by items published in the journal in the previous two years. Let me give here an example of the way the impact factor is calculated:

A. total literature citations of items published in a journal in 2004.

B. number of citations in A that refer to articles published in 2002 and 2003.

C. number of articles published in the journal in 2002 and 2003.

As recently discussed in an interesting editorial in Nature (June 23th, 2005), research assessment rests too heavily on the inflated status of the impact factor and I quote: “Impact factors don't tell us as much as some people think about the quality of the science that journals are publishing”. In that editorial it was pointed out that the high impact factor in Nature was to a large extent influenced by a small minority of papers, for example the publication of the mouse genome in 2002. Having said that, it is beyond any doubt that every editor of a scientific journal in his wildest dreams wishes to obtain with his journal the same impact factor as Nature or, more modestly, of the New England Journal of Medicine or the Lancet, to name a few! We should not be distracted too much in NDT by the impact fator, but nevertheless aim at serving our largely clinical readership with excellent papers. If these papers are increasing our impact factor, that's fine, but it should not be our first goal.

Prof Zoccali: Medical journals now transcend the printed page. Films, audiofiles, slide presentations and (accredited) opportunities for continuous medical education are the new territory. What kind of collaboration do you foresee between the parent journal and NDT-Educational?

Prof Lameire: A closer cooperation with NDT-Educational will also be developed. This highly successful electronic web-based journal remains under your capable and stimulating editorship. Many of the very informative case reports that cannot be published in the print version of the journal due to space and cost constraints can be submitted and eventually published on the web via ‘NDT-Educational'. In a step towards making the print version of NDT more useful for teachers and lecturers, the figures published in original articles can now be directly downloaded and incorporated into Power Point presentations and slides with great educational value should probably also be available on the web-based journal. I would also think of a cooperation between NDT-Educational and the print journal in pointing out together papers which could be given accreditation points, whenever accreditation in the European Union will be harmonized.

Prof Zoccali: Perhaps a weakness of speciality journals is that of overemphasising observations in a particular area. Do you believe that these journals should make an effort to maintain an integrated perspective looking also at aspects related with other specialities and at internal medicine in general?

Prof Lameire: In view of the important links that nephrology has with other fields of medicine including transplantation, diabetology, cardiology and hypertension, intensive care medicine and possibly others, we hope to develop a closer scientific cooperation with journals prominent in these fields. We will look for associate editors, who are experts in these various fields, to regularly summarize important advances that may be relevant for nephrologists, but published in non-nephrological specialised journals, which are not always directly accessible to the clinical nephrologist. We propose that such cooperation may be reciprocal and might lead other specialists to pay greater attention to the renal aspects of the systemic diseases they encounter.

Prof Zoccali: Nephrology journals are in a transitional phase and some, like the American Journal of Kidney Disease or the newly born CJASN, are entirely devoted to Clinical Nephrology while others seem to veer towards basic science. Do you think that NDT should make a choice in this respect?

Prof Lameire: NDT is and will remain primarily a clinical journal that aims to provide up-to-date information for the clinical nephrologist that will help him/her in daily practice. It is perhaps no surprise that the two leading publications in nephrology, JASN and Kidney International, have recently decided to introduce more clinically oriented journals to accompany their existing publications. This highlights the growing need for the clinician to be informed of the latest developments that may influence his/her practice. NDT will, of course, continue to publish high quality clinical research, but at the same time will aim to integrate this with the latest developments in basic sciences. Submissions of a more basic nature are therefore strongly encouraged and we hope that the Journal will continue to provide a platform for the widespread dissemination of first-rate laboratory science. We realise that it is virtually impossible for a busy clinician to read highly specialised literature in any great detail and that the journal should help to provide this material in a more readily digestible format.

Prof Zoccali: The ERA-EDTA is now a large and successful society and the characteristics and professional needs of members are very diverse. What plans do you have in order to respond to such a diversified readership?

Prof Lameire: We have indeed a very diverse readership; on one hand the busy clinical nephrologist working in mostly non-university hospitals or even free- standing renal units. On the other, we have the “academic” clinical nephrologist often with an important teaching and training duty and last but certainly not least, we hopefully also have in our readership the basic researcher in the renal field who wants to be informed of the “hot topics” in clinical nephrology. This interesting but very diverse “public” makes it a challenge to bring interesting news to all of them. Jürgen Floege (University of Aachen, Germany) besides his regular editorial tasks, will concentrate on the supervision of a new initiative in order to give our readers insight into the new and more basic developments in fields related to nephrology, such as molecular biology, genetics and biochemistry, to name but a few. We have called this new section “Translational Nephrology” because it should help clinicians to understand new developments in basic research that will hopefully one day help them in their clinical practice. David Wheeler (University College London, UK) will be helping the editor-in-chief to select the best quality clinical papers for publication in the Journal. He will also be responsible for editing the supplements. We are also fortunate that Eberhard Ritz, has agreed to continue his role in supervising the editorial comments, one of the most successful sections in the Journal. His enormous experience and wide range of contacts within nephrology remain real assets for the Journal.

Prof Zoccali: The Internet, electronic communication and the technology of devices for accessing the Web are improving thereliability and easiness of use day by day. For how long do you foresee that paper journals will survive?

Prof Lameire: It has been recognised for many years that the dissemination of information is not the sole function of the scholarly journal literature. The paradoxical survival of this apparently archaic form of literature has depended on its multiple functions, which are essential to the orderly functioning of a scholarly community. The four chief functions are:

• Dissemination of information
• Quality control
• The canonical archive
• Recognition of authors

It should be noted that print journals have a number of advantages: they are permanent, easy to distribute (many copies are stored in many places), scholars trust and understand the system, many print journals have built up prestige over many years and are portable and easy to read. We should however recognize that they also have disadvantages, such as the fact that the refereeing system is not perfect, they are costly to purchase and store, it takes more or less long time delays from submission to publication, they are difficult to index and cross reference, difficult to search, and library budgets are shrinking everywhere, so fewer journals can be bought. The library funding crisis could in principle find a solution through the technology of the Internet. We need to ensure, however, that all four functions of the academic journal are provided for, especially the quality-control and canonical-archive functions. Electronic-only journals, whether paid for or free, must have quality-controlled content that, once published, cannot thereafter be altered by the author or anyone else, other than by a corrigendum that also passes through the editor. This in no way underestimates the value of the Internet for scholarly debate, but it recognises that there is more than one kind of communication that is necessary, if good scholarship and good practice in the professions are to be encouraged. Articles can be put on the Web as soon as they are ready, without having to wait maybe months for a space in a journal issue. Also NDT has now the Advanced Access system and some of the articles are on our web site 2-3 months before they appear in the print version. This means that the information is much more up-to-date than can be achieved with paper. Electronic papers are also easily searchable. Searchability is one of the core advantages of a digital format and the easier it is to find research, the fewer duplicated experiments there will be, resulting in less wasted time. However, this raises the problem of information overload, with information easier to find, there will be much more to read and to keep up-to-date with. Electronic papers are more interactive and the rapid turnaround time means that articles can be read, commented on by the journal's readers, and amended much more quickly than can be done with print. The ease with which e-mail can be sent, or forms filled in means that there can be much greater feedback through the Web. Digital information also has disadvantages, related to the limitations of the computer monitor. This leads to problems with reading, annotation and portability. Although the ideal thing would be to read information from the screen, I think that with printing facilities, this shouldn't be a huge constraint on the development of e-journals, because at the moment most people photocopy library copies of journals before taking them away anyway. In addition, electronic journals are often not included in indexing and abstracting services and archiving can be a problem. Finally, electronic journals could lead to a disadvantage for scholars in Third World countries, however, it is far cheaper for these researchers to get a computer with Internet access rather than subscribe to many journals. In the end, o nce printed, the details of a paper journal remain constant, thus finding them again is straightforward, however, web sites change their URLs or frequently disappear altogether. For the near future, mixed paper and electronic journals are likely to continue.

Prof Zoccali: Transparency and declaration of conflict of interest is at centre stage in the present debate about the ethics of medical communication. How will NDT respond to this problem?

Prof Lameire: An important issue for editors, as well as for authors and reviewers is that of conflicts of interests. In order to avoid, or at least minimise these problems, the Editor-in-Chief of NDT has recently joined the World Association of Medical Editors (WAME).( www.wame.org ). According to this voluntary association, conflicts of interest may influence the judgment of authors, reviewers and editors and are often not immediately apparent to others. Such conflicts may be personal, commercial, political, academic, or financial. Financial interests may include employment, research funding, stock or share ownership, patents, payment for lectures and consultancies. The perception of a conflict of interest is nearly as important as an actual conflict itself, since both may erode trust. WAME recommends that all such interests (or absence thereof) must be declared in writing by authors upon submission of the manuscript and if any are declared, they should be published with the article. As well-known to our readers and authors, this policy has been followed by NDT for many years. In the future, reviewers working on behalf of the Journal will also be asked to routinely declare any competing interests that could affect their judgements. Perhaps of greater importance are the potential conflicts of interest that relate to editors, and members of the editorial board. According to the recommendations of WAME, a summary of the financial and non-financial support that editors receive will be published annually in the Journal. Editors assigned a manuscript in which they may have a conflict of interest will be asked to abstain from reviewing and the manuscript will be passed on to another editor with no conflict. The policies that govern the management of such potential conflicts will be available to readers in the print journal or on the Web. In following the WAME directive, we hope that the transparency and trust that our readers have in the Journal will be enhanced and that we will encourage even more authors and reviewers to work with us.

Prof Zoccali: What is the aspect of your editorial duties that you like most?

Prof Lameire: I very much enjoy the work despite the fact that we receive approximately 6-8 new manuscripts per working day. The aspect I like the most is writing to a (preferably) young author to say that his work is excellent and can be accepted for publication in the journal. Also the collaboration and collegiality between the two associate editors, Eberhard Ritz, the reviewers and myself is excellent and very pleasant.

Prof Zoccali: ... and which one do you least like ...

Prof Lameire: It is not pleasant to have to reply to authors, who most of the time have invested a lot of time and effort in writing a manuscript, that it is not fit for NDT. This decision is always taken in agreement with the subject editor and the reviewers. NDT is so fortunate to have a long list of excellent reviewers, who with their experience and knowledge cover not only the vast area of nephrology but also the interesting aspects of medicine in general, beyond nephrology.

An even more unpleasant task is to respond to rebuttal letters written by disappointed authors whose work has been rejected for publication. Judging by the tone of some of these letters it is now already clear that an Editor-in-Chief very rarely will make a lot of friends!

Prof Zoccali: Will NDT have a new editorial vest?

Prof Lameire: Other planned initiatives will no doubt increase the attractiveness of the journal to its readers. We believe that the journal is now so well-established in its abbreviated form that the full wording of the title is unnecessary and from January 2006 onwards, in agreement with the ERA-EDTA council, the name can be changed to simply NDT. In consultation with our publisher, Oxford University Press, we are also planning a more attractive cover which will list headlines from the issue rather than details of the contents.