Mighty journals, mega trials, and modest points.

Sir,

Journal scan is an integral part of the curriculum in academic medical teaching. The emphasis on this aspect is more during the postgraduate training than in the undergraduate training. Most of the students limit themselves in studying the review articles, but the essence of any biomedical journal lies in the research articles. Journal scan helps in keeping updated about the cutting-edge research topics that may help in improving the clinical practice. Biomedical journals are classified into either general category or specialty oriented journals depending on the journal policies. Biomedical journals have been ranked based on their impact factor.[1] The top-ranked medical journals of the world include the New England Journal of Medicine, Lancet, Journal of the American Medical Association, Annals of Internal Medicine, and British Medical Journal. All the major trials in any branch of medicine publish in these journals, which sets the benchmark for the future research.

Our voyage with mighty journals started with an innate desire of seeing our name in the print. The research activities conducted at our hospital did not merit consideration for publication by their editorial boards. A chance observation during the routine journal club presentation in the department identified few points, which were published in these journals.[23] A more rewarding observation was followed a few months later when we questioned the diagnosis of the case presented in the journal.[4] The discussants agreed to the alternate point of view and this consolidated our view that the might is not always right.

There are two major changes in the management of diabetes during the last decade. First is the introduction of gliptins and the second is the mandatory requirement of establishing cardiovascular safety of new antidiabetic drugs by the USFDA. This led to the conduct of many trials establishing the cardiovascular safety of the gliptins. They included EXAMINE with Alogliptin, SAVOR-TIMI with Saxagliptin, and TECOS with Sitagliptin. The medical fraternity was abuzz with a chance finding of increased heart failure with the use of saxagliptin. This has prompted many researchers to look at the data more closely and in comparison with other published gliptin trials. We proposed that one of the possible mechanisms could be due to the altered response to the saxagliptin due to the underlying cardiac autonomic neuropathy.[5] In-depth analysis of the gliptin trials and heart failure data suggest that the observed differences between the molecules are not significant, and the same could have been affected by the coprescription of the angiotensin converting enzyme inhibitors.[6]

The idea of writing this letter is to stimulate our younger colleagues to question the mighty as in the story of David versus Goliath. There are multiple advantages in submitting comments to the authors of the landmark trials. First, this helps in critical analysis of a trial and identifies the bias involved if any. The readers develop the ability to segregate the wheat from the chaff and do not take the conclusion on its face value. Second, this initiates the reader into the art of scientific writing. In the hierarchy of publications, letters to the editor are at the bottom and help in improving the skills of the student in medical writing. Third, this knowledge helps in framing a good research question and conducts the study without any bias. This helps the young researchers to generate robust data, which may advance the science in a particular field.

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Conflicts of interest

There are no conflicts of interest.