Interview with Helena Wang

Helena Wang is Asia Editor of The Lancet.  She is The Lancet’s first point of contact with authors in Asia, building relationships with top researchers and research institutes within the region, and identifying and attracting submissions of the best research.  She also does peer-review manuscripts, including fast track submissions, writes editorials, and develops The Lancet’s presence in China through conferences and themed issues. She oversees the content of Chinese edition of The Lancet. She has published over 30 editorials and 3 commentaries in The Lancet.

Helena Wang holds a Master degree in Medicine from Tongji Medical College of Huazhong University of Science and Technology in China. She has received editorial training at The Lancet London Office and Oxford, and taken European Organization for Research and Treatment of Cancer course on Clinical Trial Statistics in Belgium.

王辉是《柳叶刀》杂志的亚洲主编。她是《柳叶刀》杂志亚洲地区作者的第一联系人,和亚洲顶级研究人员和科研院所建立合作关系,吸引高质量的研究投稿。她同时负责审稿,包括快速提交、撰写社论、并且通过会议和主题期刊推动《柳叶刀》在中国的业务和发展。她负责审查中文版的《柳叶刀》杂志的内容。她已在《柳叶刀》发表了30余篇社论和3篇评论。王辉拥有华中科技大学同济医学院医学硕士学位。她在《柳叶刀》杂志的伦敦办公室和牛津接受过编辑方面的培训,并在比利时接受了欧洲癌症治疗组织的临床试验统计课程。

Yi: The Lancet, the British Medical Journal (BMJ), the Journal of the American Medical Association (JAMA), and the New England Journal of Medicine (NEJM) are known as the big four medical journals. Compared with the other three journals, what do you think is the focus of The Lancet, and when it started to recognize the importance of health issues in China?

潘羿:《柳叶刀》(The Lancet)、《英国医学杂志》(BMJ)、《美国医学会杂志》(JAMA)和《新英格兰医学杂志》(NEJM),并称为“四大医学名刊”。您觉得相比于其他三本杂志,《柳叶刀》的侧重点是什么,从什么时候开始关注中国的健康问题?

Helena:The Lancet is one of the world's oldest peer-reviewed medical journals. It was founded in 1823. What makes it unique among other major medical journals is that The Lancet is not affiliated with any medical association or society but was founded by a surgeon, Dr. Thomas Wakley. As established by Dr. Wakley, the purposes of The Lancet are to inform, to reform, to entertain. In addition, The Lancet pays a great deal of attention on global health issues. Not only does it publish special issues on specific clinical topics such as cardiovascular diseases and diabetes but it also publishes special issues by geographic areas, such as China, India, Japan, Southeast Asia and Brazil. The Lancet is well known and highly respected in China and has published a Chinese version since 2004. The Lancet keeps a close eye on medical research and health care reform in China and has pledged long-term support to health professionals and health care policy reform. Since 2008, we have published three China themed issues. The Lancet China themed issue for 2013 will be published in June. In 2010, The Lancet set up its Beijing office; it already has offices in London and New York.  The position of Asia Editor was established for the first time and the position was based in Beijing China, which is closely related to development and medical research in China and the great support of China's national government on scientific research.  In London office, The Lancet also has two Chinese editors.  In the process, The Lancet's editor-in-chief Richard Horton and several editors from across the Lancet family of Journals visited China regularly, becoming very familiar with China’s medical developments.

王主编:《柳叶刀》于1823年创刊,是世界上最古老的同行评审的医学期刊之一。和其它几个医学名刊不同,《柳叶刀》创刊之初就不隶属于任何医学团体或学会,而是由一个外科医生——Dr. Thomas Wakley创刊。Dr. Wakley创办这本医学期刊的宗旨是: 提供更多的医疗咨询(To inform)、 改变读者的想法(to reform),为读者带来阅读上的喜悦(to entertain)。此外,《柳叶刀》非常重视全球健康的问题,不仅出版心血管疾病、糖尿病等医学相关专刊,还出版以国家地区为主题的特刊——中国专刊、印度专刊、日本专刊、东南亚专刊和巴西专刊等等。《柳叶刀》杂志在中国广为人知,备受推崇,从2004年开始《柳叶刀》中文版在中国出版发行。《柳叶刀》非常重视中国的医学研究和中国医疗卫生制度改革发展,并承诺长期支持中国的医疗工作者和卫生政策改革。2008年以来,我们已经出版了三期中国专刊,2013年的中国专刊会在6月份出版2010年,《柳叶刀》在北京开设除伦敦、纽约之外的第三个办公室,并第一次设立亚洲编辑的职位,并就职于北京办公室。这和医学研究在中国的发展以及中国政府对科技的大力支持密不可分。在伦敦办公室,《柳叶刀》也有两位中国编辑。此外,《柳叶刀》的主编Richard Horton和《柳叶刀》系列的几位执行主编都多次访问中国各大医学院校、研究机构,对中国医学的发展情况非常了解。

Yi:Do you have specific suggestions for researchers from China regarding choice of article topics and research projects? Do you pay special attention to social medicine and health policy?

潘羿:您对于中国作者在文章选题及科研项目有怎样的建议?对社会医学和卫生政策等有没有特别关注?

Helena:My major responsibilities include reviewing submissions from Asia, especially those from China. I am also a member of fast track team, and peer reviewed many research submissions largely submitted from Europe and USA, covering different specialties. (For research papers, which will usually be randomized controlled trials, judged to warrant fast dissemination, The Lancet will publish a peer-reviewed manuscript within 4 weeks of receipt).  Hence, I always asked myself what the major gap of medical research from China is. As I have found, it lies mainly in novelty and methodology. In addition, there are also ethical concerns.

My suggestion is that before starting a study, one needs to do his homework and put together a detailed research protocol. It is not rare in China for researchers to modify their study plans midstream or to not have detailed, specific plans at all.  In terms of research methods, we will give priority to randomized controlled clinical trials, especially multi-center studies. We will also consider the generalizability of the results of the randomized controlled trials.

With respect to the research topics, I’d suggest that Chinese scientists think about whether and how their research can change clinical practice, whether the study will be scientifically meaningful, and whether their findings will have an impact on China's health policy and global health policy. Before they start their clinical research, clinicians should be familiar with research methods, and understand the essential concepts of randomized controlled studies, cross-sectional studies, case control studies, cohort studies etc. They therefore can decide if the study design is appropriate for the question they hope the clinical study to answer. It is best, at the beginning of clinical research, to consult biostatisticians about their research design such as power calculation and sample size. Researchers from China also need to think about their own research within a broader context, emphasizing the global significance and influence of their own research.

Many physicians believe that medical journals publish only articles about complex research. Therefore, they are surprised when they see that The Lancet also reports news and provides perspectives. In fact, The Lancet also serves as medical news media. Dr. Wakley proposed to entertain when he founded the journal, which means the journal should be interesting to read.  Aside from research articles in the red sections, The Lancet also has a blue section (Comment, World Report, Perspectives, Correspondence, etc), and a green section (Seminars, Reviews, Series, Viewpoints, etc). You can even read movie/book/exhibition reviews in The Lancet. Overall, the content of The Lancet is very comprehensive.

The Lancet will consider any original contribution that advances or illuminates medical science or practice, or that educates or entertains the journal's readers. Health policy and social medicine are indeed important areas and we have much contents in these areas. Our selection of articles is based on the significance and impact of the article on health policy. Of course, we hope that rigorous scientific research is used to evaluate policies.

王主编:我的主要工作职责包括审理来自亚洲,尤其是中国的投稿。同时作为快速通道小组的成员,我也评审很多来自于欧美地区、涵盖多个研究领域的稿件。 (对于某些科研文章,通常是有对照组的临床试验,经过评审为保证其快速发表,《柳叶刀》能在收到投稿的四周之内发表同行评论版。) 所以,我自己也经常思索与欧美地区的来稿相比,中国的医学研究究竟有哪些差距我发现,差距主要在于中国临床研究的方法学和创新性方面。此外,医学伦理方面也有一些问题。

我的建议是在研究开始之前,必须要做足功课:也就是要有详细的研究方案(protocol)。因为国内有些研究,是一边做,一边在修改方案,或者是有研究方案,却非常不详尽、具体。其次,我们杂志对于研究方法更倾向于随机对照临床试验,特别是多中心的研究,这样的研究结果,更具有推广性。

关于研究课题的选择,我建议中国的科研工作者思考如下问题:我的研究是否能改变临床实践、如何影响临床实践、是否有多学科的意义、对中国乃至全球卫生政策是否会有影响。开展研究之前,临床工作者应当熟悉研究方法,理解随机对照临床研究、横断面研究、病例对照研究、队列研究等相关概念。最好在开始临床研究时,就研究设计咨询一下医学统计学专家,比如统计学功效和样本量的计算。中国作者还需要有更广阔的全球视野,也就是将自己的研究放在全球研究的背景中,思考自己的研究的意义和影响力。

很多中国医生认为医学杂志只刊登方法学复杂的学术论文。因此,当他们看到《柳叶刀》上还有关于医学新闻报道和时事评论时,感到惊讶。其实,《柳叶刀》作为一本医学期刊, 也有新闻性质。而且,在创刊之初,Dr. Wakley就提出过,“为读者带来阅读上的喜悦”(to entertain),也就是一本医学期刊,也应该让它的读者读起来觉得有趣。除了红色部分的研究文章,《柳叶刀》杂志也有一个蓝色的部分(评论,世界报告,展望,通讯等),绿色部分(研讨会,评论,系列,观点等)。你可能还会注意到我们还刊发影评和书评。总体而言,《柳叶刀》杂志的内容非常全面。

《柳叶刀》杂志将考虑任何原创性推动或普及医学实践的贡献,以及教育或娱乐读者的内容。卫生政策和社会医学确实是重要的领域,在这些领域,我们有很多的内容。我们选择的文章是基于对卫生政策的意义和影响。当然,我们希望使用科学严谨的研究来评估政策。

Yi:Do you have any suggestions for researchers from China who are writing papers?

潘羿:您对中国作者文章写作有什么建议?

Helena:First of all, some Chinese authors pay too much attention to language polishing. Although language use is important, research methods, novelty, and impact on clinical practice and policy are more important. Second, many Chinese authors do not seem to read the journal’s “Information for Authors” before submitting their papers. Instead, they focus on the journal’s impact factor but have rarely read articles published in their targeted journal and also do not know the specific requirements for submission. Submitting to a journal under those conditions is likely a waste of time. Third, authors from China need to pay more attention to available guidance and protocols. For example, reports of randomized controlled studies should comply with the CONSORT Statement (http://www.consort-statement.org), and reports of observational studies should follow the STROBE Statement (http://www.strobe-statement.org). The guidelines can help the authors to be clear about what to write for each section in their papers. Finally, I suggest authors to pay more attention to writing their abstracts. Often, editors will focus on reading the abstract first. However, in many cases, Chinese authors do not follow the format of the abstract (which includes Background, Methods, Findings, Interpretation and Funding) or do not even write an abstract for their manuscript.

王主编:首先,我觉得中国作者过于纠结语言的问题。但我想强调的是,语言虽然重要,但更重要的还是研究方法、创新性和结论对于临床实践和政策的影响。第二,很多中国作者投稿时,从来都没有读过我们的投稿指南,很多作者只从影响因子的角度来投稿,但很少去读我们的杂志,也不知道杂志对于投稿的具体要求和文章的倾向性在哪里。这样盲目的投稿,很有可能浪费了作者自己的时间。第三,中国作者可以多注意写作相关的指南,来指导自己医学论文的写作,比如RCT 应该遵照CONSORT 声明(http://www.consort-statement.org), 观察性研究可以遵照STROBE 指南(http://www.strobe-statement.org)来写作。这样在写作的时候,会很清楚每个章节需要撰写哪些内容。最后,我还是希望大家注意摘要的撰写,很多时候,编辑会重点读摘要,但可能根据摘要的内容决定到底是否详细阅读全文。很多时候,大家也不注意摘要的格式(包括背景、方法、结果、讨论和资金来源),甚至连摘要都没有写。

Yi:What special services do The Lancet provide to authors, including those outside China, such as fast-track publication? A second chance to have the paper reviewed? Could you give us more details?

潘羿:《柳叶刀》提供给作者的特别服务包括哪些?比如快速通道,比如第二次评审机会?能详细介绍一些吗?

Helena:We have already discussed the importance of the protocol in a study design.  Chinese believe that a good beginning is half way to success. The Lancet provides protocol review, which will consider protocols of all types of research. For those protocols of studies that the editors consider likely to change practice, we will arrange peer-review. If accepted, The Lancet does not publish the protocol, but will post a summary on the journal website and will make a commitment to seek peer review of the resulting paper that reports the primary clinical data.

The Lancet publishes a weekly general medical journal and six monthly specialty journals in the fields of oncology, neurology, respiratory medicine, infectious diseases, diabetes &endocrinology, and global health. If a paper is considered specialized for the weekly general medical journal, it might be shown to the specialty journals to consider. Therefore, papers submitted to The Lancet might be considered twice: in the weekly journal and in a specialty journal.

The Lancet has a press office. When an article is accepted by The Lancet, we may also organize a press release with major international media outlets to promote the research coverage globally.

For research papers that are considered eligible for fast track, which usually are randomized controlled trials, The Lancet will publish a peer-reviewed manuscript within 4 weeks of receipt. Systematic reviews of randomized trials about diseases that have a major impact on human health also might warrant rapid peer review and publication.

王主编:我刚才强调过试验方案的重要性。中国人也有句话说好的开始是成功的一半。《柳叶刀》有专门的方案评审,适用于所有类型的研究。如果我们对认为某项研究有可能对医学实践带来重大改变,我们会组织外审。如果一旦被我们接受,我们不会刊登这个方案,但是会在杂志网站上登载一个方案的概况并承诺对于这项研究的主要临床研究数据会组织外审。

因为《柳叶刀》除了每周出版的医学杂志,下面还有六个每月发行的子刊,分别为感染病、呼吸、神经、肿瘤、糖尿病和全球健康,所以当《柳叶刀》觉得文章过于专业时,会向各个子刊推荐,所以对这些领域的文章,实际上投到《柳叶刀》就可能有两次机会被总刊和子刊考虑。

《柳叶刀》还有新闻办公室。如果作者的文章一旦被《柳叶刀》接受,我们还可能组织新闻发布,向世界上各大重要媒体,广泛发布重要研究的进展。

如果文章研究结果需要尽快发布,这种情况多见于临床随机对照试验,我们的快速通道,会保证文章在四周内接收。对于临床随机对照试验的系统综述,而且这种综述可能对人类疾病健康产生重大影响的话,我们也会提供快速通道的审稿流程。

Yi:How should authors prepare a cover letter? What should they keep in mind when requested to revise and resubmit their manuscript? Could you give us an example based on your personal experience?

潘羿:投稿时投稿信(cover letter) 的重要性以及应该如何写?如果返回修稿应有什么对策?您能否结合您的经历,给我们举一些实际的文章投稿的例子?

Helena: The cover letter is another opportunity to communicate with the editor in addition to the paper itself. In a cover letter, you can tell the editor why The Lancet is the proper journal to consider your paper. Also if your study had been or will be presented in any major international conferences, please inform the editor as well. If you think that there are any particular reviewers who might have a conflict of interest to review your paper, you should let the editor know in your cover letter. If your paper has been rejected by other journals, I suggest that you be transparent about it in your cover letter. If the manuscript is returned for revision, it is best to address the reviewers’ comments point by point in detail in the main text and make any necessary changes in the text to address their concerns. It has been my experience that some authors only answer the reviewers’ questions but do not revise their paper accordingly. In addition, if the authors do not agree with a reviewer's point of view, they should be polite in their rebuttal and support it with relevant references.

王主编:投稿信(cover letter)是除去论文之外,另外一个宝贵的和编辑交流的机会。所以在投稿信里可以告诉编辑,为什么你觉得要投到《柳叶刀》(或《柳叶刀》是合适的目标杂志), 还有如果你的文章曾经或将要在一些国际性的重要学术会议上做过专题报告,这个时候告诉编辑。第三,如果你觉得那些审稿人,和你的研究有利益冲突,不适合做这篇文章的审稿人,也可以在投稿信中和编辑说明情况。第四,如果曾经有被其他杂志拒稿的经历,我建议尽量公开透明的告诉编辑。如果稿件有修稿的机会,那么要尽量抓住这个宝贵的机会,全面回答审稿人的问题,并且在文中做相应的修改(我曾经碰到只回答问题,不在文中做任何改动的中国作者),此外,作答时如果不同意审稿人的观点,也需要客气礼貌提出你的反驳,最好是有相关的参考文献来支持你的反驳的正确性。

Yi: How does The Lancet choose reviewers, especially when the paper is from Chinese researchers?

潘羿:《柳叶刀》是怎样挑选审稿人,特别是针对中国作者的文章的审稿人机制?

Helena: For papers about original research, we will pick at least three clinical reviewers and a statistician. For papers from Chinese authors or focusing on Chinese issues, if we decide to send them out for external peer review, we also try to invite an expert from China. In addition to choosing from our database of reviewers, The Lancet may also invite scientists who published similar studies in the same professional disciplines to serve as reviewers. And we also ask the reviewers to disclose their own conflicts of interest.

王主编:对于原创性论文的审稿,我们会挑选三个专业审稿人,和1个统计学家,对于中国作者的投稿和关注中国问题的投稿,如果我们决定送外审,我们也会希望加入一个中国的专家来审理。对于挑选审稿人,我们除了自己有一个审稿人的数据库之外,还可能去挑选在本专业学科里发表过类似研究的科研工作者作为审稿人,我们在邀请审稿人时,也会让他们申明自己的利益冲突。

Yi:As the Asia editor of The Lancet, what do you want to say to Chinese authors and medical researchers?

潘羿:您作为《柳叶刀》的亚洲主编对于潜在的中国作者和医学研究者有什么寄予呢?

Helena:I am glad that researchers from China have made rapid progress in study design and scientific writing. In addition, the Chinese government provides strong support to research. But I would like to see authors from China learn more about the rules and requirements of submission to international journals, read more published journal articles before they submit papers, and stop focusing on a journal's impact factor. I look forward to the day when China leads the world not only in research quantity, but also in quality.

王主编:我觉得可喜的是中国作者在研究设计和文章撰写时都进步很快,国家也很重视科研,但我希望中国作者能更多了解国际期刊投稿的规则和要求,去阅读杂志已经发表的论著,再有的放矢的投稿,而不仅仅停留在杂志的影响因子上面。我也期待着有一天中国的科学研究论文不仅仅数量上领先于全世界,也要在质量上领先。

Prof. Qiang Sun (Shandong University): What do authors need to pay attention to when submitting a paper on health policies to The Lancet? Does it have to be studies on large samples?

孙强 (山东大学):卫生政策方面的研究文章向《柳叶刀》投稿时,需要注意什么? 必须是大样本的研究?

Helena:We prefer rigorous research methods and original conclusions, and ideally, we want the study to have the potential to change health policies. Large sample size does not necessarily guarantee good research. The sample size should be adequate to address the clinical questions.

王主编:如果是卫生政策原创性研究,我们还是倾向于严谨的科研方法和创新性的结论,看这个研究是否能改变医疗卫生政策。大样本不一定代表了好的研究。样本无论多少,最重要足够能回答你的研究问题。

 Qiang:With regards to the Chinese health care system especially in the area of health policy, what is The Lancet most interested in?

孙强:《柳叶刀》杂志在中国卫生系统,特别是卫生政策领域关注的主要问题有哪些?

Helena:The Lancet is interested in a variety of different aspects such as the Chinese health care reform, universal health insurance coverage, and the burden of disease in China.

王主编:我们关注的面很广,比如中国的医改、全民医疗保险和疾病负担。

By Yi Pan, PhD, Emory University
潘羿,博士,艾默里大学

 Helena Wang

Helena Wang