My Five JAMA Papers Fahad Razak Assistant Professor and Internist, - - PowerPoint PPT Presentation

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My Five JAMA Papers Fahad Razak Assistant Professor and Internist, - - PowerPoint PPT Presentation

Feb 12, 2023 333 likes •1.1k views

My Five JAMA Papers Fahad Razak Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li

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SLIDE 1

My Five ‘JAMA Papers’

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

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SLIDE 2

My Five ‘JAMA Papers’

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

  • Okay, I have only published 2 papers in JAMA
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SLIDE 3

My Five ‘JAMA Papers’

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

  • Okay, I have only published 2 papers in JAMA
  • Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine)
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SLIDE 4

My Five ‘JAMA Papers’

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

  • Okay, I have only published 2 papers in JAMA
  • Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine)
  • Paper 4 was accepted by JAMA but published in PNAS
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SLIDE 5

My Five ‘JAMA Papers’

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

  • Okay, I have only published 2 papers in JAMA
  • Paper 3 is JAMA ‘light’ (i.e. JAMA Internal Medicine)
  • Paper 4 was accepted by JAMA but published in PNAS
  • Paper 5 I burned in rage!
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SLIDE 6

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

Attempted

My Five ‘JAMA Papers’

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SLIDE 7

The following presentation represents the views of the speaker
 at the time of the presentation. This information is meant for educational purposes, and should not replace other sources


  • f information or your medical judgment.

Learning Objectives:

  • Recognize hurdles to publishing the results of research

projects.

  • Employ strategies to develop an early research career.
  • Set priorities for a career in research.
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SLIDE 8

Definition: A Conflict of Interest may occur in situations where the personal and professional interests of individuals may have actual, potential or apparent influence over their judgment and actions. “I I have no conflicts to declare”

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SLIDE 9

Outline: 5 Chapters and a Conclusion

Chapter 1 - Never turn down a good lunch. Chapter 2 - Know when to hold’em. Chapter 3 - Know when to fold’em. Chapter 4 - Don’t count your chickens before they hatch. Chapter 5 - Strike while the iron is hot.

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SLIDE 10

Chapter 1 - Never turn down a good lunch

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SLIDE 11

Chapter 1 - Never turn down a good lunch

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SLIDE 12

Chapter 1 - Never turn down a good lunch

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SLIDE 13
  • Published in 2011
  • Core ideas included ‘Prospect Theory’
  • People treat gains and loses in an asymmetric way
  • Point of reference for gain or loss is crucial
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SLIDE 14
  • Published in 2011
  • Core ideas included ‘Prospect Theory’
  • People treat gains and loses in an asymmetric way
  • Point of reference for gain or loss is crucial
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SLIDE 15

Verma AA, Razak F, Detsky AS. Understanding choice: why physicians should learn prospect theory. JAMA :2014;311(6):571-572

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SLIDE 16

Verma AA, Razak F, Detsky AS. Understanding choice: why physicians should learn prospect theory. JAMA :2014;311(6):571-572

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SLIDE 17
  • Never underestimate the potential of academic

arbitrage

Additional thought…

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SLIDE 18

Chapter 2 - Know when to hold’em

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SLIDE 19
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SLIDE 20
  • BMI < 16 = “Severe Thinness” or “Severe

Chronic Energy Deficiency”

  • Though definition was more than 25 years old -

no global prevalence estimate

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SLIDE 21
  • BMI < 16 = “Severe Thinness” or “Severe

Chronic Energy Deficiency”

  • Though definition was more than 25 years old -

no global prevalence estimate

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SLIDE 22

BMI ~ 30 BMI ~ 17

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SLIDE 23

Population* Estimate of Low BMI

Country BMI < 16 BMI <18.5

India 47,366,237 246,070,755 Bangladesh 4,132,985 23,919,079 Pakistan 2,471,033 16,219,371 Ethiopia 1,045,533 11,993,949 Nigeria 873,524 8,613,080 Congo DR 576,923 5,006,620 Madagascar 386,369 2,914,642 Nepal 326,716 2,751,791 Kenya 263,035 2,324,468 South Africa 172,865 1,283,787 Senegal 160,801 1,200,668 Tanzania 142,644 2,391,611 Uganda 134,402 2,004,234 Cambodia 119,803 1,601,906 Burkina Faso 101,286 1,166,840 Niger 98,952 1,049,460

* Calculated from World Bank country population estimate for proportion of population age 15+ that corresponds to survey year

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SLIDE 24

After 3 months of waiting, we heard from JAMA…

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SLIDE 25

After 3 months of waiting, we heard from JAMA…

  • Very positive reviews overall
  • HOWEVER, Reviewer 2 said the following:

“the authors do not have an expert understanding

  • f the current work in the field of undernutrition
  • r in the way the field has changed over time and

do not lend confidence to their ability to make a call for action in this field”

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SLIDE 26

After 3 months of waiting, we heard from JAMA…

  • Very positive reviews overall
  • HOWEVER, Reviewer 2 said the following:

“the authors do not have an expert understanding

  • f the current work in the field of undernutrition
  • r in the way the field has changed over time and

do not lend confidence to their ability to identify the relevant abstracts, let alone make a call for action in this field”

  • Paper was rejected.
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SLIDE 27

So we appealed.

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SLIDE 28

So we appealed.

  • “Our coauthors represent a fairly senior spectrum of

scientists and there was uniform concern about the tone and content of comments from Reviewer 2.”

  • “Given the personal and antagonistic nature of

comments from Reviewer 2, we strongly question whether this reviewer can provide a fully objective and scientific assessment”

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SLIDE 29

Art Slutsky Anura Kurpad SV ‘Subu’ Subramanian Andreas Laupacis Lisa Berkman

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SLIDE 30

JAMA agreed with our concerns

  • Reviewer 2 excluded
  • Paper sent out for additional review
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SLIDE 31

JAMA agreed with our concerns

  • Reviewer 2 excluded
  • Paper sent out for additional review
  • Accepted for publication!
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SLIDE 32

Razak F, Corsi DJ, Slutsky AS, et al. Prevalence of Body Mass Index Lower Than 16 Among Women in Low- and Middle-Income

  • Countries. JAMA:2015;314(20):2164-2171
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SLIDE 33
  • Sometimes, obvious and easy to answer questions

haven’t been looked at.

  • There is a lot of publicly available data out there

you can work on.

Additional thoughts…

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SLIDE 34
  • Sometimes, obvious and easy to answer questions

haven’t been looked at.

  • There is a lot of publicly available data out there

you can work on.

  • Don’t be a jerk when you review someone’s work.

Additional thoughts…

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SLIDE 35

Chapter 3 - Know when to fold’em

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SLIDE 36

Rational Clinical Exam - Does this patient have pulmonary hypertension?

2012

Invited to lead an RCE for JAMA

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SLIDE 37

Rational Clinical Exam - Does this patient have pulmonary hypertension?

2012

Invited to lead an RCE for JAMA

2012

Update literature review (1000s of articles screened, extract data from 43 articles)

2012

Submitted to JAMA

  • asked to do major revision expanding focus from PAH to all pulmonary

hypertension

2013

  • asked to do major revision including echo screening

2014

  • asked to include quality review (QUADAS)

2014, 2015

Resubmit, Resubmit, Resubmit…

2015

Rejected from JAMA

2016

Try lots of other journals - Rejected, Rejected, Rejected.

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SLIDE 38

Rational Clinical Exam - Does this patient have pulmonary hypertension?

2012

Invited to lead an RCE for JAMA

2012

Update literature review (1000s of articles screened, extract data from 43 articles)

2012

Submitted to JAMA

  • asked to do major revision expanding focus from PAH to all pulmonary

hypertension

2013

  • asked to do major revision including echo screening

2014

  • asked to include quality review (QUADAS)

2014, 2015

Resubmit, Resubmit, Resubmit…

2016

Rejected from JAMA

2016

Try lots of other journals - Rejected, Rejected, Rejected.

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SLIDE 39

Rational Clinical Exam - Does this patient have pulmonary hypertension?

2012

Invited to lead an RCE for JAMA

2012

Update literature review (1000s of articles screened, extract data from 43 articles)

2012

Submitted to JAMA

  • asked to do major revision expanding focus from PAH to all pulmonary

hypertension

2013

  • asked to do major revision including echo screening

2014

  • asked to include quality review (QUADAS)

2014, 2015

Resubmit, Resubmit, Resubmit…

2016

Rejected from JAMA

2016

Tried lots of other journals - Rejected, Rejected, Rejected…

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SLIDE 40

Is this worth it?

  • By an order of magnitude, the most work I had

ever put into a paper

  • At each revision, a huge amount of additional work
  • 5 years after we had begun, my own research

interests were moving in a different direction

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SLIDE 41

Is this worth it?

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SLIDE 42
  • Good mentorship is crucial!

Additional thought…

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SLIDE 43

Chapter 4 - Don’t count your chickens before they hatch.

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SLIDE 44

Is violent conflict a barrier to polio eradication?

  • Suspected that violent conflict may

compromise polio vaccination campaigns, allowing ongoing transmission and outbreaks

  • No empirical data to support this.
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SLIDE 45

Dataset

  • Data from 2007 and 2014 on polio

vaccination percentage and polio cases on ∼5.7 million children in Pakistan

  • Measure of insecurity based on conflict-

related security incidents (suicide bombers and drone attacks)

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SLIDE 46
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SLIDE 47

GPEI threshold for herd immunity

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SLIDE 48

Paper Accepted at JAMA!

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SLIDE 49

Paper Accepted at JAMA!

But then…

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SLIDE 50
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SLIDE 51

And then…

  • Our WHO co-authors are forced to

withdraw

  • Publication held due to safety concerns
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SLIDE 52

And then…

  • Our WHO co-authors are forced to

withdraw

  • Publication held due to safety concerns
  • 4 years later…
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SLIDE 53

Verma, A. A., et al. (2018). "Insecurity, polio vaccination rates, and polio incidence in northwest Pakistan." Proc Natl Acad Sci U S A 115(7): 1593-1598.

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SLIDE 54
  • Men plan and god laughs.

Additional thought…

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SLIDE 55

Chapter 5 - Strike while the iron is hot

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SLIDE 56

GENERAL MEDICINE INPATIENT INITIATIVE

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SLIDE 57
  • in 2015 we started building a network to link

and harmonize electronic clinical data from hospitals

GENERAL MEDICINE INPATIENT INITIATIVE

is developing actionable data and analytics to improve GIM hospital care

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SLIDE 58

Laboratory – Biochemistry Hematology Radiology Cardiology Administrative Data (CIHI) Admission Discharge Transfer System Pharmacy Laboratory - Microbiology Transfusion Medicine

Quality Checking Cleaning Harmonization

GEMINI Data

Data Collection

N = 240,00 Admissions 1 Billion+ Data Points

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SLIDE 59

A Research Platform

  • ~35 ongoing GEMINI Investigator projects
  • 25 trainee projects
  • Collaborations with >50 researchers including

Infectious Disease, Psychiatry, Nephrology, Vector Institute, Engineers, Computer Scientists and Choosing Wisely Canada

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SLIDE 60

PESIT Study

  • PESIT Study in NEJM in 2016 concludes:
  • “Pulmonary embolism was identified in 17% patients

hospitalized for a first episode of syncope”

  • Does this reflect clinical practice?
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SLIDE 61

Verma AA, Masoom H, Rawal S, Guo Y, Razak F, GEMINI Investigators. Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope. JAMA Intern Med. 2017;177(7):1046-1048

  • In GEMINI 1.4% of patients with syncope had

a PE/DVT versus 17% in PESIT

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SLIDE 62

Conclusion

  • Who cares about JAMA (or NEJM, or the

Lancet, etc.) anyway?

  • Can we even recognize important science in

the moment?

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SLIDE 63

Determining the “importance” of scientific work is fraught!

Professor Thomas Bell, President of the Linnean Society

“The year has not been marked by any of those striking discoveries which at

  • nce revolu:onize the

department of science on which they bear.”

  • Dec 1858
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SLIDE 64

Published earlier that year at the Linnean Society:

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SLIDE 65

Published earlier that year at the Linnean Society:

On the Tendency of Species to form Varieties; and on the Perpetuation of Varieties and Species by Natural Means of Selection

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SLIDE 66

Published earlier that year at the Linnean Society:

On the Tendency of Species to form Varieties; and on the Perpetuation of Varieties and Species by Natural Means of Selection By Charles Darwin and Alfred Russel Wallace

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SLIDE 67

Published earlier that year at the Linnean Society:

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SLIDE 68

When I think about my own papers…

Most cited: Probably why I got into research: The one I got the most excited by: The one that will likely have the most impact on my career:

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SLIDE 69

When I think about my own papers…

Most cited:

  • Obesity and the risk of myocardial infarction in 52 countries.

The Lancet 366 (9497)

Probably why I got into research: The one I got the most excited by: The one that will likely have the most impact on my career:

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SLIDE 70

When I think about my own papers…

Most cited:

  • Obesity and the risk of myocardial infarction in 52 countries.

The Lancet 366 (9497)

Probably why I got into research:

  • Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16)

The one I got the most excited by: The one that will likely have the most impact on my career:

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SLIDE 71

When I think about my own papers…

Most cited:

  • Obesity and the risk of myocardial infarction in 52 countries.

The Lancet 366 (9497)

Probably why I got into research:

  • Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16)

The one I got the most excited by:

  • Association between mean and deviance in 65 countries. BMJ 2018 (362)

The one that will likely have the most impact on my career:

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SLIDE 72

When I think about my own papers…

Most cited:

  • Obesity and the risk of myocardial infarction in 52 countries.

The Lancet 366 (9497)

Probably why I got into research:

  • Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16)

The one I got the most excited by:

  • Association between mean and deviance in 65 countries. BMJ 2018 (362)

The one that will likely have the most impact on my career:

  • Patient characteristics in general internal medicine (GEMINI). CMAJ Open 2017 5(4)
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SLIDE 73
  • Never underestimate the potential of academic

arbitrage

  • Sometimes, obvious and easy to answer questions

haven’t been looked at.

  • Good mentorship is crucial!
  • Don’t underestimate the role of timing, luck and
  • ther factors that are out of your control
  • Work on things that you find interesting

Final thoughts…

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SLIDE 74

Fahad Razak

Assistant Professor and Internist, St Michael's Hospital, Unity Health, University of Toronto Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto Scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Provincial Lead, Quality Improvement in General Internal Medicine, Health Quality Ontario

Attempted

My Five ‘JAMA Papers’