ASH News Daily contributor Dr. Jose Bufill sat down with the new editors of Blood, Dr. Bob Löwenberg and Dr. Nancy Berliner, to discuss their vision for the future of the world’s premier hematology journal and what inspires their work.
Q: Congratulations on your new appointments! You’ve inherited a top-notch scientific journal. As non-academic, practicing hematologists, some of us have felt a little “neglected.” Blood might be considered a journal with a basic science slant. My colleagues and I have appreciated recent efforts by Blood editors to offer more articles relevant to clinicians. Will this trend continue in the future?
Dr. Löwenberg: We could debate that Blood is a journal slanted toward basic science. We have a long history publishing traditional randomized and non-randomized clinical trials, observational studies, and interesting meta-analyses that bring value to clinical practice.
Dr. Berliner:Blood has always sought to represent the breadth of hematology and has never aimed at being a pure basic science journal. We will, of course, continue the effort to make clinicians feel more “at home” with what’s in Blood. We will continue to strive to capture the best and most important clinical content. We will also continue popular clinical features, such as the “How I Treat” series. We could go on …
Dr. Löwenberg: A new article format we are developing is the “Spotlight Review,” articles on preclinical and clinical topics that have emerged within the past one to three years, delivered in a condensed and easily accessible format – no more than 2,000 words. We hope this will be attractive to scientists and practicing hematologists alike.
Q: There is no denying that the gap between “bench” and “bedside” is rapidly narrowing. Clinicians need to become much more familiar with complex genetic concepts, and basic researchers should also benefit from closer contact with real-world clinical situations. Would you agree? If so, how can Blood address this need?
Dr. Löwenberg: Indeed. What is in development at the bench today may belong to our practical clinical “backpack” tomorrow. We want to publish high-impact studies, basic and clinical. We are committed to offer this information as quickly as possible and in a variety of formats to enhance their accessibility.
Dr. Berliner: It’s true that what was once a platonic friendship is quickly becoming a marriage. Our subspecialty is a great example of this broad phenomenon, the approximation of basic and clinical sciences.
Dr. Löwenberg: Along these lines, we’re especially excited about the launch of our new “Review Series in Hematology.” We’ve designed it to appeal to both scientists and clinicians. The first series begins next month and deals with Epigenetics and Hematology, presented in six separate chapters published sequentially. We are also planning a “Review Series” on cancer-related thrombotic disease, genome sequencing and its impact on hematology, blood cells in vascular inflammation, and antibody derivatives as new therapeutics for hematologic malignancies, all of which are scheduled for 2013.
Dr. Berliner: Yes, we are sensitive to this issue. Features like “Inside Blood” are intended to capture and interpret the essential take-home messages of important articles in the Journal, presenting them to a general, hematology-literate audience. This is just one example of many.
Q: Some have characterized the growth in scientific knowledge as a “tsunami” or an “avalanche.” How can Blood respond to the ongoing explosion of scientific information? Should there be new journals based on “benign” versus “malignant” hematology under the ASH banner?
Dr. Löwenberg: The reality is that the readership of any scientific journal can always be broken down into groups with varied interests. Blood is no different. We serve a diverse group. Taking this into account, we try to present a continuum of work ranging from pure basic science research to translational research to clinical studies. Blood provides a single hematology umbrella for all these efforts. I feel we occupy a unique and privileged position to deliver cutting-edge scientific and educational information in all these areas. Our “playing field” involves assimilating the latest information that is important to basic and clinical hematologists.
Q: You’ve served on the editorial boards of several journals in the United States and Europe. Do you view the “role” of the medical journal simply as a means to disseminate new information – a neutral platform, so to speak – or as a means to actively educate? Is there a difference?
Dr. Löwenberg: Dissemination and education should go together. What Blood brings to the table should make a difference to our readers. Our content and how it’s presented should help them grow in their understanding of the biology and pathology of hematologic disorders. We aspire to serve Blood readers by offering a resource with information that is right, novel, and impactful.
Dr. Berliner: And I might add, that we want to offer context. When there are differences of opinion regarding a research finding or clinical approach, we’ll try to present both sides and let readers draw their own conclusions.
Q: Dr. Löwenberg, you’ve mentioned the notion of Blood’s “impact” several times in your comments. How do you feel about the “impact factor” and its effect on scientific publishing?
Dr. Löwenberg: I would yield to the expert!
Dr. Berliner: The “impact factor” was originally intended to keep track of how often a journal was requested from a library. Librarians wanted to know how many copies of a journal they needed so that readers would not complain! It seemed to be a good idea at the time. Today it refers to the number of citations a given article receives in other publications. In a sense, it asks: “Do people pay attention to the articles that appear in this journal?” The results never used to be published. It has now acquired a level of importance that requires us to take it seriously. It should be recognized, however, that it is not a good measure of quality, and also that it is subject to manipulation.
Q: What proportion of articles will report original research versus review articles under your tenure?
Dr. Löwenberg: There is no rigid, predefined proportion for this. An issue of Blood may contain from one to three review articles, a special article such as “How I Treat,” plus several original research articles covering any area in hematology.
Q: Do you plan to make changes to the graphics in the journal, both online and in print?
Dr. Löwenberg: Yes, this will be a continuous effort. The developments in digital publishing and readership behavior change so quickly! Currently there are plans to redesign Blood’s website. Blood will launch hubs for related aggregated content that will serve readers with particular common interests (more about this below). Our first two hubs will be concerned with pediatric hematology and thrombocytopenia. The Blood app has been available since 2012 and is actively used. And we will also develop the print journal. I will refer readers to our website, but I should also mention the new look of Blood in print in 2013.
Dr. Berliner: Yes! We’ll continue to draw from the articles for cover art, connecting the cover with the content. Hematology lends itself to beautiful graphics, and the covers are a highlight of the journal. We’ll also add a highlighted box of “key points” appearing next to the abstract that summarize the most important take-home lessons of each article.
Q: Is this an acknowledgment of our shortened attention spans?
Dr. Berliner: Draw your own conclusions …
Q: What are you looking for in articles submitted to Blood? What advice would you give to prospective authors?
Dr. Löwenberg: We are looking for articles that are novel, original, and impactful. Those are the three ingredients, the three legs of the stool. Proportions of each of these ingredients might vary, but this is what we would like to see.
Q: There is stiff competition not only for “eyeballs” but also for quality articles. How can Blood attract high-impact articles and authors?
Dr. Berliner: The best way to attract good articles is to have a good journal. Blood has a very strong reputation as a premier journal with excellent peer review that presents outstanding clinical and basic research. But you are right, competition is increasing. We will recruit outstanding content and emphasize the advantages of publishing in Blood. We have a rapid review process that can offer fast turn-around. In addition, articles accepted to Blood are made available online on a daily basis.
Q: Dr. Löwenberg, will the editorial board of Blood under your tenure reflect this increasing “internationalization” or “globalization” of hematology?
Dr. Löwenberg: While ASH as the publisher and owner is American, Blood as a matter of fact is an international journal. Our readers and authors represent all corners of the globe. The international perspective of the Journal will require a considerable level of active involvement of associate editors and editorial board members from different parts of the world, which we consider essential. I am in fact the first non-American editor-in-chief in an American tradition of more than 60 years. I am convinced that there is considerable and growing interest in Europe, Asia, and South America in Blood. There is great growth potential there!
Q: Will you reach out to more international physicians to serve as editorial board members?
Dr. Löwenberg: The need for an internationalized editorial board is a trend that has been actively initiated by my predecessors at Blood. The treatment approach in a patient with a particular subtype of leukemia is fundamentally identical for patients in America, Asia, or Europe. And scientific knowledge obviously has generic value independent of geography. Blood as the premier journal in hematology by virtue of its role, has acquired a high-profile position as the leading journal of our field. We have just begun to review and revisit various aspects of the role of the editorial board, and in this respect we will also pay attention to the challenge of Blood’s progressively evolving international presence.
Q: People do get sick in the same way around the world, but access to care – to effective medications, to trained physicians and support services – varies widely. How can Blood address the needs of hematologists in developing countries? Is this a priority for you?
Dr. Löwenberg: For Blood this is also a matter of education. The American Society of Hematology through its International Members Committee is actually playing a major role in this area by making Blood available in less privileged areas and by its outreach educational activities. Blood is interested in studies on major health-care issues in other parts of the world, and we will continue to publish interesting reports about hematologic health-care issues in developing countries.
Q: Your experience in medical practice and research spans two continents. Can you contrast the pros and cons of the European and American systems? Are clinical trials easier to carry out one place or the other?
Dr. Löwenberg: In the 70s and 80s of the last century, the major therapeutic clinical trials were conducted in the United States by the leading cooperative groups and major institutions. In the recent decennium there has been a shift toward the major trials being conducted in Europe. The latter trend reflects a highly unfortunate development since clinical trials with adequate enrollment remain a cornerstone for evaluating new diagnostic procedures and novel treatment approaches. This shift is most likely caused by differences in the health-care system that keeps private physicians from referring their patients to institutions that have the required infrastructure and advanced know-how for clinical trials.
Q: Some physicians in the United States are concerned about the growing “centralization” of health-care policy in our country. Should they be? Is centralization of health-care policy a problem or a solution?
Dr. Löwenberg: I grew up in a country where the health-care system is socialized in the sense that it ensures equal access to health care for the citizens and ensures a certain basic quality standard throughout the society of the country. I see that as an advantage. There is however also an economic advantage. In such a regulated system, we spend a smaller health-care budget than the United States does.
Q: Dr. Berliner, your new editor-in-chief works six time zones ahead of you. How will this affect your collaboration? What practical advantages or challenges arise from the time differences?
Dr. Berliner: So far this hasn’t presented much of a problem. I get up early; he seems to often stay up late! Our emails fly back and forth at all hours, and I often forget that we are on separate continents.
Q: What will your role be in editing Blood? How will you and Dr. Löwenberg share the hard work of editorship? How will your responsibilities differ?
Dr. Berliner: On a day-to-day basis, we are both responsible for the triage of new submissions and selecting which associate editor ought to review a given manuscript. We both answer pre-submission inquiries. The rest is a work in progress. I have to say that I’m delighted to partner with Bob in this adventure. We’ve been good friends and colleagues for many years.
Dr. Löwenberg: I am grateful to Nancy for accepting this position. We have been friends for years, and we make a great team!
Q: You’re a teacher working in both laboratory and clinical settings …
Dr. Berliner: I enjoy patient care and research, and the decision to go into academic medicine reflected my desire not to give either of them up. My career has morphed many times over the years, but I have always loved being able to mix research, patient care, and teaching, although the mix has changed over time. Most of all, my passion is mentoring fellows and junior faculty.
Q: Dr. Löwenberg, you too are both a clinician and a scientist in the field of myeloid leukemia. Can you comment on a pivotal experience in your life that moved you to enter the field of medicine? A defining moment or experience?
Dr. Löwenberg: Right after graduating from medical school, I became a PhD student in one of the leading research institutes in Europe in Rijswijk-Rotterdam. These were the pioneering days of experimental hematology. I became excited about the prospects and challenges of the newest developments. This was in the early days of stem cell research – the discovery of spleen colony-forming assay, in vitro colony-forming assays, the media with colony-stimulating activity that contained CSFs – and the very first successes of clinical stem cell transplantation. There was excitement all over the place. My supervisor, Dirk van Bekkum, was involved in one of the first successful human allogeneic bone marrow transplantations in an infant with severe combined immunodeficiency disease. He worked in radiobiologic research and stem cell research. I decided then that I wanted to work at the interface of preclinical research and clinical advances. This is how it happened, and why and how I ended up in hematology.
Q: If not a physician, then what professional work would you have chosen?
Dr. Löwenberg: Probably in any field where I would meet the challenge of innovation and also in a setting where I would be able to work with people. Thus, I could have found myself in another challenging academic area, but perhaps it could also have been as an entrepreneur in business.
Q: Dr. Berliner, can you recall a decisive moment in your life – a person or event – that moved you toward medicine?
Dr. Berliner: Well, I was a comparative literature major in college. But my dad was my hero, and he was a physician-scientist, so I tried to keep options open in case I decided for science rather than the humanities. But I don’t remember a particular moment in time when I decided to take the plunge and apply to medical school.
Q: Was he a hematologist?
Dr. Berliner: Actually, he was a renal physiologist, who was one of the scientists to describe the counter current multiplier system by which urine is concentrated. After serving as the deputy director for science at the National Institutes of Health, he became dean at the Yale School of Medicine.
Q: And you attended Harvard for medicine residency. You were the first woman chief resident there.
Dr. Berliner: But I went to Yale for college and medical school. I was on the Yale faculty for more than 20 years, and my husband still teaches in the School of Architecture there. Yale is family.
Q: Any other comments you might like to make?
Dr. Löwenberg: Blood is a monument, and it is a reference point in the professional life of any hematologist. We are well aware of this inheritance. I am particularly grateful to Cindy Dunbar, my predecessor for the past five years. She and her team have done an outstanding job! While science and medicine are changing profoundly, we are committed to take Blood forward in the interest of our field and serve the hematology community worldwide in the best possible way. We want to improve wherever we can. Therefore, I encourage everyone to get in touch with us. Readers or authors, clinicians or basic scientists, wherever you may live and work anywhere in the world, we want you to share your creative ideas and suggestions about the content and the future direction of our journal! Don’t hesitate to speak out!
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