Of writing well the source and fountainhead is wise thinking

[Horace (65BC–8BC)]

Biomedical publication is conceptually very simple. Readers want to read interesting and informative articles. Authors have interesting research or clinical observations they wish to report. Editors want to connect these two groups fairly and efficiently. The problem is of course that most journals, including Liver International, receive far more submissions than can be published, so editors with the help of reviewers (1) become guardians of quality control. Ergo, improving manuscript quality is a goal we share with authors.

This is not a ‘how-to’ manual for writing a paper. That topic is the subject of numerous books and monographs. Those authors who consistently receive comments about ‘poor expression’, ‘difficult to follow’ or ‘poorly organized’ manuscripts, should read such a book – an investment that will surely pay off. Here I offer an editor's ‘insider’ tips to improve your odds of publishing your manuscript. Although these suggestions are specifically geared to Liver International, they are broadly applicable to any journal.

1. Choose the right journal

Browse some recent issues of the journal to see if they publish papers similar to yours. Ask yourself if readers of that journal will be interested in your paper. Some very specialized papers may be better suited for a more focused specialty journal. For example, we recently rejected without review a manuscript comparing two surgical techniques of liver graft reanastomosis, feeling that only a small fraction of our broad readership would be interested in such a technical paper.

2. Writing style: simple is good

(A) Effective writing is direct and simple. Use the active, not passive form. Instead of ‘it has been previously shown by our lab …’, use ‘we previously showed …’. Express the thought in the simplest, most direct way. Instead of ‘drug X induced a decrease in bile flow’, use ‘drug X decreased bile flow’.

(B) Avoid nonstandard abbreviations. Standard abbreviations such as DNA, cAMP, RT-PCR need not be defined and are probably better known than the full term. On the other hand, frequent nonstandard abbreviations hinder readability and save only a negligible amount of text space.

3. English is the ‘Lingua Franca

If you or reviewers/editors think your manuscript is poorly written, there are still options. In many countries where English is not the native language, native-English speakers can be found, often at language schools. For a relatively modest fee, these individuals will help revise the style and grammar of your manuscript. As a research fellow in Paris many years ago, my standard fee for manuscript English revision was a bottle of champagne. Fortunately for my liver, I have moved on to better-paying if gustatorally-less enjoyable endeavours. For those who cannot find local English-speaking help, numerous professional manuscript preparation/revision services are available online, albeit at significantly higher cost.

4. ‘Sell’ your manuscript

In effect, authors should be ‘selling’ their manuscript to editors. You have a product; package it as attractively as possible and convince the ‘buyers’, the editors that your product is worth buying.

(A) Accentuate the positives. Why is your manuscript important and worth publishing? A phrase such as: ‘We believe our study is significant because …’ or ‘For the first time, we demonstrated that …’ should be in every manuscript. A recent submission about hepatic granulomas was almost rejected initially. However, after an online search, we discovered that with >400 cases, it would be by far the largest reported series to date. This had not been mentioned by the authors and was missed by the reviewers. A manuscript is no place for false modesty; if you have done something great, say so!

(B) De-emphasize the negatives. Of course, I don't mean hiding things; just don't dwell on the weaknesses of your paper. If your study is retrospective instead of prospective, mention it once in the methods and don't repeat it. If your study is descriptive and not mechanistic, don't speculate at length about mechanisms, which will only highlight that you did not study any mechanisms.

(C) Clean and polish the product before trying to sell it. You cannot change your data, but you can present it as clearly and attractively as possible. Photos and illustrations should be high resolution and sharply focused. Very complicated figures should be redrawn or if this is not possible, perhaps shown in two figures. Try to eliminate all spelling errors – use the ‘spell-check’ function on the word-processing program. A sloppily prepared manuscript can give the impression, whether justified or not, that carelessness in manuscript preparation is evidence of carelessness while performing the study.

(D) Follow the ‘Instructions to Authors’. Submitting a manuscript that does not conform to the journal's wishes can mean: (i) you could not be bothered to read this, (ii) you are supremely confident that the content of your manuscript outweighs minor flaws such as nonconforming references or (iii) you are careless (see point C above).

5. Avoid common statistical errors

In my view, the three commonest such errors are (i) presuming a normal distribution of data and thus using parametric analyses when a nonparametric analysis would be more appropriate, (ii) failing to adjust or correct for making multiple comparisons when analysing a dataset and (iii) ignoring the concept of significant digits. Fixing the first two items may require a statistician's help, but the third is often a matter of common sense. A recent manuscript showed portal pressure data to two significant digits after the decimal, i.e. 15.68±2.44 mmHg. One significant digit would be correct here.

6. Suggest appropriate reviewers

You can suggest two or more peer reviewers (‘preferred’) when you submit your paper. We know that many authors suggest their friends or at least people who they believe will be charitably inclined towards their manuscript. Studies indicate that reviews from such individuals are generally helpful and insightful, although the decision recommendation from such reviewers, unsurprisingly, tends to be significantly more positive than reviewers selected by the editor. Editors, at least at Liver International, take this into consideration. Your chances of a preferred reviewer being selected improve if they appear to be impartial. For a start, suggest individuals from outside your country.

7. Use the cover letter

The covering letter to the editors should include the usual statements that the work is previously unpublished, not simultaneously submitted elsewhere and that all authors have contributed significantly to and approved the manuscript. I recommend also including a brief paragraph that starts: ‘We believe this manuscript is important because …’ followed by two or three numbered sentences or even bullet-point phrases that summarize the novelty or significance of the paper. Avoid a long explanation here – the editor's eyes will glaze over and it will probably go unread. After all the detailed summary of the work is already in the abstract. But a short note highlighting the importance/novelty of your work helps editors appreciate the value of your manuscript.

8. After the initial decision

So your manuscript has passed the first major hurdle of outright rejection. At Liver International, this means that if you respond appropriately to the decision letter, your manuscript will likely be accepted. It thus behooves you to read the letter very carefully, and respond to all comments. If the letter suggests additional experiments, then if possible, do them. Not doing so usually leads to rejection. The general principle of responding to reviewers' suggestions is to accede to all the minor or major requests and ‘fight back’ on those issues you strongly disagree with. For example, if the reviewer wants Figure 3 deleted and a brief discussion about the possible limitations of the study, do so. However, if the reviewer disagrees with one of your major messages, then contest this point, supporting your position with any available data or references. If you make a convincing argument, editors will often see your point of view, occasionally even ignoring a disgruntled reviewer's recommendation to reject.

9. Learn from rejection

If your manuscript is rejected, learn from this. Some authors simply resubmit the same manuscript, totally unchanged, to another journal. I believe this is wrong. Unless you believe your paper is perfect and the reviewers/editors were complete idiots, take a few days to reflect on the comments and revise your manuscript before resubmitting elsewhere. In the long run, this strategy will improve your overall acceptance rate.


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