The BMJ editors respond
We appreciate the vigour and thoughtfulness of those who have responded to Greenhalgh and colleagues’ open letter and to our editorial. (1,2) We see this exchange of views, and the fact that we are open about our priorities, as very positive things. We’ve listened to the arguments presented, and plan to do two things.
Over the next few months we will be consulting with qualitative researchers to learn more about how we can recognise the very best qualitative work, especially that which is likely to be relevant to our international readers and help doctors make better decisions. In addition, we will shortly issue a formal call for research methods and reporting articles about qualitative research. (3) We hope that proposals for these articles will come from some of the authors of the Greenhalgh et al letter.
Byatt, Smith and Fuller argue that, just as with qualitative studies, findings from randomised controlled trials often are not generalisable either, and that we are being inconsistent in assigning a lower priority to qualitative studies. We agree about the limited applicability of many trials. That’s exactly why The BMJ’s clearly stated policy for more than a decade has been that we are unlikely to publish certain trials, especially placebo controlled trials, and that we give higher priority to comparative effectiveness and pragmatic trials that are done in real clinical practice. Bolland asks why The BMJ continues to publish observational studies with limited generalisability, for example the recent paper on potato intake in pregnancy. We try to choose observational studies that we think have implications for a broad readership and that are methodologically sound. When considering nutritional epidemiology studies we bear in mind important caveats such as those raised by Ioannidis, and we publish only a small proportion of the nutritional studies we receive. (4)
It would be hard to claim that our, or indeed any journal’s, week by week decisions about what to publish are reproducible. But we do aim to publish work that will be both accessed by readers and cited by academics, and we routinely track usage and citations. We now have consistent data, going back a decade or more, showing that qualitative studies are on average less frequently accessed in the first three months after publication (median times accessed=4,975 (Lower Quartile 3,623, Upper Quartile 6,237)) than systematic reviews and/or meta-analysis articles (median=9,272 (Lower Quartile 5,953, Upper Quartile 14,634)). On average they also are much less frequently cited than review articles and some other designs. Because we have fewer than 200 slots for research papers in the journal each year, we have to do all we can to make those count, for patients, clinicians, and the journal. The paradox, as noted by Richard Smith, is that while journals pursue increased citations, researchers pursue publication in high impact factor journals. (5) This is borne out by a qualitative study recently published in BMJ Open. (6) Luckily, The BMJ is not the only journal in the world, and even within the BMJ’s stable of journals, there are several in which qualitative research represents a substantial proportion of published articles: BMJ Open and BMJ Supportive and Palliative Care, to name but two.
In summary, there is not and never has been a ban on qualitative research in The BMJ but nor do we plan to introduce a quota. We are open to and will seek out the very best and most useful qualitative studies and we will continue to publish methodological articles that support good qualitative research.
1. Greenhalgh T, Annandale E, Ashcroft R, et al. An open letter to The BMJ editors on qualitative research. BMJ 352 doi:10.1136/bmj.i957
2. Loder E, Groves T, Schroter S, et al. Qualitative Research and The BMJ. BMJ 352 doi:10.1136/bmj.i641
4. Ioannidis JPA. Implausible results in human nutrition research. BMJ 2013;347:f6698.
6. Tijdink JK, Schipper K, Bouter LM, et al. How do scientists perceive the current publication culture? A qualitative focus group interview study among Dutch biomedical researchers. BMJ Open 2016;6:e008681. doi:10.1136/bmjopen-2015- 008681
Competing interests: TG declares that she is editor-in-chief of and receives salary from BMJ Open, a journal that welcomes qualitative research. EL declares that she is currently participating as a researcher in a qualitative study.