Editorial| Volume 19, ISSUE 4, P383, October 2006

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A Letter of Rejection

      In the past six months or so we have had a spurt in manuscript submissions to the JHT. This is great news, but it is tempered by the fact that I have had the misfortune to have to write more rejection letters than ever before…not an enjoyable task for an editor. As this issue's editorial I have decided to share one such letter with you, as I believe it is illustrative of common pitfalls many of us make when trying our hand at scientific writing. I share it with you as a potential learning experience, not to appeal to your prurient interest in seeing somebody else get slammed. I have edited out any reference to the actual topic and substituted XYZ to protect the author. The following is the letter sent to the author (fictitiously named George):
      JHT MS #1000, second revision, Letter to Author:
      After two rewrites with the feedback from three different reviewers, it is time for an editorial decision, which the author(s) deserve, given the great time and effort put into this large paper.
      George, your passion for your topic is evident, as is your hard work. However, so is your inexperience as a scientific writer. There is much too much verbiage all over this paper. For example, you go into great lengths about the dangers to patients who have diminished sensibility. We all know that. It would be sufficient to say since we have demonstrated a relationship between XYZ and diminished sensation, it is evident that clinicians treating XYZ should evaluate sensation, and if a loss is found, counsel the patients on the usual precautions. One sentence, done. You need to stick to your topic, which is the relationship (or not) of XYZ to improved sensation and/or grip strength.
      Your Conclusion section, always one of the most important pieces, is not well done. You refer to indirect relationship between factors. That is not scientific language. What is the relationship, exactly? Can it be expressed in numeric terms? Same with the direct relationship referred to. What is the relationship? Did you find that for every unit in XYZ reduction, there was a 2-pound increase in grip strength? You need to express what you found with numbers. You can't simply say that as XYZ improved, so did grip and sensation.
      You have made a complete section on Clinical Implications. It belongs in Discussion.
      You have not made the case that the improvement in sensation is the result of improved XYZ. One of the reviewers suggested that there may be other factors that influenced sensation besides XYZ. That needs to be addressed scientifically. Likewise, the change in grip.
      You talk about ADL difficulties in patients with XYZ. Of course they have difficulties; this is not news. What you don't tell us is what causes these difficulties. Are you suggesting it is diminished sensation, weakness, increased bulk, restricted ROM, or a combination of all of these? I imagine you can't answer that question with your data. Therefore, it has no place in your paper. Again, you are introducing material in a scientific paper that is presented in a way someone might lecture to a class, but not the way it should be written for a journal publication.
      I could go on and on nit-picking about all this stuff, but the real issue is this: lost in all the writing flaws, including grammatical errors, is there a scientific study and data that support a conclusion that is valuable to our readers? I suspect maybe there is, but as it reads right now, I'm having trouble pulling it out.
      I don't know what to tell you. Should you keep trying…by that I mean stick with your data as is and try to present it better…or should you drop it and say that at least it was a learning experience? My gut tells me to offer you encouragement and hope you can find a way to bring this up to speed. If you elect to pursue it, here's my suggestion. Find an experienced author who would be willing to join you in an effort to write a paper that we can accept. You will likely have to offer such a person co-authorship, as it is going to take work. It will not be simple editing. They will have to sit down with you and really get into it to understand what you really have and what you might think you have, but really don't. Only after that critical analysis can they begin to write. I would suggest you deal with this unnamed collaborator from scratch with only method and data collected. Together decide what the results really are, and then let this new person write the paper without trying to use your manuscript.
      This is not the letter you hoped to receive, I know. But it is a common outcome when dealing with our colleagues who are primarily clinicians, not scientific writers. In our seminar Getting Started in Clinical Research, we stress the need to collaborate with an experienced writer to avoid the criticisms I have leveled at you. That is what I am suggesting here. Get some help. You might have something worthwhile. It is certainly relevant and clinically applicable.
      Best of luck and kindest regards, KF