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Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 1-3

Publish or perish

Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India

Date of Web Publication11-Jan-2019

Correspondence Address:
Dr. Anil K Jain
Director Professor and Head, Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi - 110 095
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/isj.isj_74_18

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How to cite this article:
Jain AK, Chadha M. Publish or perish. Indian Spine J 2019;2:1-3

How to cite this URL:
Jain AK, Chadha M. Publish or perish. Indian Spine J [serial online] 2019 [cited 2021 Nov 29];2:1-3. Available from: https://www.isjonline.com/text.asp?2019/2/1/1/249906

“Publish or Perish” is a common phrase heard in scientific community. The literal meaning of perish is “Die, especially in a violent or sudden way,” which evokes fear. In fact truly, nothing of that sort happens in science. Medical publications are keys for self upgradation in career, for growth of science, and for critical analysis of patients and treatment outcomes. They are the keys for evolution and practice of evidence-based medicine (EBM).

Practice of medicine is an artistic application of science. The biological processes in the body (physiological and pathological) are influenced by enumerable factors. The response of human body to inciting agents and intervention by a clinician is variable. Suspecting a diagnosis, performing suitable investigations, and determining drugs/intervention, its volume, and duration of treatment are “the artistic applications of knowledge”. The clinical response to intervention is predictable if the intervention is based on sound research evidence.[1]

The practice of medicine is an art transformed from an art based on belief in supernatural forces to an art based on science. In olden days, the art was learnt by observations of talented physician and by practice. The treatment practices sometimes were more painful than disease itself.[1]

Medicine evolved 3000 years ago in different parts of the world. While modern medicine evolved in Europe and Ayurveda in the Indian subcontinent. Ayurveda was far ahead of Western medicine particularly in surgery around first century A.D. in spite of it being based on erroneous religious and philosophical assumptions.

Modern medicine also evolved from long prescientific stage of development. While publishing journal and recording of case series were documented for the first time in United Kingdom in 1731 A.D. They applied proper scientific principles and discarded old simply superstitious ideas with no genuine medical foundation. Ayurveda never modified clinical practices based on scientific analysis (research), that is why it remained in its original prescientific stage and Western scientific medicine advanced.

Western medicine has advanced to such an extent that it has become synonymous with medicine, while Ayurveda is included as alternative medicine. Medicine is transformed from teacher-disciple linage of olden times to scientific evidence and validated evidence.

Medicine is a biologic science and biology is not stationary; hence, medical science has to evolve. The impact of evolution in medicine is reflected in improved life expectancy from 25 years around 1 A.D. to 45 years in 1900 A.D. and 80 years (in Japan) around 2000 A.D. Few diseases such as smallpox are eliminated and other health indices have also improved.

Whenever we are confronted with a clinical problem, we try to identify the cause of the problem and devise the strategy to treat the clinical situation. The treatment outcome if appraised scientifically will become evidence. The longitudinal collection of evidence on a series of identical clinical problems becomes definite evidence.[1]

The evidence generated can be retrieved beyond human life if it is published in peer-reviewed journals.[2] Summarily, the information life cycle starts with a primary research discovery which is communicated by oral presentation/poster presentation or a lecture. However, if submitted for publication, it is subjected for review by peers and finally gets published. This published report is now available far and wide for others to use the knowledge or becomes the basis of future research/discovery.[2]

Tips and tricks for writing manuscript are:

Subject: One should not search for exotic/rare topics. It should be a day-to-day clinical situation faced because the aim of publication is to provide evidence on most of the clinical problems. Adequate number of identical cases will also be available for research analysis.

The chances of publication are more for a methodically performed study which is written well to be understood by reviewers and editors. All manuscripts submitted to journal are first read by editorial team. Almost one-third of them are rejected at first instance and rest are sent for peer review for a possible publication. So the bottom line is that the article sent for publication must pass through editor's scrutiny. The manuscript addressing the lacunae in the knowledge, giving a clear research question, detailing the variables used to test research question, describing method and statistical tests to evaluate the results, conclusions, as answer to the research question are most likely to pass editor's scrutiny. A study which is well planned and conducted has the best chances of getting accepted for publication.

Choice of a Journal

The prospective author should first choose a journal to send manuscript before deciding to write a manuscript. Few journals have high impact factor but difficult to get an acceptance, while others are with low impact factor and relatively easier to get an acceptance. The authors will have to choose between them either to have a quick publication in low impact factor journal or to have a publication in high impact factor. The decision will be based on the strength of the research work and priority of particular journal. The author must acquaint himself with the instructions to the author and be familiar with content and style. The manuscript written disregarding the instructions to author may not be entertained by journal website and editors.

General Principles of Manuscript Writing

The manuscript should be written in parts. The introduction should frame the story and end with research hypothesis/question. Methods should detail the approach to test the research question. Results should include what was observed, and discussion should include why the said study is so important. The conclusions should end with evidence-based answer to intended research question.


It should be limited to 500–700 words. It should start with background information about the subject and include the current state of knowledge on the intended subject with lacunae in the current knowledge. It should end with research hypothesis/research question including the study design.

Materials and methods

This is the most common cause of rejection. It should be written in a way that anyone who is not connected with the study can perform the study after reading it. Materials are something that are examined. It could be human subjects, animals, tissue preparation or drugs, gases, or any instruments while method denotes how subjects are manipulated.

The description in this section will vary with the types of study such as systematic reviews, meta-analysis, randomized control trials (RCTs), prospective case series, case–control study, and retrospective case series. While writing for experimental work, the approval of institutional animal welfare committee must be mentioned. The complete details about an animal such as sex, weight, strain, age, and its preparation must be described. The preparation of the animal before experimental protocol should be detailed including sedation/anesthesia given for intervention. The route of administration of drugs (anesthetic, antibiotic, and analgesics) must be detailed. How the results are evaluated, must be mentioned. The manufacturer details of materials used must be listed. In case a well-established procedure is used, then reference must be given. However, in case a modified procedure is used, then validation of the procedure must be described. The detailed information about variables used to measure outcome and how they are measured should be listed.

For clinical studies, details of approval of institutional ethics committee should be described. The demographic data should include place and duration of study, design of study, and number of patients. The author must describe if number of patients included are decided after a power study or not. The inclusion/exclusion criteria for enrolling the patients and how the controls were chosen in a case–control study need to be described. In an RCT, it is important to detail the method of randomization adopted. The details about the test/scores used to measure the outcome and their validation must be described. It is important to describe who undertook the measurement (blinded or not). The follow-up protocols need description. The methods section should end with details of the statistical tests used.


This section should be short with 500–700 words. The results should be straightforward, clearly presented with appropriate tables and figures. The facts and figures should match with materials and methods. There should be no mismatch in unilateral/bilateral procedures and number of patients included. The description about lost to follow-up with the reason (died or otherwise) should be given. The table should include the information which is difficult to be described and not the repetition of text.


It is invariably too long. It should be around 1000–1200 words and not more than one-third of the manuscript. This section should evaluate the meaning of results in terms of original research question and point out any biological difference. The present study reported should be related to other studies in literature scientifically.

We should summarize the major finding and possible problems with the method used, compare the results with the previous work, and discuss the clinical and scientific implications. The articles selected for citing should be based on a comprehensive search of literature and not preferential citing of articles, supporting the study outcome. The contrary view from the literature should also be referenced and cited. The error/limitations of the study and possible need for further study need to be detailed. The discussion, in the end, should give a brief concluding paragraph describing the conclusions of the study which should be the answer to research question and based on evidence generated by the data described above. The duplication of data given in result section and preferential citing of already published work must not be done.


This is most commonly read part of the manuscript and should be written in the end. The structured/unstructured abstract depends on the demand of particular journal. The abstract should include (a) purpose of the study, (b) brief statement what was done (c) what was found, and (d) what was concluded. It should be written once whole manuscript is written.


A succinct title which raises a question, evokes an answer or reflects about the type of study should be framed.


References are the foundation of any study/publication. The reference should be chosen before the start of the study and not at the time of writing the manuscript. The reference included must be from standard textbook/monograph and well-accepted and stable electronic sources. No abstract/submitted articles must be referred.

The references are listed as (a) Harvard method and (b) Vancouver method. Harvard method lists references in the alphabetical order which are cited in the text, while in Vancouver method, the first reference cited is listed as the first article in the reference section. Most of the journals now have adopted Vancouver method.


The tables should be included to provide information which is difficult to be described in words. Each table should be numbered with clear title.

Figures and graphs

Graphs, histogram, and illustrations are useful to provide information which is difficult to be understood and presented in words. Graphs are useful to show continuous changes in variables while histogram can depict discrete variables.

In orthopedic and spinal practice, we can provide some information as illustrations of X-rays, magnetic resonance imaging pictures, and line diagrams. The composite pictures of line diagram and X-rays are useful to make certain point clear and not as proof to the observations recorded because journal is neither a photo album, nor testing the integrity of author.

  Polishing of Article Top

Once the initial draft of the manuscript is made, it is generally very long with word count more than a permitted limit (3000–3500 words). The write up needs polishing and to be made crisp and remove redundancy. The best method is to leave the write up in your file for 2 weeks or more then start reading again. The authors by themselves will shorten it by one third after second reading. After that give it to one of your colleague who is not part of your study, for reading and editing. Ensure that words never heard of, colloquial speech or slangs are not used. Only standard abbreviations should be used. The abbreviations should be given in bracket with full form when used for the first time in the manuscript. The whole manuscript should be written in past tense as the study has already been done and now being reported.

  Plagiarism Top

It is described as use of others work, idea, images, and text of some other authors as your own. It must be ensured that whenever the published/unpublished work of somebody else is used in the write up, it should be cited and referenced.[3]

Now, the manuscript is ready for submission to the journal. In a nutshell, any manuscript once submitted and understood by reader is publishable. Any study having a clear research question, proper method of study, valid observations, discussing strength and weakness of the study, and giving a conclusion which tries to answer the research question is publishable.[4] Any study which has unimportant research question, poor methodology, incorrect interpretation and analysis, and incoherent flow of thoughts is likely to be rejected. Poor English, grammar mistakes, and failure to follow journal style format are other reasons for rejections.

Apley once wrote, “Publication is like having a baby where pregnancy is long, labor is painful, but in the end, you have something to show.”[5] Nothing is more satisfying than to get an article published in a reputed journal with your name as author.

Publication is important for growth of science and to alleviate pain and suffering. Let your efforts to research be known to others and beyond your life.

  References Top

Jain AK. Research in orthopedics: A necessity. Indian J Orthop 2009;43:315-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
Jain AK. Peer review: Heart and soul of scientific publication. Indian J Orthop 2009;43:3-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
Jain AK. Ethical issues in scientific publication. Indian J Orthop 2010;44:235-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
Jain AK. Scientific communication. Indian J Orthop 2007;41:1-2.  Back to cited text no. 4
[PUBMED]  [Full text]  
Apley AG. Preparing manuscripts for publication in the journal of bone and joint surgery. A view from the former editor of the British volume. J Bone Joint Surg Am 1993;75:464-8.  Back to cited text no. 5


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