In defense of peer review

The generation of knowledge, through rigorous, established systematic methods has informed much of our progress in the past few centuries. Science guides all aspects of healthcare today including how we develop the new medications, therapeutic procedures, and non-pharmacological interventions that have improved the quality and duration of human life. Many of the crucial gates in the scientific journey- funding, ethical approval, and dissemination- are guarded by the process of peer review; a process that is increasing under attack in our current hyper-reactive, digital, media cycle.

Peer review is the critical appraisal of a scientific work by those who have requisite knowledge to evaluate one or more aspects of the work. It is a panel of experts in the related field who understand the importance and novelty of the questions under consideration and the rigor and trustworthiness of the methods proposed or employed to answer that question.

Peer review takes time. Time to find agreeable reviewers with the right expertise, time to review and think about the science, and time to determine how to weigh those critiques against the community’s need for information. From the early days of the novel coronavirus pandemic, this balance of time needed for peer review and unquenchable public thirst for rigorous information has been dominating the conversations at leading medical and scientific journals around the world. To better understand how these decisions are made and what we as clinicians, scientists, and health care consumers need to consider when reading and sharing emerging science, I spoke with Dr. Joseph Hill, the Editor in Chief of Circulation one of 12 AHA Journals.

Even though peer review is an established practice, it is important to start by questioning why we should even do it. Unquestionably, the value of thoughtful peer review is that it enhances the quality of the science. “We [the AHA journals)\] handle approximately 20,000 manuscripts a year and with extraordinarily rare exceptions, the paper always gets better with peer review”.

Having now published many of my own scientific manuscripts, I know the pain of peer review well. “They” missed that detail on line 176. “They” clearly lack the expertise to evaluate my work. “They” kept this manuscript for 8 months before sending their disposition! However, I also know that some of the best revisions to my papers have come from generous peer reviewers. Reviewers who volunteered to spend their time reading my papers and think deeply about my findings in the context of larger literature. While painful, the constant assessment and evaluation of our science is critical to improving the quality and impact of our work.

Prior to the coronavirus outbreak, up to 10 experts, including peer reviewers, statisticians, and editors, would review a manuscript for Circulation. But the need for up-to-date information about the epidemiology, pathophysiology, and treatment of COVID-19 challenged Circulation’s editorial team to move fast. While recognizing that it’s “hard to do good science in a war zone”, the quality of published science cannot be compromised in times of crisis. Dr. Hill continues, “We are walking a fine line between trying to get the information out as quickly as possible but we recognize that [in clinical science] we could make it worse and could do harm. So we have to maintain our high standards but function at a high velocity.”

High velocity seems an understatement. After an initial call for high-quality COVID-19 related papers, the editorial team has done over 300 fast track reviews, contributed to a curated coronavirus and cardiovascular disease collection, and conducted 17 interviews with experts working on the front line around the world. All in the past month. This work is exhausting but done with great energy by a team inspired to advance “cardiovascular science for the good of humanity, especially during these times of urgent challenge, anxiety, and forthright resolve.”

Peer review is the best process we have for evaluating science; but peer review is done by peers- busy, human, distractible peers- who will make mistakes. This is why many reputable journals require an editorial screen and at least two peer reviews before it can make a decision on a manuscript. Scientific volunteers do this work. Which brings us to what you, as an early career professional can do. Peer review relies on us—all of us—to sign up to review, accept the invitation to review, and spend the time carefully doing the review. You may wonder if you have the expertise to peer review for Circulation or another AHA Journal; you likely do and you should. Dr. Hill remarked that “some of the best reviews I’ve seen are from early-career scientists”.  If you are interested in helping to contribute to peer review and the sharing of good cardiovascular science, considering signing up to be a journal reviewer in your AHA Science Volunteer Form or emailing Dr. Hill your interest in reviewing for Circulation.


“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”


Why & How To Talk About Your Research: Tips From Science Writers

I’m a researcher, but I’m also a nurse. Nurses are used to talking to people about complex health topics in plain language. We are often the ones helping patients wade through jargon, numbers, and data they don’t have the experience to interpret otherwise. Many nurses can do this brilliantly on the individual level – nurse to patient. As scientists, though, we have a responsibility to translate specialized knowledge on a larger scale, and most of us are ill prepared to take on this task. In graduate school, we are taught how to present our findings to other scientists, but many of us are at a loss as to how to talk to people without a science background about our work.

In health-related sciences our research findings are often relevant to the general public. Sometimes, there are enormous public health implications. An example from my field of study is the identification of women’s symptom characteristics when they have acute coronary syndrome (ACS). Communicating common symptom patterns to women can help them to recognize ACS and seek treatment quickly, which in turn can lower their morbidity and mortality rates. Research findings like this need to reach a wide audience! But translating nuanced and complex findings into meaningful information for a general audience is challenging. The public is interested in health news, yet often research findings are stripped of context and misconstrued when they’re reported outside of the academic literature. The pitfalls of poor communication include not only obscurity, but also dangerous misinformation (see an interesting take on this at the New York Times).

Still, the general public doesn’t read the New England Journal, so how do we bridge the gap between the academic press and the popular press? How can we as scientists and health care professionals communicate effectively to the public? We don’t have to go it alone – science journalists are professional communicators. It’s their job to craft science-based stories that are both accurate and compelling.

Melissa Weber, the news editor for the American Heart Association News, talks to scientists frequently when she’s developing stories. We as early career scientists should seek out these opportunities to publicize our work. It doesn’t need to be intimidating!

“Making things simple doesn’t mean you’re making them inaccurate,” Weber says. “A good story is a good story, whether it’s about science or a football game. It’s all storytelling.”

When journalists talk to scientists, they want to hear us talk about our findings in our own words. Science journalist Flora Lichtman told the AAAS that enthusiasm from the scientist is one of the best ways to generate an interesting story, and it’s okay to be informal. One rule of thumb, suggests Weber, is to try to explain your findings like you would to a fifth-grader. And “avoid medical jargon like the plague,” she adds. Other tips for good communication include thinking about who the audience for the piece will be and thinking of metaphors to explain tricky concepts. And Weber and Lichtman both stressed that being interviewed doesn’t need to be nerve-wracking – silence is okay while you’re thinking, and you can always ask to re-state something if it didn’t come out right.


Are you talking about your work to people outside your field? If not, start now!


References: https://www.aaas.org/resources/communication-toolkit




Why Advocacy is Critical for the Future of Cardiovascular Research & Medicine

As researchers and physicians, many of us got in to our professions to push the scientific enterprise further to ultimately help others. We’ve all trained for an insane amount of years and collectively we work as a unit to uncover the intricacies of the cardiovascular system, develop therapeutics and treat patients. We traditionally think of ourselves as researchers or physicians first, but obviously we are all so much more than our jobs. We are also citizens within a really complex system that has been continually struggling to serve all of its citizens equally. It’s no secret that access to affordable health care is currently not equitable within our society. Similarly, there are also large diversity & inclusivity issues within our training institutions for both researchers and physicians.

However, something we don’t think about enough is that our intensive training and experience within these systems has also prepared us to be effective advocates for these issues. We have the opportunity to promote tangible change and some might argue it’s even our responsibility.

One of the things I really appreciate about being apart of the American Heart Association (AHA) is that this is something the organization doesn’t shy away from. During his presidential address at AHA Scientific Sessions 2018, Dr. Ivor Benjamin gave a heartfelt and determined talk about what the future of the AHA’s advocacy mission looks like. He discussed how supporting local and federal advocacy, early careers and mentoring is key to supporting the future of the AHA – but only 3% of cardiac professionals are African American men and this is something the AHA wants to help change. To help solve the diversity and inclusivity issues within the cardiac field, the AHA is expanding major undergraduate initiatives to fix the leaky pipeline. My favorite part of Dr. Benjamin’s talk was when he urged everyone at AHA18 to get involved in advocacy, not just for our field, but also for our communities. Because this is the key point: in order for our work to have meaning and to be effective, we need to ensure our communities are healthy. We also need to put value to advocacy efforts in our field – this is an essential part of our profession.

Well, this is all great, but how can you get involved? We are all insanely busy; I know adding advocacy efforts can seem daunting. Luckily for all of us, one of the focuses of the AHA for January is Advocacy. Since over 7 million Americans with cardiovascular disease are currently uninsured, advocating for the protection of the Affordable Care Act is something we can all do from our computers right now.

How can you help? (Provided by the AHA newsroom)



Looking for more ways to help on other issues?

  • The AHA has a great advocacy resource page for to get involved with efforts at the federal, state and community levels with issues regarding health care, tobacco prevention, and healthy lifestyles for kids.
  • Sign up here to become part of the AHA’s grassroots network, You’re the Cure, which is focused on advocating for heart-healthy and stroke-smart communities.
  • There are many great non-profits around the country focused on promoting science funding, literacy, inclusion, diversity & advocacy – finding the right one for you is key and many of them have already done the legwork by developing toolkits for you to get started in your community.
  • Interested in STEM outreach as a way to get involved in your community? The great Marian Wright Edelman said, “You can’t be what you can’t see.” Participating in local educational initiatives is one of the best ways to expose kids to what scientists and physicians actually look like (in addition to getting them excited about science). The STEM Ecosystem is a great way to get started; there are local chapters all over the country.

I recently watched the brilliant documentary (I highly recommend it!) about Mr. Rogers, “Won’t You Be My Neighbor”, where I was reminded of his advice many of us take comfort in during intense times.

“When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” – Mr. Rogers

We are the helpers. Its time we use our power to advocate for equity within our field and communities.




Turning Back The CLOCK: A Look Into The History of Circadian Oscillations

As an early career researcher, I feel that I lack some critical background knowledge of foundational studies and scientists in research. Most of my blog posts will focus on recent papers or topics, and I’ll dig into the history of that topic to find out how we got to where we are.

Many fantastic papers have been published on the circadian clock lately. Drs. David Montaigne and Bart Staels recently published a Viewpoint on the topic of the circadian clock and cardiovascular disease in Circulation Research.1 My basic understanding of the circadian clock is that transcription factors, CLOCK and BMAL1, are critical proteins. Light is sensed at the retina and the optic nerve transmits a signal to the suprachiasmatic nuclei then throughout the body. Since light (historically) came from the sun, these proteins and the clock functions generally oscillate with day and night. Knocking out or mutating clock proteins can alter metabolism, immunity, and a slew of other systems.

A 2013 paper published in Circulation by Xiaoyue Pan and colleagues showed increased atherosclerosis in mice where the CLOCK protein was mutated, thus disrupting the circadian rhythm.2 The mechanisms appeared to be elevated ApoB48 particles and increased macrophage cholesterol scavenging. In 2009, a Circulation paper by Ciprian Anea and colleagues showed increased collagen deposition and fibrotic remodeling after arterial ligation in the carotid artery of BMAL1 knockout mice.3 Finally, a 2018 Cell Metabolism paper by Carla Winter showed that myeloid cells behave in a circadian fashion.4 These are impressive recent papers, but how did we get to this point? I wanted to gain a better understanding of where the science of biological clocks began.

My first stop was the “circadian clock” page on Wikipedia, but it was lacking any historical context.5 Next, I found a review on Pubmed from 1993 by a scientist named Colin Pittendrigh in the Annual Review of Physiology entitled, Temporal organization: reflections of a Darwinian clock-watcher.6 This review was more of an autobiography than review, but it was a joy to read. I would suggest reading the entire review, but I’m going to summarize some it here. After reading a few paragraphs it became evident that Colin Pittendrigh might be a prominent figure in the science of biological clocks. I did a quick search (the Wikipedia page for “Colin Pittendrigh”) and found this in the second sentence, “…father of the biological clock…”, which came from a Stanford press release upon Pittendrigh’s death.7,8

What I found in Pittendrigh’s 1993 “reflections” was that he was an extraordinary scientist, and an interesting man. Pittendrigh begins by recounting how he became interested in biology. Living in the north of England, he kicked a soccer ball through the window of the town hall and needed to replace it. Needing money, he entered a contest for the best wild flower collection from the local Boy Scouts and won. This sparked his biological interest. During high school, Pittendrigh discovered Charles Darwin’s works which greatly influenced him. He says that his Darwinian beliefs later survived exposure to Lamarckian convictions of a college professor. During wartime in the 1940s, he was in Trinidad and was instructed to focus on breeding vegetables for the campaign. Later, he studied Malaria by focusing on habits of mosquitoes, and eventually he studied drosophila behavior. During these experiences, he observed periodicity in the behaviors of these organisms.6

With influences from colleagues, Pittendrigh reasoned that the biological clock must be endogenous.6 During his time at Princeton and Stanford, Pittendrigh published many papers including five in the journal, Science. Almost all of these were published on the circadian oscillations of plants and animals; however, he had other interests, as well. Notably, a 1965 Science paper titled, Proposed Biological Exploration of Mars between 1969 and 1973.9 Pittendrigh’s career in science was monumental, although he didn’t discover the proteins involved in biological clocks. The CLOCK protein was discovered in 1993 and BMAL1 was discovered in 1997, the year after Pittendrigh’s death.10,11 These discoveries undoubtedly wouldn’t have been made without the pioneering work of Colin Pittendrigh.

Dr. Pittendrigh’s life and discoveries are remarkable and in his writing, he constantly references others that were instrumental to his ideas and discoveries. With mounting pressure to have first or last author publications in our time (forgive the pun), it is easy to overlook others who make scientific progress possible. And although Colin Pittendrigh did not study cardiovascular diseases, his findings are having an impact on cardiovascular medicine now. This highlights the interdisciplinary nature of science and how ideas from diverse fields impacts others. It is always beneficial to read papers, attend seminars, and speak with colleagues from diverse fields to broaden our own experimental approaches and ideas.



  1. David Montaigne & Bart Staels. Time to Check the Clock in Cardiovascular Research and Medicine. Circulation Research. 2018; 123:648–650
  2. Xiaoyue Pan, Xian-Cheng Jiang, and M. Mahmood Hussain. Circulation. 2013 Oct 15; 128(16): 1758–1769.
  3. Anea CB, Zhang M, Stepp DW, Simkins GB, Reed G, Fulton DJ, Rudic RD. Circulation. 2009 Mar 24;119(11):1510-7
  4. Winter C, Silvestre-Roig C, Ortega-Gomez A, Lemnitzer P, Poelman H, Schumski A, Winter J, Drechsler M, de Jong R, Immler R, Sperandio M, Hristov M, Zeller T, Nicolaes GAF, Weber C, Viola JR, Hidalgo A, Scheiermann C, Soehnlein O. Cell Metab. 2018 Jul 3;28(1):175-182.e5
  5. https://en.wikipedia.org/wiki/Circadian_clock
  6. S. Pittendrigh. Temporal organization: reflections of a Darwinian clock-watcher. Annu. Rev. Physiol. 55, 17 16-54. 1993.
  7. https://en.wikipedia.org/wiki/Colin_Pittendrigh
  8. Stanford University News Service. https://news.stanford.edu/pr/96/960325pittendrig.html 1996.
  9. Pittendrigh CS. Proposed Biological Exploration of Mars between 1969 and 1973. Science. 1965 Apr 30;148(3670):667.
  10. King DP, Zhao Y, Sangoram AM, Wilsbacher LD, Tanaka M, Antoch MP, Steeves TD, Vitaterna MH, Kornhauser JM, Lowrey PL, Turek FW, Takahashi JS. Positional cloning of the mouse circadian clock gene. Cell. 1997 May 16;89(4):641-53.
  11. Hogenesch JB, Chan WK, Jackiw VH, Brown RC, Gu YZ, Pray-Grant M, Perdew GH, Bradfield CA (March 1997). “Characterization of a subset of the basic-helix-loop-helix-PAS superfamily that interacts with components of the dioxin signaling pathway”. The Journal of Biological Chemistry. 272 (13): 8581–93.



Representation Matters: How Can We Improve Equity and Diversity in Our Professional Lives?

This past August, the phrase “Representation Matters” commonly graced entertainment and popular culture headlines. Why? In what was ultimately called “Asian August,” several major movies starring Asian-American actors were appearing in theaters, led by the first American film to feature an all-Asian cast in 25 years – “Crazy Rich Asians.” This fervor was inspired by over two decades of under-representation of Asian-American culture in the entertainment industry.

As I am an Asian-American, this particular movement did indeed resonate with me in my personal life. However, I regrettably was not mindful about it in my professional life. Throughout my training, I felt that I had worked with, learned from, and/or befriended men and women of a wide variety of colors, beliefs, and socio-economic backgrounds. Perhaps it was because I was fortunate to train in programs that were diverse, but I don’t necessarily recall reflecting on the diversity nor the benefits of diversity.

In early December 2018, Dr. Hannah Valantine visited our campus at UCLA to deliver our Medicine Grand Rounds lecture, and she was kind enough to meet with many of our faculty and trainees. A renowned physician-scientist and advanced heart failure/transplant specialist, Dr. Valantine is the NIH’s first Chief Officer for Scientific Workforce Diversity. She led an outstanding, eloquent, and (of course) evidence-based discussion on the importance of improving the diversity in academic medicine. She highlighted the emphasis that the NIH is placing on this mission, and the resources her office has developed to not only educate professionals on the issues at hand, but also a toolkit they have created to help promote diversity at our institutions, including how to create a diverse talent pool and perform unbiased talent searches.

Dr. Valantine presented data showing that while there has been improvement in diversity of trainees early in their training, there remains a significant “transition barrier” for diversity upon entering the junior faculty stage of an academic career (between “Postdoc” and “Independence” in the slide below).


Further, she also mentioned data supporting the improved performance of more diverse groups. In an article from Nature this past year, the subjective and objective benefits of diversity were featured. Interestingly, in an analysis of over 9 million scientific articles, one group found that research “papers written by ethnically diverse groups were cited 11.2% more than were papers written by non-diverse groups.”

With clear reasons for why we should work to focus on a culture of equity and diversity in our scientific workforce, I realized that I will soon be at a stage where I will be choosing the members of my research team. In the spirit of the New Year and with the help of tools provided Dr. Valantine, I have made the following “resolutions” to myself to help prepare myself as I embark on organizing a research team in the future:

  • Discover and explore my implicit biases: There are online resources/tutorials on implicit bias, including an excellent one from my home institution, UCLA, as well as tests you can take to discover your own implicit biases. Regrettably, after my first test, I already learned that my results suggested, stereotypically, “a moderate association for ‘Male’ with ‘Career’ and ‘Female’ with ‘Family.’”
  • Be mindful of the benefits of diversity when present: Whether in a research group or the team I am rounding with in the hospital, I plan to acknowledge these benefits when present, whether aloud or to myself.
  • Follow the NIH Scientific Workforce Diversity blog: It is an excellent reminder of reasons and ways to create an effective & diverse scientific team.


In one of her excellent blog posts from last year, Dr. Valantine wrote:

“Our nation is presented with the unique opportunity of connecting an increasingly diverse talent pool of scientists with the full range of biomedicine careers encompassing basic discovery to health applications, a critical part of the NIH mission to advance human health.”


I am grateful that the NIH has placed high priority on this mission, because indeed, Representation Matters, and in the field of academic medicine, representation can lead to better science and better treatments for our patients.