A journal club (JC) is a group of people who get together to critically evaluate articles in the academic literature. One person typically provides a summary and review of an article, while the group chimes in with comments, questions, and criticisms. In a nutshell, JC is an autopsy (literally translated as a “seeing with one’s own eyes”): a personal observation, a form of postmortem examination. There’s often more to the story than just the abstract.
I had the luxury/privilege of being part of great journal clubs during my residency at Johns Hopkins and even more so during my time at the National Cancer Institute at the National Institutes of Health (NIH) in both medical school and, later, as a postdoctoral fellow. Some of my greatest insights into the limitations and strengths of science came from these meetings.
Our Journal Club is no different, except that it’s virtual—we’ll always be the “presenter,” and there won’t be any donuts or stale coffee. The purpose of our JC is to continually improve our ability to analyze and interpret research and share this with the community. This should help us all on our quest to be more Feynman-like…
What can JC do for you? It can help you:
- critically appraise published clinical research literature;
- cultivate a better understanding of the research process;
- develop a world-class BS detector for virtually anything the media has to say about “science”;
- learn more about how research is conducted;
- assimilate and provide summaries of landmark papers in the fields of performance, health, longevity, and the philosophy and practice of scientific methods;
- receive insights from the community; and
- challenge your thinking and the thinking of those around you.
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Journal Club Template
We generally follow the 20/80 rule in JC:
- 20% covering the 5Ws (and How) from the author’s perspective:
- Who (e.g., investigators, subjects) was involved?
- What (e.g., methods, results) happened?
- Where (e.g., settings, the type of study) did it take place?
- When (e.g., the year and length of the study) did it take place?
- Why (e.g., the motivation for the study) did that happen?
- How (e.g., proposed mechanisms, author’s explanations) did it happen?
- 80% covering our 3Cs (Criteria, Critique, and Conclusion):
- Criteria: Did the article meet our elementary standards of good science and reporting?
- Critique: What are the strengths and limitations of this article?
- Conclusion: Do we accept the author’s conclusions? Why did we choose this article? What can we learn from this JC?
Journal Club Outline
In practice, our outline is generally as follows:
- Motivation (Why)
- Design (Who, Where, and When)
- Results, Discussion, and Conclusion (What and How)
- Criteria
- Critique
- Conclusion
Journal Club is not a solo act. It takes a community of engaged individuals. They don’t call it journal club for nothing. The first rule of Fight Journal Club is, you are permitted, if not encouraged, to discuss it broadly. And so, our fellow JCers, as a wise man might say: ask not what your Journal Club can do for you—ask what you can do for your Journal Club.
Stay tuned for our first JC article. If you have any suggestions for a paper to dissect, please post to comments.
Read in the NYT today, “High-Fat Diet may fuel spread of Prostrate Cancer.” Would love your take on their findings. I’m a huge fan and appreciate all your efforts.
We’ll put this one on the list. Thanks for sending.
I look forward to learning from this group.
YEEEAARS ago, I had read a “news” account of an epidemiological study that “proved” that living under hydro wires (ehem “electrical” wires) caused cancer. It seemed very convincing. And I would shake my head at all those poor saps that lived in houses next to transmission towers… as I trotted quickly by.
Later, I read another article on “confounders” which sited that same study that I had read.
It seems that the study did not take into account the fact that there was a strong statistical association between people who lived near electrical transmission lines and poverty.
Get where I’m going? Yes, for various reasons (and one could site other studies) poor people have higher incidents of cancer… BECAUSE of lack of proper nutrition, being overworked and stressed, etc… whatever.
To this day this is my favourite go-to example as to what confounders are and why one must delve deeply into epidemiological studies to decipher fact from fiction.
Anyway… this JC Club looks cool! 🙂
Taubes wrote a great piece on this many years ago in Science, if you can find it.
https://www.ncbi.nlm.nih.gov/pubmed/24467653
Wow, what a gem of a study…
Would love some discussion on the research relating to Circadian Rhythms and the implications relating to diet/disease. This is just one of the papers. https://www.ncbi.nlm.nih.gov/m/pubmed/28162893/ Circadian Entrainment to the Natural Light-Dark Cycle across Seasons and the Weekend.
Stothard ER, et al. Curr Biol. 2017.
Recently in the news…www.pnas.org/cgi/doi/10.1073/pnas.1715035115
This one has been all over the news today: “Red meat and refined grains might increase your risk of colon cancer, a study suggests”. -US News. The title they use is “These Foods May Up Your Odds For Colon Cancer”; of course, with the picture of a steak. https://jamanetwork.com/journals/jamaoncology/fullarticle/2669777
That just never gets old…
Thank you and your staff, for this forum for discussion.
Consider this paper:
https://www.cell.com/action/showImagesData?pii=S0092-8674%2817%2931493-9
I have found interactions of NLRP3 and metabolism to be of continuing interest regarding several categories of chronic and degenerative illness.
Trish Greenhalgh’s book, ” How to Read a Paper” helped me improve my critical appraisal ability of medical literature.
I’ve enjoyed reading your various blogs from time to time. Thank-you very much for sharing your thoughts and conversations with us!
My journal article interest areas include the following topics:
1. Auto-immunity and micro-biome
Example: Diet, microbiota and autoimmune diseases. Lupus. 2014 May;23(6):518-26. doi: 10.1177/0961203313501401;
Vieira SM1, Pagovich OE, Kriegel MA.
2. Our circadian rhythms and health
Example: I used to share the out of print Dover Classic, BIOLOGICAL RHYTHMS IN HUMAN & ANIMAL PHYSIOLOGY (Luce, Dover Publications, 1971), toxicity curves of various substances vs. time of day to my students so they could make better decisions in drinking alcohol vs time of day. Old and out of date, but I haven’t found an nice modern synopsis yet.
3. Microbiome and any aspect of health
Example: January 2018 issue of Science has a series of articles on Gut Microbes and Cancer, Science- 5Jan 2018, vol 359, Issue 6371.
Looking forward to future articles/discussion.
Would love to take a closer look at this one https://www.ncbi.nlm.nih.gov/pubmed/19664276
Nutr Metab (Lond). 2009 Aug 10;6:31. doi: 10.1186/1743-7075-6-31.
Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer’s disease: a randomized, double-blind, placebo-controlled, multicenter trial.
Henderson ST1, Vogel JL, Barr LJ, Garvin F, Jones JJ, Costantini LC.
There are a lot of esoteric methods in this paper, and I would love to be able to dissect and really understand the claims the authors are making – and in particular, what they mean for the carbohydrate-insulin model of obesity:
https://www.ncbi.nlm.nih.gov/pubmed/27385608
Dear Peter,
I am soon to be a pediatric emergency physician. Long story short, my experience has mirrored yours in some ways (metabolic syndrome in my 30’s, implemented ketogenic principles last year; within 8 weeks, HDL, TG, fasting glucose, blood pressure, weight etc. moving in positive directions and normalizing).
This was the result of my trying to find a sustainable “natural” way to eat – since I had been clearly moving in the wrong direction, despite valuing exercise and being an amateur runner.
On a temporary basis, my family (wife and 3 children) implemented the same dietary changes to support me (despite their not having any weight or obvious health issues). Due to some unanticipated results, their temporary support has turned into a sustained, challenging, (and admittedly inconsistent) endeavour. My son is now off of his ADHD medication, and my wife and daughters no longer have the “hanger” issues they used to experience almost daily. There is more…and our collective mood and family interactions have also improved as a result.
I strongly support your efforts to provide a forum for scientific rigour in aid of reversing what I have come to believe is an international medical-establishment-supported push in a perhaps well-intended, but manifestly wrong direction (thanks to you, Taubes, Phinney, Volek, Fung for helping to illuminate the problem) – a wrong direction I once supported in my professional interactions (in smug “knowledge” of the truth) with families, to their probable detriment.
The potential implications for pediatric health are immense: there are numerous illnesses which are manifesting in pediatrics with increasing frequency (ADHD, IBS, IBD, DM1, DM2, depression…even febrile seizures) with potential (and potentially very direct) relationship with societal changes in nutrition. To me, it is clear that this increased frequency is due to more than just over-diagnosis or increased ability to diagnose. It clearly has a strong environmental component (in that changes have outpaced our core genetic ability to change – outside of potentially epigenetic phenomena which in turn interface with our environment). Broad societal changes in nutrition seems to be the most likely prime suspect (amongst, admittedly, many potential suspects).
I know the scientific evidence is not in place to make definitive national recommendations (along the lines of your n of 1 subtitle in your 1+ hour-long presentation) – but I would like to be involved in helping to turn the tide away from mindlessly promoting nutritional fallacies.
As a pediatrician – as a father – I feel it a duty…and it is potentially a very exciting time!
In appreciation
Nafeh
Nefeh, keep doing a great job on the front lines. No shortage of work…
Good morning Peter, Hoping you see this. I have been a follower of your work for many years and am now truly enjoying your Nerd Safari work. I’m sure you’re aware of the work being done with rapamycin and other compounds to increase healthy lifespan. I ran across this article and thought the topic would be a great Nerd Safari or JC topic in the future. https://www.frontiersin.org/articles/10.3389/fgene.2015.00247/full
I’m looking forward to the first JC!
Suggestion:
July 2020
Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials
https://jamanetwork.com/journals/jama/article-abstract/2768806?guestAccessKey=3f95d0d5-db62-44c6-a591-ca404352de6f&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=072820
Would look forward to participating in JC. Just received your review of the vitamin D/depression article in JAMA, thank you. If JC has moved to the subscribers-only portion of your work, please let me know. Appreciate your work.
Dear Dr Attia
I was watching the latest YouTube of you and Tim Ferris. You mention that in your journal club you critically review articles
I would love to listen to this if possible
How do I go about it
Dear Dr Attia
I really enjoy listening to yours and Tim Ferris podcasts, “always learn something “
I was quite excited to hear you saying to Tim that your team will critique a paper together and posted it on the JC This is great 👍
? Why did you stop taking metformin
Wondering how you’d break down this follow-up study, particularly in light of the wonderful podcast you did with Drs. Carol Tavris and Avrum Bluming: https://pubmed.ncbi.nlm.nih.gov/33025002/
Dr Attia,
I also watched your talk with Tim Ferriss posted on YouTube (6/9/21), and your comments starting around 54:45 really captured my interest, where you said you had been recording your Journal Club for about a year and you were working on putting together a course. The tone of the discussion seemed to indicate that the course would seek to help people who do not have a science researcher’s background better understand scientific papers. I’m not sure what sort of audience this is aimed at, but I’m very interested.
I did a quick Google with for the search terms “Dr. Peter Attia journal club” and I landed on this old page. Perhaps a dedicated page discussing your course, who is eligible to take it and/or would benefit, might be a good resource.
BTW: It’s a little off topic, but I just want to tell you I appreciate the work you’re doing, and your ongoing willingness to engage the public with an honest and logical discussion regarding medical research.