Interview with Prof. Samuel S. Lee in the APASL2009

Hepatology Digest: I’m here today with Professor Samuel Lee. First of all, welcome Professor, it’s an honor to have you join us today.

Prof. Samuel Lee: Thank you.

Hepatology Digest:  You spoke here yesterday at APASL about the role of the lung and heart in portal hypertension, can you give us a brief introduction to this topic?

Prof. Samuel Lee: Yes, I had to shorten the topic because I only had 18 minutes, so I just spoke on the heart as I couldn’t do justice to both topics. It’s a relatively new syndrome that was first discovered almost exactly four decades ago in patients with alcoholic cirrhosis. It was found by cardiologists that their heart function, specifically their left ventricular pumping function, was not normal and that it reacted abnormally to a cardio-vascular challenge. They ascribed it at the time, mistakenly, to some kind of alcoholic cardio-toxicity. They thought it had nothing to do with cirrhosis per se, but then, about twenty years ago some animal and human studies started coming out showing that even patients with non-alcoholic forms of cirrhosis, and, of course, animal models with non-alcoholic cirrhosis, suffered from the same thing. So, the syndrome is now called cirrhotic cardio-myopathy. My lab has been looking at mechanisms underlying this syndrome for the past twenty years or so.

Hepatology Digest: And how do you foresee further research and what are your plans continue?

Prof. Samuel Lee: Well, there’s a consensus working group which has convened and we’re trying to come up with a consensus working definition, which hopefully will be published and will appear later this year, so that will certainly help clinical research in the field. I think a lot of clinicians either don’t recognize it, or some of them don’t even believe it exists, but the weight of evidence is now accumulating in great detail that it does exist and it plays a significant clinical role. It may play a pathogenic role in the genesis of hepatorenal syndrome and may contribute to poor outcomes following major surgeries, especially liver transplantation. In that respect, interestingly enough, if you look closely, 30 to 56% of patients within the first month after liver transplant have radiographic evidence of pulmonary edema. These are patients who don’t have any underlying apparent heart disease, but I think what we’re seeing is the manifestation of this syndrome in the time of big stress, so basically the syndrome is increased – or what looks like increased - cardiac function but when the heart is subjected to a major stress of some sort, it worsens and fails to respond normally.

Hepatology Digest: And so perhaps the next step will be getting clinicians to recognize the problem and then hopefully that might influence the way they treat patients as well.

Prof. Samuel Lee: That’s correct, yes.

Hepatology Digest: We’d like to talk to you today about the topic of clinical research papers, and you’re speaking about how to write and publish a clinical research paper. For researchers from non-English speaking countries such as China and Japan, their English proficiency might not be particularly good. Will that have a great impact on the editor or the reviewer if there are some language errors in the manuscript?

Prof. Samuel Lee: It shouldn’t theoretically, but in practice it does. If your manuscript is so poorly written that it’s almost incomprehensible, then of course reviewers and editors are going to probably reject it because they won’t be able to understand the message you’re trying to put forward. On the other hand, if it looks like there’s a significant or novel finding in your paper and the paper is written poorly but at least understandable then most reviewers and editors will give that paper the benefit of the doubt, and they will ask in the revision that the paper be revised by somebody fluent in English, preferably a native speaker. I understand, of course, it’s a big world out there and it’s a global community. English has become the lengua franca, but in most countries – I can hardly think of any where there aren’t – there are some English native speakers that are teaching English. There are also professional scientific manuscript revising and editing companies-  those are much more expensive but certainly those are also an option.

Hepatology Digest: So if the person as an individual feels their English might have some deficiencies, it’s easy enough to have someone revise it.

Prof. Samuel Lee: Yes, just go to your local English language school and pay somebody, I don’t know, $100 to read your paper and revise the English.

Hepatology Digest: So another part of the topic you’re talking about is if no one amongst the authors is an expert is an expert in bio-statistics, there is a need to consult a statistician. Could you describe the significance of statistics in the conduction of clinical trials and the analysis of the results?

Prof. Samuel Lee: Just on my reading of the literature, I would estimate that one-third of clinical research papers have some minor or major error in statistics and, yes, if you’ve got a very simple study design – say, two groups, one intervention and you’ve measured a single outcome then you probably don’t need a statistician to help. But a lot of clinical studies nowadays are very complex, and I think it makes sense, if none of the authors is an expert in statistics, to enlist the aid of a statistician to help, preferably at the planning stage of the study rather than to try to do what we call post-hoc data dredging trying to find something significant sifting through the study after it’s done.