Professor Gillman?   

The ‘H-index’ average for Professors in medicine is around 15 (1). Mine is 28 as of December 2021.

I have become increasingly aware of the extent to which we all have difficulty in assessing the reliability and value of scientific information in scientific journals, or on the Internet. The doctors who contact me for advice are often unaware of my many scientific publications (almost all sole-author papers: not, like many professors, multi-author papers, to which they may have contributed ‘modestly’).

When Doctors are presented with information they are frequently not able to critically assess the accuracy and authority of that information. They are often unaware that I have published many widely referenced review papers in reputable ‘first-division’ scientific journals, or that I am acknowledged as a leading world expert in serotonin toxicity, and other drug interactions. Aside from a few well-known journals like the BMJ, Lancet and NEJM, most doctors have little idea if a journal is a reputable ‘first-division’ journal, or just one of the myriad of 3^rd-rate ‘Mickey-mouse’ journals (there are about 30,000 different journals in ‘PubMed’ database alone).

One can take the view that this is understandable and excusable, because Doctors are bombarded with so much rubbish that they have become jaded and tend to assume this is just another bit of rubbish. So, it is important to help them to understand more.

I will contextualise my publications concisely. One of the main menus at the top is ‘Publications’, these are almost exclusively papers published in prestigious peer-reviewed scientific journals.

The link here, and on my homepage, to my ‘Google scholar’ profile is the simplest way to authenticate publication metrics. Google scholar provides detailed publication metrics: mine are superior to those of 90% professors at major ‘Ivy League’ and ‘Oxbridge’ universities. In brief, the typical ‘H-index’ for Professors in medicine is around 15. My H-index 27 (higher is, of course, better).

As far as individual publications are concerned, my Google scholar profile shows that some of my major review papers have been cited frequently (like > 300 times, which puts them in the top 0.1% of all papers), and more frequently than any other comparable paper in the field. Indeed, some of them are now standard references in benchmark textbooks.

People frequently address me as Professor: that is appropriate, because although I do not hold a formal professorship, honorary or otherwise, at any university any more, I have more publications and more citations than most full professors.

As such, the quality and authority of the information in my review papers overrides recommendations in most standard texts and guidelines, such as those produced by the ‘National Institute of clinical excellence (in the UK), the ‘Maudsley therapeutic guidelines’, the ‘physician’s desk reference’ (USA equivalent of MIMs) and MIMs (the latter two being very poor sources of information — they are essentially defensive legal texts, not clinical pharmacology texts — yet MIMs and the PDR are widely used and on most doctors’ desks). Most textbooks in my fields of expertise are a couple of decades behind in terms of current best opinion and practice.

If a doctor with whom you are dealing cannot acknowledge such realities and learn the need to go beyond the PDR and ‘guidelines’ (which set are they using? there are many different and contradictory ones), then the only advice I can offer is to remind them they are there to advise, not to dictate, find an alternative medical adviser, or complain via the available channels and procedures. If needed you should be accompanied to consultations by a mature family member or supporter who is capable of being assertive and persistent and demanding a second opinion which can often be obtained from the area ‘teaching’ or ‘university’ hospital.

It is crucial to highlight and repeat that guidelines are, and can only ever be, suggestions, and that they are only applicable to ‘typical’ cases (and few cases are really ‘typical’): all good guidelines state that principle clearly in the preamble (which few people appear to read), and also emphasise that it is the doctors’ responsibility to asses each case individually, and not just apply guidelines in a rote fashion: indeed, to apply guidelines in a rote fashion may itself constitute negligence.

The fact that following guidelines may itself constitute negligence is ironic, since a frequent consideration and influence, when doctors are looking up guidelines, is to avoid criticism and censure, and also avoid the effort and hassle of thinking things through themselves, learning about ‘less-standard’ treatments. But, that is precisely what ‘professionals’, ‘specialists’, and ‘experts’ are paid high fees to do! But it appears that many find it much easier just to follow the guidelines.