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From Academic Publishing to Hot Sauce: Interview with Rupa Sarkar, The Lancet Digital Health

Hey Rupa! Thanks so much for having a sit-down with us.

So, who is Rupa?

Hmm, this is a toughie and it may take some time for me to figure this one out…but I presume you are asking about my health/tech background…I did my PhD at Imperial College London working on the role of miRNAs in embryonic stem cell differentiation, analysing a huge amount of data generated by Solexa sequencing which was exciting at that time. I then moved on to NY, to the Albert Einstein College of Medicine, where I developed a mouse model for an embryonic disorder, so I'm a geneticist and molecular biologist at heart. After this, I moved back to London to take up an editorial role at the Nature journals and worked at various journals and roles, handling a wide range of subject areas, most recently I was the Chief Editor of Nature Protocols handling omics and machine learning papers. After this, I joined The Lancet family as Editor-in-Chief to launch a new journal, The Lancet Digital Health to apply my omics, big data and machine learning background to healthcare.

You’re currently the Editor-in-Chief of the Lancet Digital Health, what does that mean?

As the Editor-in-Chief of The Lancet Digital Health I manage the publication process, develop the scope, mission, aims and strategic direction of the journal, handle papers through the peer-review process, make decisions within a team about which papers to publish, write editorials, read papers, manage the editorial team, attend conferences, give publishing talks, and more. The Lancet has been at the forefront of medical research for almost 200 years reporting many firsts in history, including the first test for TB in 1951, the first test tube baby in 1978, and the ebola vaccine in 2015. Since 1823 the lancet family has grown, we are now 18 journals in total, with The Lancet Digital Health launching in May this year and most recently The Lancet Rheumatology! At The Lancet Digital Health we showcase validated, efficacious technologies that meet a clinical need in a real-world environment. And for this we require studies to have robust methodology such as RCTs and AI tools with external and/or prospective validation. Currently there are lots of advances in technology across many medical specialities which share similarities, but the publications are disparate and scattered. Given the interdisciplinary nature of the field we want to serve as a resource, publishing News, Commentaries, Editorials and Original Research, for everyone interested in digital health, and we hope to help break down silos between medicine, public health, data science as well as institutional barriers between local/regional/national government departments, academia, healthcare systems, and industry. 

You must see the full range of new research across digital health come across your desk, what sort of studies make you particularly excited?

We have had some lovely AI studies, which show real promise to make a difference in the clinic, for example, Tien Wong and colleagues applied a deep learning algorithm to diagnose diabetic retinopathy, originally developed in a Singaporean cohort, and they now show it to work just as well in a Zambian population and it could potentially reduce the burden disease by enabling earlier diagnosis more cheaply. The potential clinical utility of deep-learning tools beyond their original application is consistently under question, and this work shows that artificial intelligence algorithms can be successfully deployed in a different population, with great potential to improve health care in low-income and middle-income countries. I am also excited by the big data studies, especially ones using electronic health record data, for example, Mohamed Abazeed and colleagues used medical records and CT lung images to personalise and predict radiotherapy treatment and I enjoyed handling Valerie Kuan et al which used 4 mil electronic health records to map disease across lifespan and identified differences amongst the population in gender and ethnicity. Interestingly this study highlighted disparities between ethnicities showing that diagnosis of most disease occurred in Caucasian patients significantly earlier than ethnic minorities. Also, check out this nifty infographic!

How did you find the move from academic research to publishing? What made you move and what sorts of decisions did you take in doing so? 

I love reading about science and learning new things so the move to scientific publishing made sense for me, as I get to read, learn and blather on about science all day. I can't say it was a calculated move, like everything in life, being in the right place right time, taking all the opportunities and being open minded helped me to find what I love doing.

With the proliferation of pre-prints and the speed of scientific discovery, what roles do journals play? Are they more or less relevant?

Pre-prints are a great way to get research out in the open quickly and should be embraced by all researchers, but the process of curating, peer-reviewing, editing and distributing scientific medical research by journals is critical to help researchers find the most relevant, reproducible and rigorous papers in their field. More than this, The Lancet journals and others stand for values and activities beyond publication, and we take this role seriously, especially in campaigning for the right to health, health equity and advancing human health. Beyond practice-changing research, The Lancet journals publish Commissions and Series about neglected areas of medicine that can contribute to advancing the social impact of science, to help inform leaders, start debates and advocate for research that can make a difference to lives. 

What interesting innovations, new approaches or business models are you seeing coming out in academic publishing? How are some folks doing things differently, and well?

Some journals are trialling cloud-based platforms like code ocean which allow peer-reviewers to easily run, test and create different versions of code to test for reproducibility which could have a positive impact on the quality of papers in digital health. 

What does academic publishing look like 15 years from now?

The Lancet Digital Health is an open access journal and the work we publish has the potential to reach the broadest audience across disciplines and industries, faster. We want to ensure that digital health research is not limited geographically, and ultimately can help those in greatest need and improve medical practice in low income regions. So, I hope the future of publishing is open. 

As a journal looking to support rigour in the field, can you name us a few things that make you, as an Editor, squeal (in the bad sort of squealing way), when it comes to tech, data and health?

There are still a number of challenges in the field; many studies don't have appropriate validation to show utility of the tools in the clinic. This challenge is partly down to the limitation in the data collection which could be overcome if data interoperability is addressed. If data sharing between institutes, hospitals and countries becomes the norm, there might be more highly powered prospective studies which could accelerate the development and validation of digital health technologies. However, in order to make data sharing a reality we need better data security and privacy measures to protect patient data. It is increasingly possible for an individual’s identity to be determined by facial recognition or genomic sequence, which could impede protection of privacy. What we need is new models of health data ownership with individuals' rights, secure data platforms, and government legislation, to counter potential security issues. 

It is a fact that we do not have data from diverse populations which is biasing the data and disadvantaging minority groups and the disproportionate use of AI could widen the gap in health outcomes and exacerbate pre-existing inequities. For example, the algorithms that diagnose melanoma often lack inclusion of skin colour and of course, much of the genomic data collated so far in western populations, has seriously underrepresented minorities. We are seeing advances, such as the recent announcement for funding for the largest pan-African biobank, but we need to continue to work to eradicate embedded prejudice and strive for medical research that provides a true representative cross-section of the global population. 

I’m happiest when…

I'm running

When no one is watching I…

Play Zelda on the Nintendo Switch

My totally tangential, left-field, alternative career would have been in…

Writing murder mystery novels

What’s the last present you gave someone? 

Hot sauce 

My favourite podcast...

I quite like the Adam Buxton podcast and I recently listened to Adam Buxton, Richard Ayoade and Sara Pascoe talk about The Catcher in the Rye. It's a goodie.


Thank you Rupa for meeting us!

Follow Rupa on Twitter @RupaSakar


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