>  Dr. Mikhail Sinelnikov (Dr. S.): Professor Michael Kidd, thank you for agreeing to talk with me today. You are a well-known clinician, academic and researcher. You also founded and are the Editor-in-Chief of the Journal of Medical Case Reports. When and why did you decide to launch a journal dedicated to case reports?

>  Dr. Michael Kidd (Dr. K): We established the Journal of Medical Case Reports back in 2006, almost 20 years ago. And at the time, it was the first international medical journal which was dedicated to case reports from all disciplines in medicine. About 200 journals focused on case reports have been founded since then. Which is great!

Case reports have been the basis of clinical medicine going back hundreds of years

        The reason for establishing the Journal of Medical Case Reports was that, as you know Mikhail, a lot of journals decided to stop publishing case reports. But case reports have been the basis of clinical medicine going back hundreds of years. Doctors and other specialists utilized them to report findings of what they'd seen with their individual patients, the conditions they'd seen, the treatment strategy, how effective those treatments were in their patients. Bringing together different case reports then helps us better understand what's happening. They help us define new research questions which need to be answered, paving the way for clinical trials. Case reports have essentially been a foundational part of clinical medicine.

        At the time of journal inception, I went back and looked at the writings of Hippocrates, and much of his writing was in the form of case reports about individual patients that he saw. And from that he came up with different postulates for medicine. So back in 2006, we started the journal. There was immediately a lot of enthusiasm. 

        As I mentioned, a lot of journals stopped publishing case reports. In part, this was because case reports are not always well cited, and many journals were worried about their impact factor and felt that having case reports may bring down their impact factors. So, they stopped publishing case reports and we thought “well, this is crazy, we still need case reports, we still need them published in the literature, so let's set up a journal which is specifically dedicated to case reports”. Our journal has an impact factor, demonstrating that case reports are well cited and remain important.

A case series, reported in CDC’s Morbidity and Mortality Weekly Reports (MMWR) about five men in the USA, who were diagnosed in 1980-1981 with an unusual pneumonia. This was the first reported publication on HIV/AIDS

        As an example of case report relevance, I provide one of the most highly cited journal articles, a case series, reported in CDC’s Morbidity and Mortality Weekly Reports (MMWR) about five men in the USA, who were diagnosed in 1980-1981 with an unusual pneumonia. This was the first reported publication on HIV/AIDS, and it was a case series of just five people. It became one of the most highly cited publications in medical literature. And we thought “OK, well, we'll publish lots of case reports and among the things that we publish will be the next first report of a new disease, a new presentation, a new relationship”.

> Dr. S.: I completely agree. It often feels like case reports are a starting point, a foundation for further research. In your response to my first question, you already answered my follow-up question: “what value do case reports have in medicine?” Do you want to comment further on that?

 In the era of evidence-based practice, we need practice-based evidence

>  Dr. K.: I like saying that in the era of evidence-based practice, we need practice-based evidence. And the basis of that evidence is often the detailed information that comes from case reports of individual people, and that helps to define prospects for clinical research. In our journal, we particularly focus on publishing case reports of things that have not appeared in the medical literature before. This includes a first time a condition may have been reported in a certain gender, particular country, setting, region, population group.

        We're interested in unreported or unusual side effects or adverse interactions involving medications, especially medicines that are new to the market, because often the first time we hear about side effects is not during phase three trials, but only after, once the drug has been released into the market. We are interested in publishing on new and emerging diseases, unexpected or unusual presentations, associations or variations in diseases. We have been publishing a lot of COVID-19 case reports, including some very unusual presentations of COVID-19 since the disease first appeared four years ago. We publish unexpected events that have happened during patient treatment. We actively publish findings that shed new light on a disease, condition, or drug, and which can help inform the medical community, improve our knowledge and most importantly - improve the safety and quality of patient care.

        Now, those criteria may seem quite restrictive that we're only publishing things which haven't been published in the medical literature before, but our journal publishes over 600 case reports every year, so there are lots of things that have not yet appeared in the medical literature. And I think the greatest value of having publications like this is getting people thinking about things in different ways.

There’s lots that can actually be done with case reports that can help foster further research and further discovery

        We also consider research articles that use case reports. For example, we receive case series articles where researchers are looking at reports of patients with similar conditions, even with meta-analysis. What knowledge can we pick up looking at different case reports on a particular condition from around the world, and does that help us to develop a new set of principles on the management of a new disease or a new association? This way, we encourage looking at how case reports can be used in larger research projects. There’s lots that can actually be done with case reports that can help foster further research and further discovery.

>  Dr. S.: Thank you. And again, I absolutely agree with what you are saying. Case reports are often regarded as having a low impact. However, many clinicians rely on case reports in their practice for the detailed information they offer that would otherwise be absent in larger prospective studies. Do you think case reports have a capacity to serve as a resource for larger data synthesis and analysis? You have touched on this question in your previous response, but I would like to hear more of your thoughts on this.

It's rare to have a day go by as a clinician where you don't see something and think “I've never seen that before”

>  Dr. K.: As I've mentioned, there are some case reports which end up with a lot of citations, particularly if they describe something new, something novel. And you're exactly right, the capacity to bring case reports together from around the world to allow large data analysis and synthesis is promising and undervalued. That capacity for this is certainly there and it's a lot easier to do now than it used to be. In our time you can search and find case reports very easily. And for those of our readers who are clinicians, you know it's rare to have a day go by as a clinician where you don't see something and think “I've never seen that before”, so the capacity to report is endless.

        Often when you can't find something in a textbook, but you can find something similar by looking up published literature and find published reports on similar patients. And then you can get some insight into how this was managed by that particular author group and “does that apply to the patient that I'm seeing in front of me right now?”. 

Case reports will become even more important as we move more and more into the era of precision medicine, designer drugs and boutique therapies

        Our journal is particularly interested in case reports focused on early detection of serious side effects of new medicines, and I think these case reports will become even more important as we move more and more into the era of precision medicine, designer drugs and boutique therapies. Being able to say “here is our patient, with this particular precision medicine application, here's what happened” is central to transparent reporting and knowledge sharing. And then other doctors who have patients with similar presentations can read it and say “well, this gives us some guidance on how to manage our own patient”.

Being able to look at individual genetic profiles and work out personalized approaches to disease prevention and management, hand-in-hand with targeted pharmaco-genomics will give case reports a whole new value and solidify their importance while these new technologies evolve across healthcare

        So I think - I know you're going to ask about the future - I think the future for case reports is going to show substantial growth. Case report publications will grow as we finally become able to meaningfully apply genomics to healthcare. Being able to look at individual genetic profiles and work out personalized approaches to disease prevention and management, hand-in-hand with targeted pharmaco-genomics will give case reports a whole new value and solidify their importance while these new technologies evolve across healthcare.

>  Dr. S.: Going back to the novelty and types of case reports that are published, we can clearly see that the criteria to publish a case report remain strict, with a decisive focus on novelty. However, in the era of Open Access publishing and research convenience, where researchers have access to nearly unlimited sources of data with a click of the mouse, does it make sense to relax criteria for publication of case reports for the sake of data accumulation and synthesis? Along with that, should stricter standards be imposed on how a case report is reported? For example, asking authors to be more detailed about things that you might not even attribute to the case for the sake of identifying patterns that would otherwise go unnoticed?

>  Dr. K.: We adhere to CARE case report guidelines, developed by the CARE group which our journal was part of back in 2013. And they provide a framework for the structure of case reports. I completely agree with you and I support your approach about having some consistency in the way case reports are structured. We require our case reports to contain all necessary information to conform with those guidelines.

        What you are saying is very interesting. In this era of big data, we have access to large numbers of patient records from encounters in hospitals, clinics, primary care centers, and each of those records is a description of a single case, a single person. Research commonly looks for data linkage, data consolidation, but a lot of big data work in healthcare is challenging due to lack of consistent reporting. But that’s a challenging task. There are 200 case report journals, many of them are listed on PubMed, and you want to find case reports on a particular condition, medication or complication, you can look and find these reports, but some of them will be of better quality than others, some will report differently. And so that accounts for the challenges that you're describing. But I think this is just another area that will continue growing, evolving and improving.

There's a huge value in Open Access publishing, and content published this way may be beneficial in ways that we never imagined. This is one of the great strengths in the move to Open Access publishing and we are very proud that our journal has been Open Access for 18 years, which made it one of the pioneering journals in this movement, which has now become the standard

        Journal of Medical Case Reports began publishing Open Access back in 2006 as part of BioMed Central, now BMC, and we very much supported the idea of publications being available freely to everyone in the world, not just available behind paywalls or available through University libraries. We feel that the general public should be able to access the publications as well, and Open Access allows that. Many of the people who end up reading our case reports are people who may have the condition that's being described or may be about to consider starting treatment with a medication which is being described in one of our articles. There's a huge value in Open Access publishing, and content published this way may be beneficial in ways that we never imagined. This is one of the great strengths in the move to Open Access publishing and we are very proud that our journal has been Open Access for 18 years, which made it one of the pioneering journals in this movement, which has now become the standard.

>  Dr. S.: So what advice would you give young researchers, doctors and medical students who are reluctant to publish case reports, due to the notion that they are not impactful?

Many of us started out our academic careers with our first publications being case reports... If you see something in one of your patients which is interesting and new, I think you have an ethical imperative to seek consent from that patient and, if consent is provided, report it to share that knowledge with colleagues around the world

>  Dr. K.: Many of us started out our academic careers with our first publications being case reports. Noticing something interesting among a member of our patient population, looking up and discovering that this wasn’t reported – is how many of us published our first manuscripts. Besides, case reports do include research: we do expect authors to have reviewed the literature to find out what they can about the condition as part of the discussion section in their case reports.

        For many young clinicians, a case report is a great way to get started in their academic career. If you see something in one of your patients which is interesting and new, I think you have an ethical imperative to seek consent from that patient and, if consent is provided, report it to share that knowledge with colleagues around the world. Yes, it may be a low impact publication, but it may also be a very high impact publication.

>  Dr. S.: You never know.

>  Dr. K.: You never know - exactly. And I fervently believe that this is part of our ethical imperative as clinician researchers - to share the findings that we have, but as I mentioned, it must be done with the consent of the patient or someone who can provide consent on their behalf.

>  Dr. S.: Thank you. Now my final question, which lines everything up: what advice would you give journals and editors in consideration of case reports?

 Every case report is a little bit like a mystery story where you're working out as you read what might be happening and what might come forward

>  Dr. K.: I think the approach that journals have, where they don't publish case reports because they affect the impact factor - I think that is an old-fashioned approach. I think that we proved over the last 20 years that case reports can be impactful and important contributors to medical literature. I think they are especially important for journals that focus on a particular specialty, a group of diseases or conditions – for these journals, case reports add great value for the readership. Clinicians enjoy reading case reports and enjoy testing their own knowledge, because every case report is a little bit like a mystery story where you're working out as you read what might be happening and what might come forward.

        Case reports help to get you thinking in different ways and often they relate to a patient you may have had or a patient that you may see in the future, so I think that there is a strong argument for journals publishing case reports. Having said that, you know I've been very happy that a lot of the journals in the BMC series have engaged in transferring of case reports to our journal. I think this is one of the strengths of the BMC series: that we've had the Journal of Medical Case Reports sitting alongside other journals in the stable and we're all benefiting from these publications. I hope that journals will start to see that they should bring case reports back into what they publish rather than having what they had 20 years ago: a rather arrogant attitude towards case reports.

>  Dr. S.: What if we did not have the Journal of Medical Case Reports in BMC. Would we have missed the opportunity to publish numerous valuable reports?

>  Dr. K.: If we didn't have it, we'd probably be creating it now, as many other publishing houses have done over the past 18 years since we launched the first international journal publishing case reports from all medical disciplines, the Journal of Medical Case Reports.

>  Dr. S.: Thank you, Professor Michael Kidd. It was a great pleasure talking to you today. I am positive that our readership, editorial board members and journal teams will be inspired by your talk. I know many of us share your enthusiasm and passion toward case reports and are excited to see how they evolve in the era of Open Access publishing.

Interview held on October 25, 2024. Published on SN Research Communities on January 31, 2025.