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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122
Competition is an integral factor in virtually all forms of the human endeavor. The competitive process is perhaps best recognized in athletics, business, or politics, but is nearly always present whenever 2 or more individuals engage in the same activity. So it is not too surprising that, although scientific publications (and medical journals in particular) operate in a genteel environment, competitive forces are also present in this arena. The possibility that these forces may have an adverse influence on the behavior of journals has stimulated this Editor’s Page.
As in any form of competition, the way efforts are directed is determined by the way that the score is kept. As I described in an earlier Editor’s Page, a number of criteria exist by which the success of a journal can be graded. The simplest and most often used criterion is the impact factor based upon the number of citations to articles published in a journal. This standard is badly flawed and of questionable value, a statement I feel comfortable making since the impact factor of JACChas done well for the past several years. The size of the readership of a journal is an important metric of success, as is financial profitability. The number of manuscripts submitted, the quality of the reviews, and the rapidity of the decisions regarding publication are additional parameters of the health of a journal. While none of these criteria are perfect, in aggregate they represent the criteria by which the score is kept when journals compete against one another.
Regardless of the standard applied to evaluate journals, all are strongly dependent upon the quality of the manuscripts which are published. Clearly, the potential to be cited is much greater for novel, clinically important papers, and these papers are more likely to attract readers and, therefore, advertisers and subscribers. These factors will in turn lead to more and better submissions so that the cycle is repeated. Thus, the major goal of every medical journal is to attract that relatively small number of manuscripts which contain very original findings which are accurate and will have a significant impact on clinical practice.
A variety of strategies have been employed by journals to obtain these high-impact articles. As previously stated, rapid review and decision was a mandatory starting point. Editors thereafter began to solicit the submission of manuscripts which were identified as potentially having high impact at the time of their abstract presentation. Subsequently, some editors sought manuscript submission prior to abstract presentation, and a few invited manuscripts upon the completion of study design or the beginning of enrollment. The solicitation initially consisted of expressing a strong interest in the work and promising to provide an initial decision very rapidly. However, in some cases an agreement to publish prior to completion might be offered contingent upon the study being implemented as designed. The ante was increased in many cases by agreeing to publication simultaneous with the abstract presentation, usually with major coverage by the lay media. As time went by the “football fan” phenomenon took place; just as fans in a stadium have to stand if those in front of them do, so editors had to offer the same attractions as the competing journals. And so, the release of new, clinically relevant data, usually with great media attention, emerged as a high-scoring action in the competition between journals, and became a magnet to attract high-impact papers.
I should confess at this point that JACChas not been immune to participating in the game. From the start we have offered expedited review of papers that are of immediate clinical or research importance. We have made each issue of the Journalavailable to the media, and highlighted select articles for press releases. Recently we have offered expedited review (with the potential for simultaneous publication/presentation) to the most highly graded abstracts selected for presentation at the annual meeting. We have fully been a part of the football fan phenomenon.
I have been stimulated to write about this topic for several reasons. I marvel at the changes that have occurred during my years in cardiology. As a junior faculty member I would never have dreamed of asking for expedited review. The only journals that solicited manuscripts seemed to be those that were not receiving them otherwise. I cannot recall many major media events based upon the publication of a paper. Times have changed.
I am concerned that the competition between journals has begun to influence our behavior. The inappropriate importance given to the impact factor can bias manuscript acceptance toward those that are “most citable.” The attempt to garner readers may similarly influence the rejection of good papers which may be of interest to only a subset of readers. Expedited reviews may be rushed and not as thorough as possible. Based upon the relatively low percentage of highly graded abstracts which we have accepted for publication as full manuscripts, the process of aggressive solicitation of papers at an early stage may be disappointing for the author and embarrassing for the editor.
My greatest concern, however, relates to the seeking of media exposure and the fanfare that frequently accompanies publication of select articles. The ability to attract media attention appears to have become a criterion of a successful journal. It seems to me that this media orientation has the ability to influence the selection of manuscripts and the portrayal of their results. Although it is impossible to know, one wonders if such considerations played a role in the recent controversy surrounding a published manuscript which reported a possible increase in adverse cardiac events with rosiglitazone (1). In addition, to being a meta-analysis, the study had many limitations. In fact, the authors themselves were very circumspect in delineating the limitations in the manuscript and were very cautious about the conclusions that could be drawn from the data. Nevertheless, not only was the manuscript rapidly accepted for publication, but it was quickly made available online and trumpeted widely to the media, creating problems for both patients and physicians. This was done despite the fact that the data were inconclusive and that many authorities did not feel that any change in patient management was indicated (2). It would certainly be regrettable if the desire to attract high-impact articles, evidenced as such by the ability to garner media attention, had any influence on the way the manuscript was handled. Perhaps the time has come for all medical journals to evaluate such policies.
Although medical journals are erudite and genteel, they are subject to the same competitive pressures as all other segments of society. This is good as it elicits the best possible performance. However, competition can provide incentives which are capable of negatively influencing behavior. I believe that attempting to couple major media coverage with the expedited publication of manuscripts, if intended to endorse the importance of the paper and the journal, may be one example of such negative influence. For medical journals, it is probably better to be definitive than first, to be circumspect rather than to extrapolate excessively, to first provide data to those best able to interpret them rather than directly to the lay public.
- American College of Cardiology Foundation