Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Journal of the American College of Cardiology, Dr. Valentin Fuster, Editor-in-Chief, Heart House, 2400 N Street NW, Washington, DC 20037.
“One may know how to gain a victory, and know not how to use it.”
–Pedro Calderón de la Barca (1600 to 1681) (1)
Only through sharing, collaboration, and helping each other will the field of cardiovascular medicine continue to advance at a rapid pace. No single investigator or physician can gain victories toward unique pathways of care without standing on the shoulders of their colleagues. It is with this recognition and a desire for true transparency of clinical data that I started to incorporate certain changes for the future of the Journal.
Among these changes is a Clinical Perspectives section as a pragmatic summary at the end of each original investigation in the Journal. This summary has 2 components: 1) a competency component, or learning implications for the reader that may be applicable to the contemporary care of the patient; and 2) a translational outlook component, or anticipation of the next or future steps of research that may be applicable or developed by our research community. Thus, both components of the Clinical Perspectives section have 1 thing in common: a genuine “sharing” between the authors and the medical community that can significantly facilitate advancement in our field.
First, what are the Clinical Competencies? The American College of Cardiology Foundation has adopted 6 domains of physician competency-based learning in cardiovascular medicine for its training statements, career milestones, lifelong learning, and educational programs. These competencies, promulgated by the Accreditation Council on Graduate Medical Education and endorsed by the American Board of Internal Medicine, include medical knowledge, practice-based learning, patient care and procedural skills, systems-based practice, interpersonal and communication skills, and professionalism. As stated in the JACC Instructions for Authors, authors are asked to consider the clinical implications of their report and identify applications in 1 or more of these competency domains that could be used by clinician readers to enhance their competency as professional caregivers. In other words, such summarized “sharing” with the clinician reader of the most valuable clinical material from the published investigation may provide instant knowledge applicable to the patient as a new addition to “clinical judgment” before “clinical guidelines or statements” slowly evolve.
Second, as part of the Clinical Perspectives section summary, the Journal also asks the authors of every original investigation to delineate the directions for future research with the most promising translational implications for patient care. This short overview should provide, in particular to the investigator reader, insight into the next steps of research that may be applicable or developed by our research community. Having been part of the translational research community for at least 3 decades, I know that this component of the Clinical Perspectives will be a challenge for the investigators. Having read about 3 dozen papers to be published in the next few weeks, I am learning that some authors are much more cautious or perhaps less committed than others when writing the translational outlook. This comes as no surprise to me because, as it is well recognized, academic medicine and research fosters a competitive nature—even within single institutions. As a result, some authors are hesitant to reveal the specifics of where research is heading for fear that someone will publish first in the same area of investigation. It is exactly these fears that I am trying to eradicate through these Clinical Perspectives. Thus, in the JACC Instructions for Authors, we present 3 examples of Translational Outlooks—1 for basic science, 1 for clinical investigations, and 1 for global research—that illustrate our intention. In the basic example, we encourage investigators, who are evaluating positron emission tomography imaging of “high-risk plaques,” to develop a randomized study on the evolving and existing use of mannose as a tracer. In the clinical example, despite recent discouraging results, we encourage investigators and industry to pursue further research to understand the mechanism, safety, and efficacy of the so-called novel oral anticoagulants, alone or in combination, in patients with mechanical prosthetic heart valves. In the global example, based on the unsatisfactory compliance to medication of patients with coronary artery disease, we encourage randomized studies comparing the compliance of patients taking 1 of the already-developed “polypills” (i.e., including aspirin, statin, and an angiotensin-converting enzyme inhibitor) with the compliance of patients treated conventionally with the individual agents.
As demonstrated in the 3 preceding examples, we are trying to convey a sense of transparency to advance the cardiovascular field. With the hope that our whole community will embrace this philosophy, I challenge my fellow researchers—and I will hold myself to the same standard—to be as transparent as possible with the translational outlook for their work.
However, being transparent about the direction of research does not necessarily correlate to instant online publication of the results. There is a current trend in which papers appear online almost immediately after the authors are done writing the manuscript. But who benefits from posting an unedited manuscript online without the context of an editorial comment or the Clinical Perspectives: the author himself or herself or the cardiovascular field at large? I would argue that this type of fast-paced medical publishing reinforces the more selfish, competitive aspects of academic medicine, as opposed to truly helping the clinician to care for his or her patients. It is far more important that we take the time necessary to release high-quality, completed manuscripts, accompanied by a thought-provoking editorial commentary to contextualize the findings.
To return to the concept that began this Editor's Page: we all need to learn from each other and help each other to propel the field of cardiovascular medicine. The great 17th-century Spanish playwright Pedro Calderón de la Barca spoke about those individuals who attempt to attain victories in a silo, self-contained and independent from the rest of the medical community. The result is that “they know not how to use [their victory]” (1). The best medicine always results from an ongoing, collaborative process.
- American College of Cardiology Foundation
- ↵Pedro Calderón de la Barca. Available at: http://www.brainyquote.com/quotes/quotes/p/pedrocalde176293.html. Accessed June 9, 2014.