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 for correspondence:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
“Patience is bitter, but its fruit is sweet.”
—Jean-Jacques Rousseau (1)
Contemporary Western culture is breeding impatience and instant gratification. In most American metropolitan areas, shoppers can place an order on Amazon by 11:00 am and, for a small fee, have that item delivered within the same day (2). Similarly, Walmart launched Walmart-To-Go, with same-day delivery. Multiple studies have demonstrated that the proliferation of smartphone usage is leading to more impatience as a result of decreasing attention spans, especially among the younger generation who were raised with this technology (3–5). One recent survey of 1,000 U.S. adults demonstrated that >50% of Americans admit to honking after the light turns green, a majority will wait ≤10 seconds before passing a slow walker on the sidewalk, and 72% of the younger generation surveyed admit to pushing an already lit elevator button (6).
Amid this fast-paced, impatient culture, the publication and communication of clinical science should stand apart by maintaining a thoughtful, responsible approach. Thus, when faced with the emergence of pre-print servers of unreviewed clinical publications (7), some of my fellow editors become quite concerned. In fact, I have consistently expressed caution about the efforts to rush clinical data into the public arenas before it undergoes an appropriately rigorous peer review process. In February 2016, I warned that expediting the publication process in medical research could result in a race to open Pandora’s box (8). Since that time, I have only become more resolved, as it is my impression that papers that are rushed through the peer review process for the purpose of simultaneous publication with major medical meetings often contain the most errors. Clinical medicine manuscripts should undergo rigorous peer review, including a statistical evaluation; and only after that process should they be disseminated into the clinical community. As I have written many times, our first calling as cardiovascular clinicians is to the Hippocratic Oath: to do no harm (9). As editors, we see manuscripts evolve and improve in accuracy through the review and revision processes, including sections of the text, analyses, and the author’s interpretation of the findings (10). The iterations of these manuscripts are substantive and critical, because we recognize that the findings could influence how the clinician treats his or her patients. Although I have always acknowledged the imperfections of the peer review process, it is the best system available to us for thoroughly evaluating clinical manuscripts for the medical community. Being challenged by our peers only makes the field stronger.
Again, publishing scientific data within clinical medicine is a tremendous responsibility, which is distinct from papers published within the biological and physical sciences communities. Pre-print servers in clinical medicine are not easy to justify. We already know that it takes 15 to 20 years to truly translate evidence-based research into clinical practice (11), even when those data are well validated. Why would we want to muddy the waters with rushed, unreviewed data? Oftentimes, it is difficult to discern where information is originating from when we search online. Thus, I propose that we could be inadvertently harming the patient/physician process if we allow for unreviewed data to be published in the public domain.
Finally, who will benefit from the release of such data earlier? Neither the general public nor the practicing clinician will benefit, as they may be confused by potentially conflicting data and recommendations, if unreviewed manuscripts are equally as discoverable as peer-reviewed papers. Thus, I would propose that manuscript authors are the only ones who may benefit from the process. They can promote their “publication” on social media and within their departments, but these manuscripts should not maintain the same level of credibility as peer-reviewed papers. Maybe, the medical community could all benefit from a little patience.
- 2017 American College of Cardiology Foundation
- ↵BrainyQuote. Jean-Jacques Rousseau quotes. Available at: https://www.brainyquote.com/quotes/quotes/j/jeanjacqu122782.html. Accessed November 3, 2017.
- ↵Muther C. Instant gratification is making us perpetually impatient. February 2, 2013. Available at: https://www.bostonglobe.com/lifestyle/style/2013/02/01/the-growing-culture-impatience-where-instant-gratification-makes-crave-more-instant-gratification/q8tWDNGeJB2mm45fQxtTQP/story.html. Accessed October 27, 2017.
- Wilmer H.H.,
- Chein J.M.
- ↵Watson L. Humans have shorter attention span than goldfish, thanks to smartphones. May 15, 2015. Available at: http://www.telegraph.co.uk/science/2016/03/12/humans-have-shorter-attention-span-than-goldfish-thanks-to-smart/. Accessed October 27, 2017.
- ↵Rogers S. Your mobile attention span is now so short you won’t finish this article. July 11, 2016. Available at: https://venturebeat.com/2016/07/11/your-mobile-attention-span-is-now-so-short-you-wont-finish-this-article/. Accessed October 27, 2017.
- ↵Fifth Third Bancorp. Ninety-six percent of Americans are so impatient they knowingly consume hot food or beverages that burn their mouths, finds Fifth Third Bank Survey. Available at: https://www.prnewswire.com/news-releases/ninety-six-percent-of-americans-are-so-impatient-they-knowingly-consume-hot-food-or-beverages-that-burn-their-mouths-finds-fifth-third-bank-survey-300026261.html. Accessed November 3, 2017.
- ↵The Yoda Project. MedArXiv. Available at: http://yoda.yale.edu/medarxiv. Accessed October 27, 2017.
- Fuster V.
- Edelstein L.
- Bauchner H.
- Morris Z.S.,
- Wooding S.,
- Grant J.