Monday, June 30, 2008

Medical journals join the 21st Century at WOC

In a time of instant messaging, online interaction, and easy access to information online, medical journals often seem soooo last century. EuroTimes listened in on a session given at the World Forum of Ophthalmological Journal Editors in which editors discussed issues they face in the 21st century.

Open-access publishing

Cost issues, commercial influence scandals, and a call for public access to government-funded studies all helped create demand for new models of peer-reviewed medical information delivery. In particular Biomedcentral and the Public Library of Science have quickly gained support and have forced traditional journals to re-evaluate their methods.

However, the concept of what should be open access in the medical field is controversial because while it offers advantages, it can also result in a variety of threats, said Thomas J Liesegang MD, editor-in-chief, American Journal of Ophthalmology.

Quality of content and its interpretation are two major concerns about open access.

“Access to information is crucial to the health and economic wellness of people in all countries, but I maintain that health information is not the same as other information on the web. It needs to be vetted and I also maintain the average consumer does not have the skill to discern good from bad science,” Dr Liesegang said.

There is also the concern that historical scientific literature may be lost as there may not be enough resources to support both traditional and open-access systems simultaneously and continuously. Some journals may not be able to afford to appear in open access and the result could be the termination of small non-profit scientific journals or societies, Dr Liesegang explained.

Open access can be supported by a pay-to-publish model. However, some authors, especially in developing countries, cannot afford the fees, and institutions will have to decide which researchers to support. The result may be that journals become filled with articles supported by commercial interests.

Quality of research published is another issue as some start-up journals in need of material may be willing to accept any manuscript.

“The old subscription-based model has worked well and should not be abandoned until another form of communication is vetted and proven successful,” Dr Liesegang said.

EuroTimes looked at these issues in an earlier article,
Click to read article.

Evidence-based medicine

Randomised clinical trials are considered the gold standard of medical knowledge, and yet the high costs of developing this evidence-based medicine are making it affordable only to multinational drug and device company sponsors, said Francesco Bandello MD, Chinese Journal of Ophthalmology.

The result is a potential for publication of biased and misleading information. And even when the study is high quality, questions remain about how far and to which populations the results can be generalised.

Dr Bandello acknowledged he has no answers to the existing issues. He proposed it may be useful to have trials conceived, designed, and planned by physicians and sponsored by public, independent bodies. Importantly, it is also critical that trials with negative results be published.

“Perhaps we need to pay greater attention to small, smart, independent studies and to focus more on the substance of the research and not just the methods,” he said.

Citation analysis

Citation analysis methods assume more influential articles are cited more often, and these data are being widely used in research environments and by institutions. However, the information can be misleading, said Charles McGhee MD, PhD, editor, Clinical & Experimental Ophthalmology.

Dr McGhee discussed how the perception created by such statistics as citation counts and journal impact factor can differ from reality, and he also reviewed a new parameter – the H factor and provided an example to show it can be misconstrued when comparing two authors.

“The sole reliance on citation data provides at best an incomplete and often shallow understanding of research, an understanding that is only valid when reinforced by other judgments. Numbers are not superior to sound judgment,” said Dr McGhee.

Clinical trial registration

Andrew Schachat MD, editor-in-chief, Ophthalmology, discussed registration of clinical trials, noting that this issue gained attention due to concerns about publication bias favouring clinical trials with positive results. The idea behind registration is to get all trials out into the public record and it is required by all International Committee of Medical Journal Editors' member journals.

While three years ago registration was the exception; it is now becoming the rule. This is a change for the better. However, there is still room for improvement, said Dr Schachat.

“Registration facilitates the dissemination of information among clinicians, researchers, and patients. It also helps to assure trial participants that the information accrued as a result of their altruism will become part of the public record. However, key challenges remain, including problems with duplicate registrations and a need for better search engines,” he noted.

Reviewer issues

For peer-reviewed journals, the present system an editor uses to decide whether a submitted manuscript should be accepted, revised, or rejected depends on his or her review of comments provided by two or three reviewers who are “experts” in the field and anonymous to the author(s). However, problems plaguing this system have driven interest in an open system of review where the reviewers’ identity is made known to the author(s).

“The open system seems to make more sense because it would level the playing field and result in a review that is fair, just and constructive. However, it may be more difficult to find reviewers, and those who accept may tend to be less critical, resulting in higher acceptance rates for already overburdened journals,” said Arun Singh MD, editor, British Journal of Ophthalmology.

Studies evaluating open systems show these fears are well founded, and Dr Singh noted that while reviewers for papers submitted to the British Journal of Ophthalmology are offered the option for open review, only 15 per cent accept.

“We must move towards an open system of review, and newer technology, like Internet blogs, may make this easier. While we are not there yet, I think we may get there sooner than some think,” he said.

Continuing with the topic of reviewers, Alexander Brucker MD, editor-in-chief, Retina, discussed the challenges and opportunities for their selection that have emerged in the computer age. While the number of manuscripts being submitted to journals has increased thanks to the ease of online submission and recent growth in the number of journals, the number of reviewers has not kept pace with the demand, Dr Brucker said.

On the positive side, the Internet has made it easier to identify and contact potential reviewers, and it has also facilitated the reviewing task itself. However, potential reviewers receiving an email message soliciting their cooperation are also finding it easier to refuse by simply selecting the “decline” button, noted Dr Brucker.

“These are exciting times for medical journal editors. We face a number of challenges, but also have opportunities to seize that can result in an improved final product that is better for our consumers,” he said.

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