Editorial

from ACMS Bulletin October 2022

Legal Summary

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Paper Chase

Academic advancement, no matter what the discipline, is predicated on the “Publish or Perish” principle. Having one’s work published in peer-reviewed literature is a mark of academic productivity, sometimes regardless of the quality of the research. My entire fifty-year medical career in radiology was spent in academic programs. During that time, I was productive, being fortunate enough to have 170 papers accepted in the peer-reviewed literature, nine medical textbooks1, and 19 book chapters. Over the years I, like all authors, experienced the joys and disappointments of having my papers accepted or rejected, respectively. In the process, however, I learned a lot about the dynamics and the politics of medical publishing in my roles as an author, manuscript reviewer, and member of editorial boards for two radiology journals. What follows are my unapologetic observations on this important industry.

When I began my radiology career in 1970 there were two authoritative monthly radiology journals, the American Journal of Roentgenology (AJR, “Yellow Journal”) and Radiology (“Gray Journal”). Both earned their nicknames because of the color of their covers. AJR, first issued in 1906, was the official publication of the American Roentgen Ray Society (ARRS), founded in 1900. Radiology, first issued in 1923, was the official publication of the Radiological Society of North America (RSNA), founded in 1915. At that time there were several quarterly journals as well. With the explosion of new imaging technology (CT, ultrasound, and MRI) that began in the 1970’s, radiologists became superspecialized and new professional societies (such as the International Skeletal Society [ISS], formed in 1972) dedicated to those disciplines were formed. Each of these societies soon began publishing a journal (ISS began publishing Skeletal Radiology in 1974). Interestingly the tally of my papers published, by journal was: AJR – 48, Skeletal Radiology – 33, Emergency Radiology – 10, Radiology – 4 (the remaining 75 articles were in miscellaneous journals).

Evolution

As new technology developed there was an interesting pattern to the articles being published. CT was one of the first of the new technologies to emerge. Those practitioners who were fortunate enough to have the early CT units – almost exclusively academic teaching hospitals – began publishing their initial experiences of CT images of different diseases. Sometimes, these initial observations were erroneous. Once enough case material had been obtained, the same authors published follow-up reports on the topics they had initially reported, either validating their initial observations or explaining their mistakes. As ultrasound and MRI developed, the pattern of publication was repeated. MRI was ripe for publications because of the unlimited number of scanning protocols that are available. Hardly a month goes by today without a new scanning protocol for knee or shoulder MRI. The Paper Chase was made for this kind of technology.

Playing favorites?

The review process for all journals is supposed to be performed in an anonymous fashion, where the reviewer does not know the author or the institution at which (s)he is working. In my many years of reviewing manuscripts I encountered only two instances where I was aware of the authors’ identities, having been in attendance when they delivered the paper at a society meeting. In both cases, I returned the manuscripts with a note of explanation to the Editor-inChief, even though I knew I could give an objective review of the papers.

Loyal readers of the many medical journals will often recognize the same names of authors, or the same institutions of the published papers. In most of cases, this is justified. My colleague Dr. Donald Resnick at UCSD, a world-class researcher and author on musculoskeletal (MSK) disorders is a prime example. Some editors, however, have “favorite sons or daughters” or favored institutions and will accept any paper they write, regardless of its merit. An example from many years ago was a paper in the New England Journal of Medicine on the prospect of patients developing radiation-induced cancer from repeated diagnostic x-rays. This paper, which in my opinion was bad science (extrapolating radiation exposure data from the Hiroshima atom bomb), was published because it came from the Harvard School of Public Health and a prestigious main author.

The review process used to take weeks to months from the time a paper was submitted until a decision was made regarding its acceptability in the journal. The old system relied on “snail mail” via the USPS at every step. Since the mid-1990’s, the process has been significantly shortened. Submissions are electronic, Editors now ask reviewers to submit their assessments within ten days to two weeks, and authors are notified whether their work has been accepted (pending a revision according to the reviewers’ comments) or rejected within a month of the submission. Even if a paper is rejected, today, the author is sent a detailed explanation for the editorial decision. It was not always so.

Years ago, I presented a paper on the use of CT for diagnosing facial fractures, at the annual meeting of the RSNA. When authors present at these society meetings, they are required to submit a manuscript of that work to the official organ of that society. I duly submitted our paper which, to my knowledge was the first on the subject, to the “Gray Journal”. After six months had elapsed, and I had not heard from the editors, I made a phone call to the editorial office to inquire about the delay. I was told the paper was “still under review”. Three months later the paper was returned with a cover letter telling me that “the paper was reviewed and deemed unsuitable for publication” with no other comments. Coincidentally, that month’s issue of the journal had a similar article on CT for facial fractures, written by one of the “golden boys” the journal favored. Interestingly, our paper had more case material and better examples than those in the published article. I submitted our paper to another journal, where it was accepted with minor changes. I never submitted another paper to that society’s journal.

The “Publication Mafia”

Several journal editors-in-chief relied on their own faculty members for initial review of submitted papers. This has the advantage of saving time in the review process. However, this can also have a downside. One Editor relied heavily on this process, and his faculty reviewers applied their own interpretation of the findings reported in the papers submitted to them. I called this group the “Publication Mafia” because of some of their methods. We had submitted a paper on the use of T-1 MRI images of the pelvis and spine for the detection of metastatic bone lesions2. On T-1 sequences such lesions are uniformly dark and indicate areas where a bone biopsy should be performed to confirm the diagnosis. The paper underwent requests for six revisions before it was finally accepted for publication. The final revision request asked us to add material that earlier reviews had told us to delete! The reviewer’s comments demonstrated that the reviewers did not understand what we were trying to say. The published paper was subsequently listed among the top 100 the journal named in its centennial year for number of citations in the medical literature.

As another example, I wrote the editor of that same journal after receiving a very unprofessional review after a paper I sent to them was rejected. The second reviewer gave a different assessment with concrete suggestions to improve the paper. The editor asked me to resubmit the paper and he would send it to a different reviewer. I made the suggested changes of the second reviewer and sent the revised paper to another journal, where it was accepted as is.

Today, at least in the world of radiology journals, when authors submit their work electronically, they are often asked by the journal if they had any suggestions for who they would like to review their paper. This allows for true peer review. For example, in MSK we are even more specialized, with experts in trauma, arthritis, infection, sports medicine, and

Continued on Page 12

From Page 11 even modality (CT, MRI, ultrasound). In addition, the authors are asked if there any reviewers they do not want for reviewers (to prevent professional jealousy).

Times have changed

The last decade has seen the emergence of many commercial journals that will publish anything submitted to them, provided the author pays a fee for publication. Most are not listed in Pub Med. Hardly a day goes by where I don’t find an invitation in my Spam file to submit a paper. My former secretary, Maggie Cauley often said, “Every paper eventually finds a home”. Many of these papers are simply bad science. When I reviewed manuscripts that were sent to me, the first area I looked at was the “Materials and Methods” section, where I could quickly determine whether proper scientific methodology had been used or whether the paper reported bad science. Fortunately, in the “Publish or Perish” realm of academe, where the size of ones resumés are used for promotions, samples of the candidates’ works are submitted to outside reviewers to validate the quality of the research. It is a good system of checks and balances.

References:

1. Daffner RH. Making a book.

ACMS Bulletin July 2022, pp 9-11. 2. Daffner RH, Lupetin AR, Dash N,

Deeb ZL, Sefczek RJ, Schapiro

RL: MRI in the Detection of

Malignant Infiltration of Bone

Marrow. Am J Roentgenol, 1986; 146:353-358.

Dr.Daffner is a retired radiologist, who practiced at Allegheny General Hospital for over 30 years. He is Emeritus Clinical Professor of Radiology at Temple University School of Medicine.