The Open-Source Journal Epidemic! A New Money Changer In How Science Gets Published


My first submission of a manuscript to a medical journal was in 1983, and whether it was going to get published or not was up to a small, discrete group of highly educated “old dogs” at the top of the ladder in that field of surgical medicine.  That was during the “golden age” of medicine when a few individuals, who had taken full advantage of the opportunity afforded them in our free and democratic society, rose to a level that influenced the direction that their branch of surgery would take from that point on. After many brutal reviewer comments and several revisions, the paper did get published. Was it a landmark paper that I would be proud to reference today? No! Did the conclusion of that article hold up over time? No! Other than the journal getting its usual subscription fees from their readers and the author getting a small amount of notoriety, which in this case wasn’t all positive, did that article do anything more than just present to an interested group of people a particular set of data from one surgeon on a particular subject? No! Was there value to the medical education system in going through that whole submission and publishing scenario with this particular study? Yes!


During this golden age journals did succeed, most of the time, in presenting subscribing surgeons with the latest data and conclusions resulting in the necessary dialogue that creates controversy and growth. With this steady influx of new information through journal articles surgical medicine and the way it was perceived and practiced slowly advanced over time.  During those times surgeons published for two major reasons. The first was that they were part of an academic institution and expected, by both the institution and their peers, to be responsible for advancing surgical medical education. The second was that hundreds of surgeons who were in private practice made observations that they pursued for the sheer passion of assisting in the process to change how surgical medicine was practiced. In both cases the academics and the private practice surgeons would gather their data, write their papers and submit them to a journal without paying the journal anything, in hopes that their work would be published. The other glaring fact was that during this time industry had not yet infiltrated medical education and the surgeon was not first and foremost an entrepreneur.


Fast forward to 2018.  Everyone should agree that the landscape for creating research projects, gathering data, and submitting studies to journals has changed immensely since that golden age. I am pretty sure that most will agree that many of these changes have been for the better in terms of involving investigational review boards to protect patients, having medical credentialing committees to keep dangerous surgeons and projects on the shelf, creating levels of evidence to be able to judge a study on scientific merit, the advancement of statistical analysis to better quantify data, open source publishing in it’s pure form, and the growth of national and international meeting platforms to allow all opinions concerning a study to be heard.


There are two areas where the deviations from those of the golden age are creating situations resulting in generating potential opinions on surgical studies that may be loaded with what has come to be well known as, “conflicts of interest”.  These deviations are; the way articles are being peer reviewed and how the journals are getting paid to publish a study.


These two items go hand in hand and are found in what we now recognize as open source publishing. In the past ten years a plethora of open source surgical journals have sprung up all over the world. The way that a purely open source journal differs from a printed journal is that no one has to pay to read an open source journal article. If someone wanted to read an article by a journal that prints the article they would have to pay for it or for a subscription to the journal.  Unfortunately for the reader, and ultimately the reason for this post, is that they ultimately get what they pay for. Let me explain.


When a surgeon or scientist or whoever submits an article to an open source journal, that journal does not get paid to sell that article to anyone. Once its on line anyone who wants to read it can do so for free. The open source journal company thus has to change how they do things in order to get paid.  They do this by having the author pay up front for the handling of any images that are contained in the article.  That is how it all started out, but due to the genius of these open source journal companies there are now several ways for them to make their money up front.  These costs, as stated to me by reliable sources, can be anywhere from a few hundred dollars to a few thousand. What naturally follows is that these open source journals are now actively soliciting authors to submit their work.


The way these articles are “peer reviewed” so they can then get published is very different than the golden age when we knew that this very important and crucial component would be performed by one of the “experts” on that subject.  As an example, one of my colleagues during the submission of a paper to an open source journal was asked if he would provide a list of potential reviewers for the paper. They did stipulate it could not be a partner. There are many similar scenarios like this, but I’m sure you get the point. This is a far cry from the standard for reviewers that once existed.


Let me get to my main point. Let’s say that you are an enterprising orthopedic surgeon who has created a device that you believe does a particular job well. You do your cases, gather and analyze your data, write your paper and send it to a respectable journal with strong peer review and one that, if it gets printed or published, makes their money off the sale of that article, which can occur in a multitude of forms. To your forlorn it is rejected, and you submit it to other similar journals with the same result. You are wanting to get this published as you know it will help to sell your device and your procedure to both surgeons and hospitals. You are also aware that a publication can possibly help you to sell it to industry. Selling a device these days in the good ole USA capitalistic system can mean millions. In the past that was it; no further publication options. Today you are in luck.  There are open source journals to get your data published. The only thing you have to do is locate one, that is unless they have already contacted you. You put lots of images in the article, pay their fees and off it goes to their “reviewers”, which you helped to chose. Bingo! You just got published. It doesn’t take a brain surgeon to see that this particular incident is full of “self interest”, both on the part of the author as well as the open source publisher. This is only one of the multitudes of possible scenarios that do occur, every day.


I accept all criticism this post will generate concerning my narrow and relatively harsh assessment of our, now here forever, open source publishing system. In reply my reason for doing it this way is not to condemn the process in any way, but to point out the potential abuse that this new-found freedom can produce in the hands of self-serving authors, entrepreneurial surgeons, Industry and open source publishers. My opinions on this subject have been evolving over the past several years as I continue to receive in my own e-mail at least a dozen solicitations a week, each from different and seemingly new open source publishers, to submit papers to their journals. As the cases of abuse for profit of the open source publishing system continue to occur, the burden then falls totally on the reader and interpreter of the published material to determine the true validity of what is being said and the potential underlying reasons for it being published. It is now that ethical clinicians, scientists, engineers and so forth, need to be applying the same scrutiny to these papers and the data they contain as did our reviewers during the golden age of medical science journal publishing. The big question is, how many readers today possess the abilities to perform that task?   At the very least every reader of an open source journal article discussing the results of a surgical device should seek out if the company making the device paid to have it published.  If it did it could be a big red flag.



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