Who Should Publish: A Call to Arms

I come from medical academia where the well known mantra “publish or perish” dominates behavior. Unsurprisingly, my fellow academics and I lord over the universe of traditional peer-reviewed medical journals as we strive to climb the scholarly ladder. Ironically, what this has come to mean is that the cradle of all medical knowledge, i.e. that information contained within peer-reviewed journals is, in reality, merely an indirect result, an epiphenomenon, of the totally unrelated, academic rat race. For several generations this symbiotic relationship with the professorial class collectively advanced the commons of medical knowledge. However, maybe now, it’s time for change.

In the modern world there is a widely acknowledged need to establish what works and what doesn’t work in healthcare; colossal sums of money are being spent on ineffective or even dangerous drugs and procedures, while some effective drugs and procedures go unrecognized and uncompensated. Moreover the pace of technical innovation and adoption is often glacial. This situation exists for one reason: inadequate published outcome studies.

Clinical trials funded by government and NGOs, and typically organized by academic researchers, can, when well executed, provide answers to important, albeit selected, clinical questions. However, the time and expense for such endeavors is substantial, which limits scientific queries to a mere handful of clinical subjects. Meanwhile, for the thoughtful observer of the medical landscape, it is clear that, if only by virtue of their numbers, the vast majority of clinical experience, and therefore medical knowledge, rests with non-academic physicians who very seldom publish in the peer-reviewed medical literature. If our modern world expects to answer many of the big medical questions of our time, is it not long overdue that non-academics participate in scholarly clinical research? Is it finally time to engage a vast army of underutilized foot soldiers to become citizen physician scholars who can also publish within journals and take credit for the findings they unearth?

Why is the clinical experience and knowledge of non-academic physicians woefully underrepresented in the world of peer-reviewed journals? For starters, the world of scholarly publishing has become the clubby province of medical academia, the origins of which stem from the above-described quest for academic promotion. In the subjective world of “peer review” the resulting culture can become exclusionary; academic studies have demonstrated an analogous bias against the papers submitted by female and foreign scientific researchers. The stereotypic perspective is that academics aspire towards an austere life of grand purpose and the status that comes from publishing their ideas, while non-academics, motivated merely by money, must toil away devoid of any of the recognition which publication bestows. Should they even attempt to publish in journals, innate bias stacks the deck against non-academic physicians. And yes, they know it! Moreover, what incentive does a busy private practice doctor have to contribute to the medical literature when arcane procedures and statistical analysis, designed for authors who aspire to NEJM or Lancet, increasingly dominate the process? Finally in the new world of open access, a cost of $1,000 to $2,000 is not entirely chump change!

I will argue that there are good reasons for non-academic physicians to publish in peer-reviewed journals. First up, there’s duty. Without a credible commons of medical knowledge no doctor can live up to his/her responsibility to patients, and we all know that hard won experience has taught each of us important lessons which could and should be shared with others. Out of collective need, comes a collective obligation.

Publishing good work also serves as its own reward. If only out of vanity, seeing one’s ideas in print (and now online) is ego gratifying. However, from a more selfish standpoint, publishing establishes one’s professional skills and knowledge for others to see, and in doing so, judge, the quality of our expertise. Smart clinicians have always known that publishing in the peer-reviewed literature can be the single most credible tool for establishing and burnishing one’s reputation among colleagues and patients. Isn’t a well reasoned scientific paper, even if only a case report, a better (and less costly) reflection of one’s skills than a highway billboard, to which many physicians resort when marketing themselves to colleagues and the patient community at large?

Once upon a time it was necessary for non-academics to withstand the capricious slings and arrows, and oftentimes utter nonsense, of a tradition laden academic-centric, peer-reviewed publishing industry, but no more! Although still a work in progress, Cureus has greatly simplified publishing processes, and even more importantly, removed reviewer bias from the equation; all credible medical science is welcome from any physician who seeks to publish in good faith. As Co-Editor-in-Chief my dream is that some day it will be possible for any physician to contribute meaningfully to a free medical literature in a manner that is only slightly more difficult than generating a first class history and physical exam, the sort that might be presented at weekly hospital grand rounds. As Cureus reaches for this goal, I would argue that all physicians, including you, can and should join us by contributing to the commons of medical knowledge! For that matter, why not start today?

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