When Covid first appeared in the US, several Asian physician friends had simple advice for me, “Wear a mask.” Having dealt with various coronaviruses for over a decade, this was the fundamental lesson taken from dealing with and controlling these respiratory viruses. Now, I may only be a dumb neurosurgeon, (said with humility, irony and in jest), but I know a thing or two about masks, having spent 30 years of life wearing them, sometimes for 12 or more hours at a time. There is nothing pleasurable about wearing a mask, but I have experienced first-hand how masks can protect patients and physicians from illness. More broadly I have seen how masks can protect healthcare workers from the worst of infectious diseases, even giving them supernatural-like protection when they must enter the belly of the beast while caring for highly contagious and fatal illnesses like Ebola. Meanwhile, each and every day, healthcare workers all over the world, including my own family members are able to avoid infection while caring for hospitalized Covid patients who are often spewing the virus everywhere. It’s incontrovertible – masks truly work!; they prevent Covid infections.
Last week the New England Journal of Medicine announced that a survey of readers selected the 1842 publication of a paper by Henry Jacob Bigelow, reporting the first use of anesthesia, as the single most important paper in the 200 year old history of the journal.
Given the future implications of what was being reported in this paper, especially as we now look back over the medical landscape 150 years later, I cannot disagree with the selection. However, what I do find more than a little bit ironic is that such a paper, if submitted today, would stand almost no chance of being published in the NEJM, or virtually any so-called high impact journal.
As the Bigelow paper wended through the review process, this in-hindsight completely transformational paper, would be rightly criticized (and surely killed) as being little more than anecdote.
There is certainly no randomized blinded trial with rigorous statistical measures that ensures the quality of findings live up to the highest “scientific standards”. Moreover, lacking an IRB stamp of approval would certainly invalidate the paper for publication right out of the gate.
So I ask, have the standards of the NEJM and nearly all modern journals become so obtuse and elevated that the findings they now report are irrelevant to truly novel clinical innovation?
Also last week, I was advised by one of the journals for which I have long served as an editor, that future observational studies, if they are to even be considered for publication, must now assiduously adhere to STROBE guidelines.
Such STROBE guidelines represent the consensus of a 2004 big funded workshop, i.e. self appointed committee, composed of editors and sundry luminary academics who, presumably with the best of intentions, felt compelled to improve the reporting of observational studies.
But what started as well meaning “guidelines” have (perhaps not surprisingly) now morphed into a compulsory directive enforced by the editor in chief. Will the quality of the journal articles now being published under the STROBE guidelines truly benefit from this new set of regulations? Surely the editor in chief and politically-connected self-appointed STROBE experts would argue yes, but notably these sacrosanct “guidelines” have themselves never been subjected to any empirical test.
What I am quite confident about is that the journal in question has put up yet another barrier to authors reporting potentially interesting, and even ground breaking, clinical studies. As a result is it possible that that today’s equivalent to the good Dr. Bigelow’s reporting of anesthesia will go undiscovered because of the sheer hassle of publishing in the peer reviewed literature?
Is it possible that STROBE processes might drive some of today’s clinical innovators to just throw up his or her hands and say no thank you to reporting their findings? This leads to the bigger question, should the process of publishing a paper trump the power of scientific ideas within?
Readers of Curēus are well aware of our Journal’s bias in this regard!