Two years ago, Triological Society President Michael Benninger, MD, chair of otolaryngology–head and neck surgery at the Cleveland Clinic, saw Samuel Selesnick, MD, at a meeting.
Dr. Selesnick is the current editor-in-chief of the society’s journal The Laryngoscope, and the two physicians began talking about invitations to review articles that are being considered for publication. Dr. Benninger said he felt a little overwhelmed.
“I get these all the time,” he told Dr. Selesnick. “I’m doing so many reviews.”
Dr. Selesnick took a quick look at some records and then told him, “You’ve gotten six invitations this year and you’ve only done two of them.”
The exchange made Dr. Benninger, who has devoted much of his professional time to journal editing, realize that maybe he was no longer doing enough when it came to medical publishing. He shared the recalled conversation in his Presidential Address at the 2022 Triological Society Combined Sections Meeting in January.
“Now I try to do every one, or I get a resident or fellow to do it with me,” Dr. Benninger said.
During his presentation, Dr. Benninger reviewed the state of journal publishing, pointing out its flaws, its benefits, and its sometimes untapped potential. And he underscored the importance of being involved, even when it might feel as though spare time is too limited.
“Get involved in publishing,” he advised. “If you get invited to review, then do the review. You learn so much by reviewing. If you’re a young faculty member or senior faculty member and you have a number of reviews that you’re requested to do, ask your residents and fellows to help you do those reviews.”
Dr. Benninger, whose resume includes time as the editor-in-chief of the journals Otolaryngology–Head and Neck Surgery and the Online Interactive Journal of Otolaryngology, as well as serving on the editorial boards of 15 journals and as a reviewer for 75, offered advice to those who have interest in editorial board positions. “If you’re ever going to get to the point that you’re on an editorial board, you have to get involved early,” he said.
Quality publishing helps make sense of information in a world that is producing an astounding amount of data and knowledge. Dr. Benninger pointed to reports estimating that medical knowledge is now doubling about every 73 days, while in the 1950s it was estimated to be doubling every 50 years (Schilling DR. “Knowledge Doubling Every 12 Months, Soon to be Every 12 Hours.” Industry Tap. April 19, 2013. Accessed Feb. 8, 2022). “It has become really difficult for us to keep up,” he said.
Get involved in publishing,” he advised. “If you get invited to review, then do the review. You learn so much by reviewing. —Michael Benninger, MD
There has been a significant increase in the number of indexed articles since 1975, in part due to the dawn of open access journals, some of which are associated with academies and are typically of good quality, and some of which are based on author-paid publishing fees that sustain the journal, and whose content might be more suspect.
“With any very well-done published journal that has an associated online open-access journal, the open-access journal is probably fairly good,” Dr. Benninger said during his presentation. The number of open-access journals has recently plateaued, possibly because of the COVID-19 pandemic, but possibly because they’ve hit a saturation point, he added.
He also made some observations about medical publishing:
The dominance of China. China is rapidly becoming dominant in relation to the total number of articles published, he said. The total number of publications produced by the United States has fallen in recent years, but those out of China have increased, surpassing several European countries, including the United Kingdom (Johnson R, Watkinson A, Michael M. STM Report: An overview of scientific and scholarly publishing, fifth edition. Published October 2018.)
Increased scrutiny of author contribution. The number of citations of the top 1% cited articles has not changed much during recent years. Also, he said, the average author hasn’t increased the number of articles they publish, but there has been an increase in coauthorship. This has led to increased scrutiny of author contribution.
“One of the things that the journals are doing is really wanting to know how you participate,” he said. “Why are you an author? Why do you deserve to be an author? Authorship becomes very, very important, and if you’re going to put your name on something, you should have contributed meaningfully.”
The prominence of the P value. The prominence of the P value continues to be a concern in medical publishing, Dr. Benninger said. He noted that the threshold value itself was chosen arbitrarily—the P value threshold could easily have been 0.025 or 0.1—he said, and the P value can often be misused.
But a given P value doesn’t really measure whether or not a treatment is more effective, Dr. Benninger explained. “A lot of people just throw numbers into a computer to get a P value that’s under 0.05, so now they say something is statistically significant when they really haven’t done a power analysis,” he said. “So most people are really relying on other things.”
Study levels and randomized controlled trials. In the otolaryngology literature, Dr. Benninger believes not only are there not enough Level 1 studies, there are also not enough Level 3 studies, which can be valuable. There are “probably too many” Level 4 and 5 studies, he said, such as case series or low-quality case-control studies.
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He also said it was important to keep in mind that while randomized controlled trials are vital, the medical field might sometimes put too much emphasis on them, hindering medical progress. In transplantation, for example, the lack of data from randomized trials delayed the use of immunosuppressants such as cyclosporine and tacrolimus, which have become essential treatment tools since the start of their use, he noted.
The Cochrane Collaboration, an example of a database that includes only Level 1 evidence, is valuable because it’s a go-to resource where physicians know the evidence level is top grade, said Dr. Benninger. But there’s a catch: “The problem is that it’s not only prospective clinical trials that have value, and therefore we miss much of the important literature if we’re focusing only on Level 1 data,” he said.
More letters to the editor. Dr. Benninger encouraged physicians to put their thoughtful critiques on the record in journals. “We’re missing thoughtful letters to the editor,” he said. “How many times have we done a journal club and we’ve really torn through an article, and then we never write a letter to say, “Here are the issues with it’?” (When writing letters to the editor, however, it’s important to note any biases the authors might have, he added.)
Should researchers publish? On the basic question of whether a researcher should publish, the answer is yes more often than they might think, said Dr. Benninger. If a study adds to the literature, impacts care, could lead to further research, could lead to personal promotion, or could support the career developments of others, then your work should probably be published.
In general, he said, prospective studies should usually be published, case reports involving a special finding or circumstance should be published, and review articles that are particularly thoughtful should be published.
“Everything we do has a little effect someplace,” he said. “And so publishing your work is really important.”
Thomas R. Collins is a freelance medical writer based in Florida.