The Role of Tabloids in Ophthalmic Education: Pro

P HYSICIANS CONTINUE learning in many ways after they complete formal internships, residencies, and fellowships. These learning opportunities may be formal (attending continuing medical education [CME] courses and local, regional, and national meetings, reading peerreviewed journals, grand rounds at a local medical school’s department of ophthalmology). Less formal opportunities (dinner meetings sponsored by a pharmaceutical manufacturer, non–peer-reviewed journals, reading textbooks, listening to audiotapes in the car or watching videotapes, speaking with colleagues in hallways and at cocktail parties) also abound. All of these can be valuable learning opportunities, but each has its advantages and possible disadvantages, and the information gleaned from each source should be viewed with these potential limitations in mind. Of these different options, non–peer-reviewed “throwaway” publications offer articles that are timely, readable, and highly clinically relevant. Peer-reviewed medical journals serve a valuable purpose that is universally recognized. They publish, in full detail, the study design, methods, and results of carefully designed, rigorous scientific studies, including prospective randomized controlled trials. Authors with potential conflicts of interest are required to disclose any financial relationship to the subject matter of the report. To the extent that the peer review process improves the work submitted or the author’s interpretations (which has not been proven to be the case), the peer review nature of these journals helps to assure the reader that this work is well designed and credible. Those of us who serve pro bono on the editorial boards of such journals do so because we believe in the integrity and value of the peer review process. The peer review of even a brief article such as this one hopefully prevents gross errors or illogical thoughts from persisting into the final version, and as an author I appreciate the time spent by reviewers. The landmark articles in peer-reviewed journals often significantly change patient care. There are, however, some limitations of peer-reviewed journals. They are very competitive and space is at a premium, so they routinely reject a large percentage of manuscripts, some of which are perfectly reasonable and interesting but not good enough to “make the cut.” The peer review process is often a lengthy one, and authors must commonly wait at least 3 to 4 months to receive the results of the review. If the review is negative, the author must resubmit to another peer-reviewed journal, only to wait another 3 to 4 months as the process is repeated. If the editor asks for revisions and resubmission and the revisions require a month to perform, then the author must resubmit and often wait at least another month or two to find out if the revisions now make the article acceptable. After acceptance, there is usually a wait of at least a few months before the article can be published. If one adds up these time increments, it is often a year or more between when a study is completed and an article appears in the journal. Add in the time required for study design and institutional review board approval (for clinical trials), and an article in this month’s journal may describe clinical practice from 2 years ago. In some instances, the authors may state at meetings that an article published that week does not reflect their current practice. Because of this lengthy process, peer-reviewed journals are often “scooped” by tabloids, whose reporters attend our scientific meetings and report on interesting new ideas and studies that are presented. Due to the nature of many studies and the peer review process, the articles in the top peer-reviewed journals are typically very focused and test a single hypothesis, and therefore may often not be of interest to a wide readership, or address fundamental and complex issues of patient care. Many practicing ophthalmologists have told me that on scanning the table of contents of some issues of peer-reviewed “toptier” journals, they have not found a single article that attracts their interest, and with some titles the practicing physician has no idea what the article is about. Unfortunately, sometimes the journal is placed on the shelf unread. My own belief, and some data support this, is that many such journals emphasize rigorous science over clinical relevance. The requirement for scientific writing style discourages contributors who are not facile with scientific writing, do not have statistical support readily available, or may have limited skills in written English. Basically, in prestigious peer-reviewed journals such as the ARCHIVES, authors almost never write the way they talk. These journals, in general, are not the place for interesting conjecture, logical inference, or the description of current practice “pearls” by respected clinicians. Yet, From the Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Md. CONTROVERSIES