Janusian Peregrinations and Progress

It seems fitting that as we begin the new year, we should reflect on our accomplishments over the past year and highlight some of the issues we confronted and the changes we are making to continue to move our discipline forward. Yogi Berra once observed: ‘‘In theory there is no difference between theory and practice. In practice there is.’’ My point here is that although his statement appears to be contradictory at face value, its true essence is inescapable. We often assume that having defined something and subsequently demonstrating and proving it to be true by using the scientific method and experimentation will lead to its acceptance and adoption. That is the theory. However, as Yogi rightly concludes, that is not often the case in the real world. There are a myriad reasons that reality does not conform to the theory, ranging from the use of a proof scenario that is much more constrained to one that is overly simplistic relative to the typical case(s), or that does not permit fine tuning for variability in the attendant biology, practice scenarios, technical skill, or belief structure of the clinician or the mainstream scientific community. These nuances are highly relevant and can certainly affect adoption, use, and outcomes. An example would be helpful here. Consider the case of the black box warning. This labeling is required by the United States Food and Drug Administration (FDA) when there is a fatal, life-threatening, or permanently disabling adverse reaction that must be considered before use of a drug, or if a serious adverse reaction can be prevented or reduced in frequency or severity by appropriate and proper use of that drug. The expected outcome following the publication of a black box warning would be a decrease in the prescribing of a drug or drug class that would in turn translate into fewer serious adverse events or deaths. That is the theory. However, in the case of erythropoiesisstimulating agents, the black box warning had no effect on the use of these agents in dialysis patients. On the other hand, a black box warning on the increased risk of suicidality with antidepressant use in young people did dramatically decrease antidepressant use. However, this resulted in a significant increase in poisonings related to psychotropic drug use and an increased rate of suicide in young people. Therefore, in practice, the warnings led to unintended consequences and a series of worse outcomes in the population whom the admonition was intended to benefit. Using these concepts as a backdrop, let us consider photobiomodulation (PBM), its visibility in the scientific literature, and its acceptance in the mainstream. Readers of this journal generally understand the merits and limits of applying light in clinical and research scenarios. However, that is often not the case in the mainstream scientific and clinical communities, despite the publication of thousands of publications on the topic. Proponent ‘‘believers’’ would argue that there is a preponderance of literature that demonstrates the scientific validity of the PBM effect and supports its use. Nonbelievers on the other hand, are either unaware of the literature. or question its validity. This lack of knowledge or lack of acceptance has some interesting effects. Some of the so-called ‘‘believers’’ have asserted that the reason for this is either because PBM papers are not being published in, or alternatively should ‘‘only’’ be published in ‘‘high quality’’ or ‘‘high powered’’ journals rather than in journals such as Photomedicine and Laser Surgery, which are familiar with the discipline. These threads imply a double-bind bias, as the inference is that photonics-related journals are either less discerning than the high powered journals or that the latter have a negative bias against otherwise compelling PBM research. A corollary is that the academic and clinical communities do not ‘‘see’’ progress in the field, because photonics journals have a lower visibility profile. There are those who posit that a dedicated journal or section of a journal devoted to PBM would solve this problem. Clearly, this journal, like any other journal, is dependent upon its receipt of high quality manuscripts being submitted for peer review and consideration for publication. We are also indebted to and dependent upon our editorial board and ad hoc reviewers for their thoughtful and timely review of submitted material, which is then published, indexed, and made available to our readers and the scientific community at large. Published articles become accessible through a variety of channels, and can be retrieved through various literature search and information aggregators. In short, the content of this and other journals is truly global, and extends well beyond its sphere of subscribers. It is ultimately the nature and the quality of the work and its real or perceived applicability that drives its acceptance. A somewhat related issue is the concept of using the journal impact factor as a surrogate for the quality of a publication. This is a thornier and more complicated discussion than is appropriate for this editorial. However, a few heuristics are worth noting. Journal indexing is a process that takes several years to achieve, and new journals do not