Plastic Surgery Journals: A Meeting of Minds in Berlin (2007)

At the recent International Confederation for Plastic, Reconstructive, and Aesthetic Surgery Meeting in Berlin in June of 2007, an international group of plastic surgery journal editors convened to discuss the current state of publishing plastic and reconstructive surgery articles (Fig. 1). A large number of editors from a wide variety of journals were invited. Because of scheduling conflicts, however, many could not attend. The following journals were represented by their editor-in-chief or editor-elect:Fig. 1.: Attendees of the Quadrennial Plastic Surgery Journal Editors Meeting, in Berlin, Germany, June 29, 2007. Front row (left to right): Foad Nahai (Editor-Elect, Aesthetic Surgery Journal), Roxanne Guy (President, American Society of Plastic Surgeons), and William Morain (Editor-in-Chief, Annals of Plastic Surgery). Back row (left to right): Mutaz B. Habal (Editor-in-Chief, Journal of Craniofacial Surgery), Robert Goldwyn (Editor Emeritus, Plastic and Reconstructive Surgery), Rod J. Rohrich (Editor-in-Chief, Plastic and Reconstructive Surgery), Jan Lilja (Editor-in-Chief, Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery), Ioan Lascar (Editor-in-Chief, Annals of Plastic Surgery and Reconstructive Microsurgery), James R. Mulligan (Executive Publisher, Lippincott Williams & Wilkins), and Paul Pomerantz (Executive Vice President, American Society of Plastic Surgeons). Present at the meeting but missing from this photograph are Carol Kerrigan (President, Plastic Surgery Educational Foundation), Carol Lazier (Assistant Executive Director, American Society of Plastic Surgeons), and Dan Sullivan (Managing Editor, Plastic and Reconstructive Surgery). Jan Lilja, Editor-in-Chief, Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery Ioan Lascar, Editor-in-Chief, Annals of Plastic Surgery and Reconstructive Microsurgery (Romania) William D. Morain, Editor-in-Chief, Annals of Plastic Surgery Mutaz B. Habal, Editor-in-Chief, Journal of Craniofacial Surgery Foad Nahai, Editor-Elect, Aesthetic Society Journal Rod J. Rohrich, Editor-in-Chief, Plastic and Reconstructive Surgery In addition, leaders of the American Society of Plastic Surgeons (Roxanne Guy, President; Paul Pomerantz, Executive Vice President; and Carol Lazier, Assistant Executive Director), Plastic Surgery Educational Foundation (Caroline Kerrigan, President), Lippincott Williams & Wilkins (James R. Mulligan, Executive Publisher), and Plastic and Reconstructive Surgery (Dan Sullivan, Managing Editor) were represented. What follows are the highlights of the meeting. THE STATE OF PLASTIC SURGERY JOURNALS A key reason plastic surgeons become and remain members of professional plastic surgery associations and societies worldwide is to receive the journals that are offered by their representative society, such as Plastic and Reconstructive Surgery, which is distributed to all members of the American Society of Plastic Surgeons. Medical journals, along with medical meetings and conferences, serve as the primary source for surgeons to keep current on the latest techniques, trends, and technologies. According to a recent survey of European plastic surgeons,1 the primary topics of interest are as follows: Aesthetic surgery, 83 percent Breast surgery, 72 percent Facial surgery, 69 percent Reconstructive surgery, 55 percent Body contouring, 46 percent These topics of interest are consistent with those reported by plastic surgeons in other parts of the world as well. There is an active interest in a variety of plastic surgery journals (both general and subspecialty journals) worldwide, as circulation figures from various plastic surgery journals show that there is a healthy demand for peer-reviewed literature. Journals serve as a primary conduit for education to plastic surgeons and are seen as a one of the main benefits of membership in a professional society. Lastly, topics of interest remain consistent among plastic surgeons worldwide. CURRENT ISSUES FACING PLASTIC SURGERY JOURNALS Subspecialization and Internationalization Plastic surgery journals worldwide face a number of challenges, including the subspecialization and internationalization of the field. Many, if not most, subspecialties within plastic surgery now have their own peer-reviewed publication. Because of the finite number of articles generated, journals now have to compete for manuscripts. The debate over where to send articles ensues among authors: should a paper be submitted to a generalist plastic surgery journal (which will provide a larger but more diverse audience) or to a subspecialty journal (which will provide a highly focused but smaller readership)? Similarly, many regional and national societies have their own journals, which again compete for articles that would otherwise be submitted to international journals. The debate here is, should I support my own society’s publication, even though it may enjoy a smaller audience, or submit to one of the international journals? Online Publication Additional challenges and opportunities exist. One of the most compelling changes in all of biomedical publication today, including plastic surgery, is the transformation from print to online publishing. Only a decade ago, the print-only journal was all that existed. Today, nearly every biomedical journal has its content available both in print and online. Some journals are published exclusively online. With the ever-increasing growth and permeation of the World Wide Web into every area of life, online publishing will also see continued expansion. Web publishing expands the reading audience of a journal. The Plastic and Reconstructive Surgery subscription base of 11,000 is dwarfed by the total number of potential end-users (more than 13 million) who have access to the journal through Web-based databases. Such a large potential audience could never have been reached with a print-only publication. Furthermore, Web publishing opens the possibility of audio (podcasting) and video publication, transforming static text and picture presentation into dynamic, real-time learning. Plastic and Reconstructive Surgery’s Video+ articles provide real-time, high-resolution operative videos with progressive download; there is very little wait to see extended videos online. Web-based video learning offers a fundamental shift in article delivery. Additional benefits of Web publishing include the potential of having content translated into multiple languages and hosting online archives of articles. Plastic and Reconstructive Surgery’s Legacy Archive makes available to subscribers the entire contents of the Journal, going back to volume 1, issue 1, 24 hours a day. Online publishing offers a wealth of as-yet untapped possibilities.2 Online publishing makes possible the dissemination of information to a nonscientific audience, with the advent of “open-access” electronic journals. Open-access journals provide peer-reviewed content through the Web to anyone; availability of articles is not controlled or limited to subscribers. These e-journals argue that peer-reviewed data should be available to all people, stating that most scientific studies are conducted with public money and therefore should be available to the public. The question of who pays for publication is quickly raised. The peer review process, production of articles, and posting of information online all require money. Most open-access journals require authors of articles to pay, which can create a bias in favor of wealthy authors or authors in wealthy countries. Some journals follow a model of open access but provide open access only after a fixed amount of time, thereby allowing the most current articles to be available to paid subscribers. The concept of open-access publication is an important issue that has not yet been resolved among plastic surgery journals. Piracy and Author Apathy Another major concern for journals is piracy (outright copying and unauthorized distribution of content for money). Protection of intellectual property and loss of revenue are critical to a large number of biomedical journals worldwide; untold millions in potential revenue are pirated away each year. With plastic surgery journals in particular, a separate issue is the apparent apathy of authors. A large number of practicing plastic surgeons worldwide will simply not write articles; they are too busy in surgery, have little extra time to write, or are otherwise not interested in writing or motivated to write. Their extensive experience with many reconstructive and cosmetic procedures is not documented or shared with the larger community, which is a loss to everyone. Ethical Issues Plastic surgery journals face a growing number of ethical issues. In the forefront is the issue of financial disclosure and conflicts of interest.3 A climate of public scrutiny has brought the issues of transparency and disclosure in biomedical publication to the forefront, and it is becoming standard policy to insist on a complete disclosure of conflicts of interest for authors, reviewers, and editors alike. Plastic and Reconstructive Surgery is helping to champion this atmosphere of openness, publishing a financial disclosure statement with every article in the regular journal as well as in supplements. Furthermore, the Journal has disclosure statements on file for all its Editorial Board members and is obtaining similar statements from its entire review panel. Financial disclosures are mandatory now with all articles and from all reviewers. If reviewers have a conflict of interest with any paper sent to them, they can recuse themselves without prejudice from the review. Any sponsorship for supplements must be provided through unrestricted educational grants, with sponsorship being fully and openly disclosed. Lastly, supplement topics and content are determined and articles are written before solicitation of industry sponsorship. Disclosure of author and reviewer financial involvement is not the only disclosure issue being raised. Authors (and reviewers) are required to acknowledge that in conducting their clinical trials, they have abided by ethical guidelines for clinical trials as set forth by the Declaration of Helsinki and/or their own institutional review board.4 Fully documented, thorough patient consent for any clinical experiment or trial must now be obtained and reported. Along with this mandate is the newly implemented registering of clinical trials.5 Authors who report on clinical trials submitted as manuscripts must now register their report and patient database with an internationally approved patient registry. Another ethical issue that occurs with distressing regularity is that of duplicate publication. A few times a year, an author or group of authors will submit identical papers to more than one journal, attempting to have two (or more) articles published for only one set of data. The plastic surgery journal editors remarked that this is a concern, and they have agreed to continue a policy of friendly cooperation among themselves to help investigate incidences of dual publication. When an incident does occur, the journals involved cooperate in an investigation and in contacting offending authors for their explanations. If an author has indeed committed a violation and double-published an article, stiff penalties can be levied, including the following: Extending a multiyear moratorium on the offending author(s) Withdrawing all active or accepted manuscripts by an offending author(s) Contacting the department chairman or dean of the institution of the offending author(s) Publishing a retraction of the article, including a retraction on PubMed The submission of manuscripts to only one journal at a time for consideration, and the publication of only one article on a given topic, is very much on the honor system. Fortunately, most authors are honest in this regard, and the number of duplicate submission violations remains low. CME and MOCERT Many plastic surgery journals now offer continuing medical education (CME) articles; these articles are very popular with readers of Plastic and Reconstructive Surgery. The addition of Current Procedural Terminology (CPT) codes to CME articles is a new element in the Journal. The newest extension of these articles, however, is the addition of maintenance of certification (MOCERT) articles for U.S.-trained plastic surgeons. The objectives of the MOCERT program are to ensure that diplomates (or fellows, depending on the specialty) are engaged in lifelong professional development and to provide standard documentation for diplomates (or fellows) to use to record their learning activities. One component of the MOCERT program is CME learning. Journals are working with their publishers, societies, and accreditation boards to provide specialized CME articles and modules to their readers. The process of writing and validating these articles, and then integrating them into test taking, record keeping, and board certification, poses many logistical and technical challenges. Revenue One of the biggest and most consistent challenges concerns finances and advertising. Journals obtain operating funds from a variety of sources, including subscription dues (from society and nonsociety members), online consortia subscriptions and institutional subscriptions, advertising, reprints, and endowments. Each journal at the meeting presented different levels of overall journal income derived from these income sources, but all agreed that currently, the advertising market for plastic surgery is lower than it has been in previous years. Recent public scrutiny into potential industry sponsors has encouraged some companies to pull back on their advertising and other sponsorship initiatives associated with journals. Many advertisers do not want to appear to be sources of bias for journal articles; as a result, they have distanced themselves incrementally from advertising. AN EYE TO THE FUTURE Two final issues were raised by the various editors at the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery meeting. One was the value of articles. In our world of instant gratification, text messaging, and real-time blogging on every conceivable topic, every person with access to the Internet has become his or her own author. Anyone can post an opinion and make it appear as if it were fact and not just a personal view. Wikipedia is the world’s largest online “encyclopedia,” with more than 7 million articles. Its content, however, is posted by anyone who wishes to contribute; there are no content-specific experts who verify the accuracy of data. Information on plastic surgery is subject to similar “wikipediation.” Peer-reviewed journals need to take the lead in letting the Web-viewing public (and scientists) know that their content is highly credible and validated precisely because it has undergone peer review; it is not merely opinion or one person’s perspective. A second, unrelated issue raised was the need for journals to develop a disaster management plan to ensure the stability of undisrupted publication. Disasters occur in many forms, including natural disasters, unanticipated illnesses or loss of key individuals, terrorism, and skyrocketing oil prices, and there are many secondary causes, such as increasing paper prices, mail disruption, societal upheaval, and so on. It is only prudent for a journal to develop a plan whereby it can deliver its content in the face of disaster. In light of this reality, the journal editors discussed disaster management plans based on a four-phase approach: (1) preparedness, (2) response, (3) recovery, and (4) mitigation. It is clear that a plan needs to be developed in advance. Communication of plans among journals will assist in coordination among societies and journals that have been affected by disaster. Training for disaster will help mitigate deleterious effects. Overall, the state of plastic surgery journals is good. Journals are in the forefront of the field, chronicling the present and leading the way for the future. I anticipate more dynamic, powerful, and educationally sophisticated initiatives in the near future.