Publishing scientific papers, with what purpose?

The explosion in the number of biomedical journals and scientific articles during the last quarter of a century has exceeded every imaginable expectation, with the volume of information increasing up to the point that it is virtually impossible to assimilate. It appears that 55% of published works are never cited by another author in the first 5 years (citation rate).¹ Thus, the question arises; why go to the trouble of presenting a hypothesis and an experimental design or reviewing patients and squeezing out data to elaborate a publication?

Taking a look at the first issues of our Journal, we could be surprised by the works published therein. Most of them were reports by prestigious surgeons regarding their experiences and opinions about a given musculoskeletal pathology, of course with scarce discussion and few supporting references. The aim of the authors was simply to disseminate personal experience among colleagues with the laudable intention of offering an example to any other surgeon in a similar situation. This is what we currently call “expert opinion”, which, following the Hippocratic tradition of learning from teachers, would serve as a basis to justify a given procedure.

The scenario has changed dramatically since then. In 1955, based on the idea that the value of a publication is determined by its impact on readers, Garfield² proposed a classification system that has since become a high-quality and prestigious index for journals and is currently the basis of selection for academic positions and the allocation of research funds. Publishing constantly has become the only way to be evaluated and to advance in academia. As mentioned before in these pages, this assessment system has multiple biases.³ It is not an indicator of the quality of individual works, but rather a quantitative measurement of the position of a journal within its area of expertise. Nevertheless, it has become widely accepted as a tool to evaluate the complex issue of research.

Are we publishing only to fatten our CV? And for those who do not seek an academic position, is it vanity? Is it a competition among peers to obtain a better position within departments?

No one could have thought that the introduction of a novel approach called “Evidence Based Medicine” into the training program of Internal Medical Residents at McMaster University (Ontario) in the 1990s would have such a relevant impact on our daily clinical practice, as it represents a philosophy aimed at solving clinical problems.⁴ It is not the relevance of the author or the journal in which the article is published, but the quality of the scientific evidence presented (less bias) that allows us to make solid recommendations to our patients in most circumstances of our daily practice. Clearly, the experience of the physician, the working context and the preferences of patients should qualify these recommendations in all cases,⁵ and even more so when it comes to surgical techniques.

Our ethical obligation must be to publish works in order to advance scientific knowledge and to be able to integrate research evidence into daily practice. In order to do this, we need to select the best works, knowing that “more is not necessarily better” and, unfortunately, reject those works which reviewers and editors do not consider reasonably appropriate. Quality should always take precedence over quantity, and it is to this end that the editorial team which I have the honor and pleasure of directing have pledged their personal effort.