Moving From Inconsequential to Relevant Publishing

A few days before this editorial was written, there was a message from an overseas colleague announcing the successful publication of his 24th scientific paper of this year. Naturally, there was a tinge of pride and a feeling of self-accomplishment. Twenty-four articles in as many weeks is certainly an achievement. To conceive a study, plan the methodology, analyze the study material, formulate the results, and write a publishable manuscript at the rate of "one article every week" is indeed impressive. It could be that since the person is a radiologist, the lack of burden of patient recruitment and the necessity of clinical follow-up probably made it possible. However, these humongous numbers, which could have never been possible just a decade ago, underline the current era of massive scientific publications. The year 1665 was a landmark year as it saw the first scientific papers published in Le Journal des sçavans from Paris and the "Philosophical Transactions of the Royal Society of London." The cover page of the latter had printed—"Giving some accompt of the present undertakings, studies, and labours of the ingenious in many considerable parts of the world," making clear that the purpose of the journal was mainly "research communication." However, over the years, the published papers have transformed into various roles—as a measure of research excellence of an individual, the basis for selection to academic positions, for tenure and promotions, the criterion for the awarding of grants, and the source of funding for salaries. It is also true that publishing in scientific journals is also the vehicle adopted by the medical industry to have their products approved and accepted for entry into clinical markets. Peer-reviewed publications have thus become a multipurpose vehicle for achieving various ends. The phrase "Publish or Perish," first coined by HJ Coolidge in 1932, has become a grim reality as a published paper controls academic survival, professional progress, and even industrial growth and promotion of new products. In 2006 alone, approximately 1.3 million peer-reviewed scientific articles were published, aided by a large rise in the number of available scientific journals from 16,000 in 2001 to 23,750 by 2006 and more than 30,000 in 2022. Global publication output reached 3.3 million articles in 2022, based on data from the Scopus database. However, a review of the Citation Index, which is a measure of the scientific value of a published paper is disappointing. Only 45% of the articles published in the top 4500 scientific journals are ever cited within the first five years of publication even once; a measly 42% receive more than one citation and between 5% and 25% of these citations are self-citations. This makes one wonder whether these high numbers of published papers imply an explosion of scientific knowledge or just the accumulation of wasteful publications and junk science. The results provide a compelling need for us to move away from inconsequential publishing to worthwhile and relevant science. The publishing from India was relatively low in the 1990s and raised substantially to 8% of all medical publications in 2016. The lower numbers of yesteryears were probably reflective more of the absence of the pressure of publishing rather than a lack of research opportunities. As the publishing tempo increases among our community, we must remain focused on research that is, relevant to our needs and not as a replica of research from advanced countries. The healthcare costs in most countries have become sky-high. The reason is the attraction for the latest, costliest, and most interventional treatments often supported by research and published evidence promoted by industrial funding. We cannot afford blind imitation of clinical practices and need clinical trials that validate questionable research. Of the 49 of the most highly regarded research findings in the past 13 years—41% were found to be totally wrong or significantly exaggerated. Mathematical proof of significant error leading to biased conclusions was identified in 80% of non-randomized controlled trials (RCT) studies, 25% of "Gold Standard" RCT studies, and 10% of "Platinum" RCT studies. Here, comes the need to question and validate the conclusions of papers that advocate a change of practices, changes, especially, which advocate a move from a proven and time-tested procedure to a more expensive and instrumented procedure. Papers that promote the use of expensive drugs and newer interventions must also be validated. The lessons learned from publications promoting bone morphogenetic protein and steroids for spinal cord injury are stark examples of the need for validation of published papers irrespective of the eminence of authorship or the scientific reputation of the journal. We also need scientific documentation of the effectiveness of our methods of treatment. A simple example would be a multi-arm trial or patient-reported outcomes of anterior cervical discectomy alone or fusion with tri-cortical bone graft, stand-alone graft, with the addition of plates or ADR. This will be highly relevant as it implies a huge variation in cost and affordability in our circumstances. In India, there are many favorable factors that we should take advantage of. First, we have one-sixth of the world population and an accompanying huge disease burden. Our patient population does not have the issues of litigation and compensation as in the West and is more cooperative for research. Research costs in India are much lower when compared with the West. Most of the research is not industry-funded and hence not biased. However, to be effective, such efforts are also needed. If only we could make documentation very robust and allocate quality time for research, then the settings for good clinical papers would be made. The Association of Spine Surgeons of India should also be provocative to teach young investigators the value of good research morals and correct methodologies. Senior surgeons must teach by example and build a research environment that will foster good research practices. The Association of Spine Surgeons of India must also take the lead in identifying the right topics and selecting the right centers in the country so that multicenter prospective trials can be set up. The association should also make available research support so that stumbling blocks for good research can be removed. The Indian Spine Journal will be privileged to be the vehicle for dissemination of the results of such excellent research from members of our association. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.