I want to echo Bruce's comments about this august group in this room. Your work is critically important to the journals. And as we go through this presentation today, I think you'll see a heavy emphasis on the role that peer review plays in our medical publishing industry. Unfortunately, you also see some of the forces at work that are trying to change traditional publishing and why we should all be concerned and what things we need to be involved with. To me, a lot of this is going on without, you know, obvious view by many of us. But it is quite concerning. So these are my disclosures. I think the only possible conflict is I am the editor in chief of sports health, so I do express a certain amount of bias, which I'll try to hide. So medical journals function primarily in peer review. That is the critical step that makes medical science what it is today. It's not perfect. There are sometimes problems. Sometimes there's bias. But still, it's the best system we know to screen literature and to accept and publish the best possible work. It's critically important, not just for clinicians and scientists, but also for the public, because we know the public spends a lot of time on the Internet these days looking at what is published. And it also becomes a permanent record of studies. Now, if you look at the AOSM journals, over the last several years, they've had tremendous success, not only on articles published, but strong online usage, high impact factors. Bruce will speak a little bit more about this later on. We all took a hit this year. But that's primarily due to processing. Our impact factors are still very good. But because the way they calculate them, they did go down this year, which we'll address a little bit later. But we have a robust presence on social media, which is a very important indicator of what the public is seeing, and we need to pay attention to that. So the evaluation metrics for scientific papers, you know, at the journal level, for years it's been citations and the impact factor. With the emphasis now on online publishing, that's changing a little, but it's still an important factor. It has focused more attention on usage, and downloads on the Internet have become an important metric for us to pay attention to, and of course, the social awareness level through altmetrics. Now, you know, we know that the number of citations over a published, over the number of total published papers over a two-year period is what constitutes the covariate analytic impact factor. But it's not associated directly with the quality of peer review. It's usually driven by a small number of articles that get a lot of attention, but it is often used by institutions for promotion and tenure, and especially outside of North America, it's really important. Libraries obviously prefer journals with high impact factors. But when you look at an impact factor, say, of like 9.5, what does that mean? What does that tell you about the journal's role within the discipline? Well, quite honestly, telling me that, you know, it's the fifth journal out of 100 tells me more than that absolute number. So the role of the journal within the discipline is an important thing for us to look at. Also consider the changing role, the changing mechanics, and the role journal plays nowadays. In the past, we looked more directly to journals. Now, whether you're on Google or PubMed, you're usually looking for a topic or a specific article, and the emphasis isn't as much on the specific journal. But if you want to know what role, you know, a journal plays within that discipline, you can take the journal citations per paper, look at the total number of publications in the field, and that gives you an idea. It's called a SNP, and it's something helpful in judging the significance. So certain journals have learned to inflate their impact factor. We know that that's done. That's been written about previously. Self-citation, not only by editors, but by authors, will increase impact factor. It's clear that reviews usually gather more citations. And also controversial papers, many of which are not very good science, but they often get quoted just because people reference them. So how do we know about, you know, self-citation, and how do we judge when things have changed within a journal? This was written in PLOS One a couple years ago, where if you look at the number of citations in a two-year period, and you compare that to the average, you can tell whether or not protocols of a journal have changed. Now again, our impact factors for 2022, which just came out, they did go down across the board. But if you look at, they're based now on the electronic publication date, which is a change, and also the fact that we had a big blip in submissions and acceptances during the COVID, and when that went away, that changed the numbers significantly. So I view this as nothing more than, you know, like the stock market has its ups and downs. It's going to be, it's a correction, but it's not going to hurt us long term. Oh, if you're looking at the scientific impact of a paper, it's really not a, you know, unidimensional construct. There's a number of things that you look at, and especially online downloads might be one of the best things to take a look at. If you're interested in the most cited paper ever, this was written by Lowry in the Journal of Biological Chemistry back in the 50s, got over 300,000 citations, just to put it in perspective. Now open access is changing the landscape in publishing. It does improve the visibility of manuscripts, scholarly work all across the world, but it has put more emphasis on the new metric usage data. Not only the downloads, but the HTML views. But the disadvantage of this is you really don't know how the downloads are being used. You know, with citations, you know, that's a reference that appears in another paper. But when someone downloads a paper, you really don't know what that's being used for. So when we look at sports health, for instance, our downloads have been very healthy. If you look at the sports health site and also the PubMed Central, we've been well over 2 million per year. And if you look at AJSM and OJSM, their numbers have been very healthy and very strong, which is a very good indicator of use today. Now in the past, years ago, 100 downloads, a relationship, one citation, I wish it was still that because we'd be off the wall with citations, but I don't think that holds anymore. So just stepping back for a second and looking at the industry right now, medical science publishing, we are critically dependent upon peer review. And if peer review is diminished or hurt in any way, it's going to hurt our publications. And that is part of the fear of what's going on in open access publishing. So it is the cornerstone of scientific publication. Its maintenance is essential. It's the core mechanism for quality control. And people like this, I'm happy to see he just walked in, George Davies, he's an associate editor for sports health, does a lot of reviewing. He's undervalued, he's not compensated adequately, underappreciated, but he is worth gold because of the work that he does and all of you do for our science publications. Now it's no secret that sometimes that peer review process is a little slow. And that has helped out the preprint servers. It's been popularized by that. But in terms of the ultimate effect it has on the published papers, I couldn't find really what that means. I don't know how much they are hurt by the preprint servers. But it has pushed a little bit more emphasis on the push away from peer review. Now this is the current status of medical publishing. You know, in the past, authors submitted manuscripts, journals reviewed them, publishers charged individuals, libraries, consortia, in order to pay for those subscriptions. And now the forces at work, both in Europe and the United States, are pushing that system more and more to open access. And it has profound considerations for what we're going to see. Now, what some of those institutions view as the problem is authors, not well paid. They're paid indirectly through the jobs they have, but they don't get paid directly for their manuscripts. Reviewers never get paid, yet these organizations are looking at the publishers saying, this is a multi-billion dollar industry that doesn't benefit science and the public enough. So that's why publishers have sort of become the target of much of the open access movement. Take for instance Elsevier, publishes 18% of the world's scientific papers, profit margin 40%, and you can see the increase in their revenue just recently. In the United States, in the US publishing, it's, you know, a 19 billion dollar industry as of 2020. So this is part of the reason it's become, not the total reason, but part of the reason it's become the target of the open access movement. Now when did all this start? The first wave was back in the 90s by individual scientists who would publish their papers in regular journals, subscription journals, but then post the paper on repositories and other platforms so that they would be open to the public. Medical societies certainly caught on, but the big third wave was when the Public Library of Science or PLOS, you know, the pioneering of APCs, the article processing charge. This was done because the finances were changing. In 2013, the US Office of Science and Technology got into this and started pushing for open access. And it's hard to argue when the government says, you know, if this is publicly funded, it should be published and available to everybody for free. It's hard to argue with that. But in 2018, Plan S came, primarily from Europe and a few other places, and this really wants to change everything to open access, and there are some problems with this. Now Plan S stands for shock. They wanted to shock the system. They want everything open access, and those things that are in hybrid journals, they want hybrid journals to disappear, and both AJSM and Sports Health are hybrid journals. One of the other problems that was noted just recently by the American Association of University Professors is this Creative Commons license, where anyone, once it's open access, can republish your work, even for profit. They have a big problem with that. You can see the problem with that, and that is part of Plan S. So again, this is a demographic that's changing. Now researchers, agencies, library systems, academic groups are paying publishers for open access, and the consumers really are not paying. That is what's changing. Now does open access benefit a lot of people? It certainly does, especially communities that consume more research and don't produce as much. Developing countries, this is a significant impact. Institutions and individuals that produce research will be paying to publish. It shifts the financing in the publishing world from the consumer to the author, but there's more and more available to the public. Now there's multiple colors. The two on top are the ones we see the most of, green, which is usually a publication in a subscription journal that is then made open access either on a university platform or a repository, and gold, which has the APC model. The only other one to be aware of probably is black, which is Sci-Hub, which is the legal access to journal subscription articles. Now the institutional repositories take publications from faculty across many journals and put them on a single platform, and this does get a lot of visibility, and it does promote intellectual works. It is one of the ways that at least partially satisfies Plan S. Gold is where some of the challenges are. Why? For many young, junior, and underfunded researchers, the APCs are a significant roadblock, especially when you look at some of the more high-profile journals like Nature, where you can have APCs even up to $11,000. I mean, a lot of unfunded researchers, I don't know any unfunded researchers or junior people who can afford that type of charge. Now the positives, no doubt open access papers are readily recognized and cited by peers, can benefit the whole system by accelerating dissemination and uptake of research findings, really has revolutionized the communication in the scientific world, and several publications now have shown that the typical open access article is cited more often than one that's in a closed journal. But the bottom side is it does put traditional publishing at risk, and part of traditional publishing is all of you, reviewers in the peer review system. There's become financial incentives to publish with the APC model, and with increased quantity, the worry is decreased quality. There's only a limited number of you that are willing to review papers. It's hard, it's time-taking. We don't have enough qualified reviewers for what we already have, and with the great influx of publications that can occur with open access, that's going to get diluted even more. So it really has commercialized a lot of research, and the total cost of publishing really has not gone down, it's gone up. So if you take a look at this, which is about 10 years old now when this was first formulated, you know, there are the research impacts of what we publish, and citations have been the traditional way to follow that, but then more and more, the social impact metrics have become important as we realize how a lot of this information gets transmitted. So the altimetric score is important. It does cover all of the posts, blogs, Facebooks, tweets. One of the problems is how do you verify the authenticity, bias, and also sometimes misleading comments. Now when you look at open access back about 10 years ago, at least the open access journals in the Web of Science and Scopus, those were approaching the same scientific quality and impact as subscription journals. But then something happened, and that was the coming of predatory journals. What's a predatory journal? Predatory journal is one that basically only has one function, and that's to generate dollars. And that's hurting the system because a lot of people have learned how to do this. As of June of this year, it's estimated that there's 8,000 predatory journals out there. They often attract young, inexperienced authors. The peer review is really the problem point. They don't archive content, and it has the potential to really hurt the literature, which affects not only clinicians but researchers and also the public. So this was also an interesting article, again, from the American Association of University Professors. It just came out in June. Open access is a financial bonanza for some. Many of the processes lack transparency, which is worrisome. It has diminished the importance of peer review and has harmed our scientific literature. If you want to look at probably one of the worst examples of what open access can do, it's this. Bohannon, back in 13, came up with a fictional paper. It was about a cancer drug from lichen. It had obvious methodological errors, and the data in the paper, in the results, actually was opposite of what the conclusion said. And most people thought that if you had a high school knowledge of chemistry, you should be able to tell that this was a bogus paper. So what did Bohannon do? He submitted similar papers to 304 open access journals with variations in the authors and the institutions that they came from, but they were all about the same thing. Molecule X from lichen Y inhibiting cancer cells Z. They were basically all the same format. Ten papers submitted per week to 304 journals, 157 accepted the bogus paper, which tells you a little bit about what the peer review must have been. Sixty percent of the final decisions, there was no sign of peer review, and those that did get reviews, 70 percent accepted the paper. This was bogus. So think about what this could do to the medical literature. The public goes there, clinicians go there, scientists go there, and if we're populating the medical literature with things that haven't been critiqued, that are bogus, could really dilute what's out there. Now plus one rejected it, but unfortunately several other major publishers accepted the manuscript. Hindawi, which is one of the largest publishers, 559 journals, 25,000 articles per year, dodged the bullet. They did reject the article. They noticed the glaring fault. Now problems with predatory journals go farther than that. Many times they cloak their geographic location, IP address, bank invoices. It's not clear where the money goes. One third of those journals are thought to be based in India. Bohannon's paper was accepted by 63 of those. And one of the other interesting things that I found when you take a look at some of those predatory journals, especially if you look at several articles, many of them are using a certain political ideology to push a political agenda. Something really dangerous to see in science. Now several people have noticed that this is a problem, including the Web of Science who just, in March, delisted 50 journals, 19 from Hindawi themselves, took away their impact factor recognizing what was going on. If you're interested in the open access journals, this is a good place to look to see which ones are legitimate. The directory of open access journals, it's a leading multidisciplinary platform that really does look at peer review and the quality control of what's going into the journal. You know, our journals, the Sports Health and AGSM, are hybrid journals. In my mind, at least for right now, this may be the best compromise between open access and traditional publishing. Why? Because you still maintain high quality peer review, but you can get open access for a fee. So it's a compromise between the two systems. But this is what Plan S wants to see disappear. They don't want to see scientific publications that are funded in hybrid journals. Now the transformative agreements that are currently going on, again, these are negotiations between universities and publishers. And the idea here is the university or academic system pays a lump sum fee. The scientists affiliated with those groups get to publish in that journal and they get content in those journals for free in these transformative agreements. So these are taking aim at our hybrid journals. They really do want full and immediate open access. But again, it's the whole issue of quantity versus quality and what's going to be the right balance so that publishers can survive, yet, you know, the prices of publishing get placed where they should be. Underfunded researchers and junior people, it's going to be very hard for them to bear the cost. So again, the arrangements are between the publishers, government, agencies, libraries and universities. No doubt libraries are going to be paying more. But for that, the individual researchers associated with those groups will be able to publish. Now the U.S. government is pushing this fairly hard. And last year in August, this letter came from the Office of Science and Technology with the goal being ensuring free, immediate, and equitable access to federally funded research. And who can argue with that? I mean, if the federal government through public funds is paying for research, then it should be open access. But the downside is, look what open access is doing in several other areas, and I think it's quite concerning. Now, it's been noticed by a number of groups. NeuroImage, which is published by Elsevier, had its entire editorial board, 40 scientists, professors and scientists from all over the world walk out. They quit. And all over the changes in finances and publishing and what they were seeing in the publishing world. So to bring this to a conclusion, what's the future? We don't know. But it is a little scary when you take a look at what's going on. What you guys do as a group in terms of peer review is no doubt the bedrock of medical publishing. And if quantity takes over for quality and peer review can't keep up with the publishing world and is not emphasized, you can see what's going to happen to the medical literature, and that's not going to be good. So I think our challenge is, how do we maintain the scientific integrity of peer review? No matter who's funding it, no matter which way the dollars flow, how do we maintain the scientific integrity? That's what's most important. Thank you.

peer review

medical publishing

traditional publishing

open access

scientific literature

evaluation metrics