C. Richard Conti, MD, MACC

Introduction

As I reflect back on my time as an editor, I recall a few issues that bothered me relating to publications in medical journals, e.g. Impact factor and the relationship of editorials and self-citation on the impact factor and acceptance rates for original publications.What follows are some thoughts on the subject.

What is the Impact Factor?

In simplest terms, the impact factor of a journal is the average number of citations received per paper published in that journal during the two preceding years. The calculation is complex and I will not describe it here. The impact factor of a cardiovascular journal is managed by a commercial company,not by a professional society, e.g. American College of Cardiology. This is similar to ABIM which is a testing agency not aligned with any professional organization.

Review articles often have a high impact on clinical practice because they are cited often and usually offer direction to the readers. Clinical guidelines also are cited often. Thus journals that publish guidelines (professional society journals) get the so called bene fit of a higher impact factor but these same articles are usually not published in journals with the highest impact factor.

What Good is the Impact factor?

Most readers of cardiovascular journals have no idea what is meant by the impact factor. Most readers are clinicians looking to learn something that applies to their interests, generally related to patient diagnosis and management. Interestingly, the majority of published peer reviewed articles are not cited.

Most readers are practicing clinicians and not academic physicians. The latter might cite the article in another publication, the former do not cite publications but might write a letter to the editor.Many journal readers enjoy reading review articles that apply directly to their needs as a practitioner.

During my 20 plus years as editor of Clinical Cardiology, readership scores were high, and impact factor low. Readership scores at the time were often 2ndto a major cardiovascular journal sent to all members of the journal’s professional society whether they wanted it or not (part of the member benefit).

Now that I am a former editor of Clinical Cardiology and current editor of a new journal Cardiovascular Innovations and Applications (CVIA) I remain a clinical cardiologist and as you probably have sensed, I have never been impressed by the impact factor, for the following reason. In my mind impact factor is equivalent to eliteness of the journal not eliteness of the published article. I am not sure, but it is my concern that impact factors have increased in many current cardiovascular journals because of self-citation,and possibly, by focused editorials about each article since these focused editorials clearly cite the original article in the references.

It has been my impression that journals with the highest impact factor are usually not read by most of the doctors responsible for patient diagnosis and management.

What is the Impact of the IMPACT Factor?

Impact factor is perceived as very important in Europe (very few Professors) for promotion to academic positions. Not so much in the USA where there are many professors (at UF there are 9 professors in a division of 27 cardiovascular faculty). These professors were promoted for various reasons, usually a combination of different types of productivity:manuscripts, external funding, teaching of students,medicine residents and Fellows in training, and administrative service to the University e.g. service on committees, in and outpatient leadership etc.

Recommendations of a Scholarly Group

Let me paraphrase what a group of editors and publishers of scholarly journals who met during the Annual Meeting of The American Society for Cell Biology (ASCB) in San Francisco, CA, on December 16, 2012 had to say about publications.The group developed a set of recommendations,referred to as the San Francisco Declaration on Research Assessment [1].

1. Impact factors are often used by governmental and other funding agencies and by academic institutions as a measure of the quality of a researcher or research group, and guide the decision on whom to award grants for research projects. The journal impact factor ‘in isolation’ should not be used by funding agencies and academic institutions to evaluate the output of scientific research.

2. Do not use journal based metrics such as impact factors, as a surrogate measure of the quality of individual articles, to assess an individual contributions or in hiring, promotion or funding decisions.

3. The content of the paper is much more important than the identity of the journal in which it was published.

4. Consider a broad range of impact measures including qualitative indicators of impact, such as influence on policy and practice.

5. For hiring, tenure and promotion decisions,content of a paper is much more important than the identity of the journal in which it was published.

6. Greatly reduce the emphasis on the journal impact factor as a promotional tool.

7. Provide information about the specific contributions of each author.

8. Mandate the citation of primary literature instead of reviews in order to give credit to the group(s) who first reported the findings.

9. Be clear that “gaming the system” will not be tolerated.

10. When involved in committees making decisions about funding, hiring, tenure, or promotion, make assessments based on content.

11. Whenever appropriate, cite primary literature in which observations are first reported rather than reviews in order to give credit where credit is due.

12. Publishers and editors should accept part of the blame for inflating the importance of the impact factor: Some find ways to subtly increase the impact factor e.g. by publishing annual overviews of all papers published in their journal,citing them all.

13. Quality cannot be equated with the number of citations. For instance, reviews are often cited,and few would argue that these contribute more to the progress of science and cardiovascular clinical medicine than original papers.

Are Editorials and Self Citation affecting the Journal Impact Factor?

An editorial in a medical journal is (in my opinion),an article or essay expressing the opinion or attitude of the writer about some experience such as a clinical problem, or in general is a commentary on an original contribution to the journal (as opposed to a letter to the editor).

Types of Editorials

Medical journals publish two types of editorials: free standing editorials e.g. editors page, or editorial comment on one of the original contributions published in that issue. Free Standing editorials: a free-standing piece may be short, and focused on a clinical topic with a few teaching points or points of view about a topic not published in the journal e.g. Editors Page or some equivalent title. I am all for free standing editorials but not for editorials related to original contributions. Editorials on Original Contributions: an editorial related to an original publication is usually laudatory of the work but may rarely include comments or criticisms of the published peer reviewed work of the authors of the original contribution. A few new points may be added but usually do not contribute very much to the discussion by the original authors. I will admit that an editorial citing a published article in the same journal is usually only a one-time experience.Citations about clinical guidelines are much more frequent and editors welcome the publication of society recommended guidelines. Editorial commentary on an original contribution is not like a letter to the editor,which often is critical of the original contribution [2].

I prefer to read letters to the editor since they may point out issues that may have been glossed over by the authors or missed by those who peer reviewed the manuscript before publication.

In addition, the high pro file editorial writer with national or international prominence, may diminish the importance of the original investigators who may not have the same national or international visibility. This is unfortunate for the author(s) of the original contribution to the journal.

Do Editorials on Original Contributions Decrease Acceptance Rates for Original Contributions?

I do not have the answer to the question but I expect they do. To satisfy my curiosity, I arbitrarily selected a four-week period in November 2005 and another four-week period in March/April 2006 to tabulate the number of editorials in three major journals during those four-week periods. In the November 2005 issues ofJACC, (then a bimonthly journal), there were 16 pages of editorial comment relating to original contributions; in the two April 2006 issues there were 17 pages. In 2005,4487 pages of material were published, of which 4.4% was editorial commentary, according to my sample.

In the first four issues of November 2005,Circulation(then a weekly journal), contained 36 pages of editorials related to original contributions;the last two issues in March and the first two in April 2006 contained 25 pages in 2005, 4034 total pages of material were published, of which, by my sample, 9% was editorial commentary.

The November 2005 issues of theEuropean Heart Journal(then a bimonthly journal), had 24 pages of editorial relating to original contributions; and in April 2006 there were 15 pages.Thus, 2747 total pages of material were published, of which, by my sample, 8.5% was editorial commentary.

Since most journals have a fixed allotment of pages for the year, it is logical to assume that if the number of editorials written about original contributions can be decreased or eliminated, the acceptance rate of original contributions, as well as other contributions can be increased. The publication of clinical guidelines in cardiac journals takes up a considerable amount of space that could be used for original contributions.

REFERENCES

1. San Francisco Declaration on research Assessment (DORA).San Francisco, CA: Published by American Society for Cell Biology;2012.

2. Conti CR. Editorials on original contributions to medical journals.Clin Cardiol 2006;29:235–6.