The front and back of medical journals

Rinckside 1999; 10,4: 15-17.

here are tens of thousands of medical journals worldwide. Nobody knows the exact number. There are hundreds of radiological journals. I always wonder how they survive, because there is only a limited number of readers, and if you talk to the readers, hardly anyone reads thoroughly journals.

Diagnostic Imaging is now in its 21st year, having published its first North American edition in November 1979; DI International first appeared in April 1983 and was renamed DI Europe in January 1995. For several years there has also been an Asian edition and a Latin American version in Spanish. Published under the same name, all these editions reflect, without doubt, a United States background, but have their own character according to the region of the world for which they are written.

Diagnostic Imaging is not considered one of the “serious” scientific journals fighting to be the leader in the impact-factor war, but it has its own impact factor and is listed in Index Medicus. Articles are not peer-reviewed by two or three referees, but they are reviewed and thoroughly checked. There are similar journals around, and the editors of the big and smaller scientific journals are sometimes not very happy about what some of them regard as the competing “frivolous throw-away free-of-charge gazettes”.

Some contributors to Diagnostic Imaging were painfully made aware of this fact in the 1980s when Radiology, the world’s largest circulation scientific radiological journal, rejected their submitted papers because some of the results had been published in the news section of Diagnostic Imaging (a year earlier than Radiology would have published their paper). I would have considered this an excellent public relations stunt for Radiology – people were keen on reading the entire story.

However, there were other factors to be taken into account. One of the main reasons is the competition for advertising. Advertisements fill the coffers of the publishers, but in a defined market such as radiology the number of potential advertisers is limited.

Yet, many readers are looking for review journals – easy to read, with well-written overviews summarizing original contributions at scientific conferences, a high and dense information content, and enough, but not too much, to read for one month until the next issue appears. If such a journal is put together and edited properly, it will have a market in these times of information overload.

This is also reflected in the secondary use of scientific news magazines such as DI Europe. They are not considered citeable sources in the list of references of articles written for serious scientific journals. Increasingly during recent years, however, I have seen copies of articles published in DI Europe used as references in governmental, non-governmental and other institutions when health politics and economics were discussed by radiologists and by laymen.

spaceholder red600   For a long time, medical news magazines were not accepted as equal partners by other journals, yet their competition and attraction have been perceptible. Some scientific journals have analyzed their rivals and integrated some of their ideas into their own layout, for example RöFo, the journal of the German and Austrian radiological societies, which has turned from a boring scientific and provincial magazine into a well-made monthly for radiologists in Germany and Austria (and neighboring countries). Similar efforts have happened in other countries such as France or, in a different way, for instance in Britain with newsletters in parallel to scientific journals.

There is another factor in the categorization “serious/non-serious”. Scientific journals were created as, and considered to be, independent and nonpolitical. Of course, they were political in the sense that the group of editors (not the publishers) would select and influence the priorities of who was allowed to be published and what was published, but there was no or limited commercial influence upon the contents.

spaceholder red600   This has changed. There is commercial influence, both from potential or actual advertisers and from publishers. There is hardly any major scientific journal left which relies on subscription fees only. Shareholder value has replaced critical independence. Particularly, the big journals such as JAMA (Journal of the American Medical Association) and NEJM (New England Journal of Medicine) have been turned into money-making businesses, relying on their reputations of serious medical journals. They fit into the trend of U.S. newspapers.

Al Neuhardt, the founder of the US-American daily tabloid USA Today described the mission of his publication as “journalism of hope” which “doesn’t dictate. We don’t force unwanted objects down unwilling throats [1]."

In democratic countries, however, it is the task of the press to pinpoint good and weak aspects of the state and society. In its own form, this also holds true for scientific journals. There are public and scientific developments hardly anyone wants to hear about, but somebody must have the conviction and courage to monitor and mention them. Newspapers and scientific journals that are not published as sales magazines should not be subordinated to the marketplace; their contents should not be censored for the sake of fast money. They should also allow a pluralism of information, and even more important, a pluralism of opinions, although this might be difficult within a single publication.

spaceholder red600   The current scandals involving JAMA and NEJM were brought to the point by Richard Horton, the editor of Lancet, who stated that the dismissals of the editors of JAMA and NEJM highlight “an acute crisis that is developing between the professional values of medicine and corporate values that have overtaken much of U.S. medicine in recent years”. He stressed that medical journals are sustained by the trust that readers place in them [2].

It is not only the readers but also the authors that put trust in them. Some time ago I published an article about myocardial imaging. I was quite amazed when I saw an advertisement for cardiac imaging equipment in the middle of the paper, covering half a page. When I talked to the publisher, he stated that this was completely unintentional.

In 1988, I published an article in Radiology on contrast and field strength in MR imaging. This article was used by a minor US-American MR equipment manufacturer, otherwise well known for suing its competitors over patent claims, to promote its products without asking me for permission. The editors of Radiology were never been asked either. Personally I have no problem with my results being used by companies, even if they have not supported the research. However, I want to be asked first; secondly, I do not like to sponsor publishers with my work; and thirdly, I do not like to be used to promote products I would rather like to see disappear from the market.

Still, I was lucky compared to a German cardiologist who published an article on the pharmacological background of cardiac drugs. Several pharmacological companies ordered a total of 100,000 off-prints of this paper, which were promptly printed and delivered by the publisher, without paying any royalties to the author.

spaceholder red600   This brings us to a related topic: the rights of authors. Most scientific journals require signing a "transfer-of-copyright" agreement before an article is published. In other words, if you do not sign the agreement, the paper will not appear in the journal – a classical case of blackmail. However, by signing this agreement, you sign your soul away. All rights and all possible income go straight to the publishing company.

In many instances, the authors not only lose all rights, but they even have to pay for reprints. I have recently contributed a chapter to a book. Two years after I had submitted my contribution I wrote to the publishing house, asking what had happened to my contribution. I received as answer a letter stating that I could buy a copy of the book at a special author’s discount, but they did not even send a single reprint of the chapter. You have to pay for your own proof reprint.

Another example: Not too long ago I received an unsolicited letter from a British publisher. He sent the manuscript of a chapter for a new textbook for review, 75 pages:

“I am writing to request your help in assessing the suitability of a manuscript on xyz ... I am afraid that we are in rather a rush to have this review completed and ideally, I would hope to have your review completed in one week.”

The word "please" did not appear in this letter. It was just taken for granted that I would spend a weekend to work my way through the manuscript, check it for mistakes, edit it, and make proposals for changes – for the benefit of mankind and for a new Mercedes-Benz for the publisher.

This attitude is immoral and dishonest. Intellectual property is property after all – the expropriation of the author does not include the free use of the Mercedes-Benz of the publisher.

spaceholder red600   Thus, I would suggest to potential authors to change and return the “transfer-of-copyright” form with the following addition:

"The publishers will inform the author(s) in case they want to make use of their limited copyright. In case of sales of reprints or of other reproductions of the article in printed or electronic media, the publisher will compensate the authors financially or by other means. The authors retain the right to reject publication for purposes they deem to be conflicting with their personal or scientific integrity."

spaceholder red600   The special relationships between authors and publishers are a tell-tale story of many authors (although mostly of fiction books, not of non-fiction “scientific” contributions to journals).

Kurt Tucholsky, a famous German political and satirical writer of the 1920s and 1930s, once summarized the relationship between his publisher and himself as follows:

"Negotiations with the publisher. The author, at the end: 'I guess it will be best if both of us marry rich!' and hands some money to the publisher [3]."

... and the dedication of a book by the Hungaro-British writer George Mikes reads as follows:

"This book is dedicated to my friend and publisher, André Deutsch, without whose kind help I could not have managed to remain poor [4]."

spaceholder red600   Disclaimer: Since certain people always construct connections where there are none I would like to stress that this column was written independent of and with no con­nec­tion to the editors of Diagnostic Imaging.

spaceholder blue   PS: However, ... I thank the editors and publishers of Diagnostic Imaging for not censoring this column. If you want 100,000 reprints, please feel free to contact me.

spaceholder blue   Footnote: Many years later: In the meantime the magazine Diagnostic Imaging was sold and its format changed. And I stopped writing for it.


1. Frank TC: US ‘newseum’ to mediocrity. Le Monde Diplomatique (English edition). August 1999. 4.
2. Marshal E: Kassirer forced out at New England Journal. Science 1999; 285 (30 July 1999): 648-649.
3. Tucholsky K: Sudelbuch. Hamburg: Rowohlt 1993.
4. George Mikes: How to be Poor. London: André Deutsch 1983.

Citation: Rinck PA. The front and back of medical journals. Rinckside 1999; 10,4: 15-17.

A digest version of this column was published as:
The front and back of medical journals.
Diagnostic Imaging Europe. 1999; 15,11: 20-21.

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