Publishing in Science: Are Industry Standards Serving Researchers, Clinicians, and Science?

Recently, @JasonSilvernail and I wrote a letter to the editor of the journal Manual Therapy entitled Innominate 3D Motion Modeling: Biomechanically Interesting, but Clinically Irrelevant. The article is currently in press [Reference: Ridgeway K, Silvernail J. Innominate 3D motion modeling: Biomechanically interesting, but clinically irrelevant. Manual Therapy (2012). doi: 10.1016/j.math.2012.02.017]. The letter was a response to a recently published article on the non-invasive 3-D modeling of SI joint and pelvic motion, which in our humble opinions lacked any clinical utility or relevance.

Our submission was denied prior to review 2 separate times because of word length. The (we feel arbitrary) word length for an editorial or letter to the editor is 500 words. Despite multiple e-mails explaining why our piece should be considered in it’s entirety, the editor (through the Journal manager) insisted on a 500 word maximum before being considered for review. The original submission was just over 1,100 words.

We were faced with some decisions. Increasing the scope of the piece to a different manuscript type such as a “masterclass” or “professional issue” was discussed. But, these pieces are usually 3 to 4,000 words and are beyond the scope of what we were trying to convey. We also debated about submitting to another journal, such as the Journal of Manual and Manipulative Therapy. In the end, we decided to cut the length to 500 words, publish our original piece (in it’s entirety) HERE on PT Think Tank, and start a discussion regarding the original topic as well as our current peer review and publishing system. We thought it was an ideal time to explore whether the current journal peer review system is working for clinicians and scientists and what, if anything, we should do about it.

The original piece can be found in it’s own blog post HERE. An excerpt is at the end of this post. Feel free to comment and distribute freely. We would love discussion surrounding the actual issues the letter raises, and some of our criticisms of the research.

In the end, our goal was to express our interpretation of the study Inter-tester Reliability of Non-invasive Technique for Innominate Motion by Adhia et al, including it’s relevance in the context of the current scientific research on the topic and modern clinical practice. We hoped to facilitate scientific discussion and discourse surrounding the topic. Yet, arbitrary word lengths and overly specific categorization of manuscript types actually hindered REAL discussion. For this, we are disappointed. We were not requesting 4,000 words in the journal for an unsolicited narrative review of an area not relevant to the readership. We were seeking consideration for an 1,100 word response letter to an article Manual Therapy had published. A response that in our minds was well written (you be the judge!!) and presented some key issues beyond the study itself that would be of interest to the readership.

We think it is likely that Manual Therapy and it’s editorial staff are forced into industry-standard practices that currently define the for-profit publishing industry.  We have every confidence that the clinicians and scientists on the editorial staff of Manual Therapy are as interested in professional discourse as we are, but are hindered by the system. We do not doubt their scholarly curiosity or suggest any bias against us personally or our perspectives. In many ways they are as hindered by the system as we were. In fact, perhaps more so.

Many people feel the current medical publishing industry does not support clinicians and scientists, but in many ways is primarily about making money for publishing conglomerates. There are many well educated, well published scientists who have raised these concerns, including the people at Body In Mind. A group of scientists the New York Times featured is actually boycotting the publisher Elsevier. Interestingly, Elsevier publishes Manual Therapy. As again highlighted by the New York Times, the Office of Science and Technology Policy is currently debating the issue of access to publications, research, and data that are federally funded.

So, what are the problems?

Access. Most clinicians do not have access to the plethora of articles from countless journals across disciplines that could affect their practice. Thus, how are they supposed (or even expected) to provide evidence or science based treatment? Secondly, how are they to intelligently discuss the literature with other colleagues or scientists? At BEST, they are left to skim abstracts. Chad Cook, the editor of the Journal of Manual and Manipulative Therapy, discusses some of the biases and problems within the PT literature regardless of some these publication issues in his piece Don’t Always Believe what you read… on Joe Brence’s Blog Forward Thinking PT. How do you think research and readership biases are compounded when many (most?) clinicians have limited, if any access, to full text publications? Especially, when abstracts can drastically misrepresent not only the results, but clinical implications of a study. We highlight this issue in our letter regarding Adhia’s et al’s piece; the abstract and conclusions far outstep the data and study design.

Time. From submission to review to dissemination is a LONG process, especially for larger studies. Originally, we began work on our letter in the beginning of DECEMBER. Our first 2 submission were February 14th and 15th, with the final submission on February 24th. Our piece as accepted February 29th (yay leap year!!). Manual Therapy provided proofs  for review March 14th. We are still unsure of when the letter will be electronically published. And, this is just for a 500 word letter to the editor!

Now, we fully understand the time required for adequate peer review in order to ensure proper scholarship and science in large scale trials that involve the presentation of large data sets and sophisticated statistical analyses. But, is there a better way? Does the current system allow for broad access, discussion, and connection? And, really, who benefits?

So, what needs to change?

(Un)fortunately, more people will likely read, access, share, and comment on our original, longer piece published via this blog than the published letter to the editor in Manual Therapy. So, it appears the system is changing right before our eyes. The strength of Web2.0 is that discussion can happen right now. The process is dynamic as knowledge grows over time or people understand differently. I conceptualize this as real time peer review. Researchers, clinicians, students, and even those from other disciplines around the world can access and comment. This creates a vibrant, robust, and expert community of minds that are not limited by word count, publishing rules, or location.

A discussion on “Trigger Point Dry Needling” on @MikeReinoldBlog is an interesting case example. The post has generated 217 comments to date, some of them well researched, articulate, and publishable in our opinions! Imagine that type of discussion playing out in the literature of the current publishing system and paradigm? Unfortunately, the current literature at times is not as robust as these real time, remote, technologically driven interactions.

Fortunately, technology has afforded us the ability to highlight some of the pitfalls of the current publishing system, highlight our frustrations with our experience, and disseminate our original piece. Hopefully, this spawns discourse on scientific research and publishing, including open source and open access issues. Also, we would desire further discussion regarding the actual content of the research article as brought up in our response.

Interestingly, this entire project came about because of Web 2.0. Dr. Ridgeway stumbled across the abstract in his RSS feeder. It was e-published ahead of print. The article seemed out of step with the research evidence, and the author’s conclusions were in our opinion not supported by their study design and the current state of the literature regarding SIJ mechanics, treatment interventions, and lastly (but certainly not least) pain neurophysiology. So, @Dr_Ridge_DPT pushed a link of the abstract to both Twitter and Facebook. Dr. Jason Silvernail commented over social media and suggested a letter to the editor. The rest, as they say, is history. And oddly, despite their collegial nature Kyle and Jason have never met face to face! In total, 10 separate versions were created. The 10th version is the one that will be published in Manual Therapy at a mere 500 words. The 8th version, our best, can be read, in part, below:

We would like to thank Adhia and colleagues for their contribution to the literature regarding the non-invasive modeling of Sacro-Iliac joint (SIJ) motion. This study is interesting from a biomechanical perspective of the inter- and intra-rater reliability of measuring innominate motion via non-invasive palpation based measurements. However, in our opinion, this study has limited relevance to practicing clinicians and to the overall science and practice of manual therapy. The authors conclude “The results support clinical and research utility of this technique for non-invasive kinematic evaluation of SIJ motion for this population. Further research on the use of this palpation digitization technique in symptomatic population is warranted.” This seems to be a rather large logical leap given the results of their investigation and other data in the literature on the manual therapy assessment and treatment of the SIJ and pelvis region. We feel the clinical utility of SIJ palpatory movement testing has not been demonstrated by other research and we struggle to understand how such an assessment tool assists in evaluation, clinical assessment, or treatment with manual or physical therapy…CLICK HERE TO CONTINUE READING

We thank you for reading, and urge you to comment with your views of the current publishing standard. In addition, what is your interpretation of the original Adhia et al article, and our reply?

@Dr_Ridge_DPT      Kyle J. Ridgeway, DPT

@JasonSilvernail      Jason Silvernail, DPT, DSc, FAAOMPT



14 Replies to “Publishing in Science: Are Industry Standards Serving Researchers, Clinicians, and Science?”

  1. Sorry, Kyle… I don’t have time to comment on the article. By title alone I know the Adhia et al article has no clinical relevance. There’s no reason to read past the darn title.

    With regard to what you are mentioning here about publishing standards, the issue is a money and control issue – maybe it’s even a bit of fear? There are many of our colleagues who are *just* normal physical therapists out there working in clinics, treating patients. These colleagues seem less valued because our profession has gone the way of valuing “experts” and “credentials” when it comes to voicing opinions and sharing perspectives in a formal manner. I have met some awesome thinkers online. I have also run into a few who aren’t quite so awesome in their thinking ability.

    Writing a letter to an editor is a complete waste of time. Look at all the hoops you had to jump through – for what? To please an editor? So, fine, it may get published… your perspective may be shared. Sadly, it wasn’t shared in the way you or Jason had wanted. The individuality of who the both of you are and how you formulate your thoughts was hacked to meet some standard and maybe reduce the effectiveness of your message. And it will be shared WAY too long after the darn article was published to even leave an impact to be memorable. How interactively engaging was the process?

    I mean, really… we are all altering not only our expectations in what facilitates a learning experience but we are also demanding a real conversation. You can get more engagement via a blog post or twitter… you can also help mold/mentor/alter beliefs and perceptions of others much more quickly via social media. You can also have your own beliefs challenged. The sky’s the limit and it allows freedom of real expression.

    Remember, there ARE alternatives to having any article published…the “new” way will be a 2.0 way. Think of Physiopedia. Real time sharing, updating, collaborating, offering knowledge via a wiki. Who says the best standard is some stuffy peer-review process? There are plenty of articles I have read that make me shake my head because certain aspects were allowed via the peer-reviewed process. The peer-review process isn’t infallible.

    Oh, dear… the fear of online learning, wiki’s and blogs. How, oh how, will we ever know “credible” when we read it?

  2. Selena, excellent, excellent response!

    Jason and I actually agreed to begin writing a response to the article before even reading it. The title and abstract were so out of line with current science, pain, manual therapy, and clinical practice.

    The TIME is a huge issue with the current system, especially for those consuming the literature, and desiring to comment, discuss, and integrate it. The current publishing paradigm does not allow for appropriate discussion, sharing, and critique.

    Now, I do not know the answer for the actual review and publishing of larger studies. Obviously, as you mention the current system is not great, and bad studies, mis-interpretations, bias, and even fraud have crept in. But, science should be methodical and systematic. So, how do we combine the intent of peer review with the tools of social media and web 2.0. I am not sure….

  3. Open access to the literature would be glorious. Selena is right though, and publishing in print has a high cost. I think we are seeing a general shift in the process. An example is an interesting trial with paywalls at commercial print magazines for long reads while other content is free online. Of course, they pay their writers, and those who submit to journals are not paid for their efforts.

    The ban of Elsevier is fun to watch, not sure what effect it will have but if the boycott grows, at some point the editors will have notably fewer articles, reviewers and referees.

    I feel strongly that PTs/PTAs need access to the full article if we are to aim for science/evidence based practice. Reading titles and abstracts just doesn’t cut it. I think $30-40 per view is absurd. Somebody needs to come up with an i-research version of i-tunes. I would not grumble much for a $5 charge if it was a recommended article by trusted folk from twitter, or excellent blogs such as (who post their pdfs as soon as they are available).

    The process itself is too slow in this age of instant access and communication. I think Physiopedia has the right of it, and a post-publication peer review process can be a good thing.

    We can’t expect critical thinking skills if no one has the chance to learn them, practice them, and see how they can make clinical practice more relevant and effective. Now, there’s a study – does it really do all that or do I want to believe it does to justify the time I spend?

  4. Stellar work, Kyle and Jason.

    Per Selena: “You can get more engagement via a blog post or twitter… you can also help mold/mentor/alter beliefs and perceptions of others much more quickly via social media.”

    Eric has generously given his platform for this discussion – it would be worth your while to ask him again if you do not press your message on your own blogs. Selena writes often at EIM’s blog.

    I also suggest you consider taking on one issue at a time per post, possibly doing a ‘series’ of related topics. (On my blog I have several series – linked in boxes in the right margin.)

    I know that sounds similar to the word-limit enforced by the journal editors, but I do not mean it in that way. I almost did not read this post based on its length. I can only spend so much time online and have to prioritize. Perhaps that is just me, but a post has to be very compelling on a widely read blog in order to get a full-on discussion in comments.

    Regarding problems with current publication conditions…the pressure to publish under the guise of tenure is a deeper etiology to the for-profit business of publishing ‘research’.

    While the two of you do not think the rejection was personal I remind you that we (PhD, PT) a small (elite?) group among most industries. Competition for publication for us is not unlike what actors and musicians experience. IMHO

  5. Also, here is a new tool:

    This new tool will go beyond impact factor and track hits and social media shares. This could be big!!

    Via Body in Mind ( and I quote:

    “Many journals including the BMJ looking at introducing a ‘Usage Factor’ which will incorporate social media usage and ‘hits’ in addition to standard impact and citation counts. This model has been accepted by funding bodies (eg Wellcome, MRC, NIH etc).

    The Director of COUNTER (Counting Online Usage of NeTworked Electronic Resources) was at the BMJ editorial retreat talking about his work incorporating the consortium of scientific journals”

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