How much money do journal publishers make A lot

Many, including me, have written about who is making money in healthcare. Sure doctors do very well, but not as well as hospitals, hospital administrators, insurance companies and their corporate officers, drug companies, device manufacturers, and others.

Another lucrative area is medical journal publication, especially if you are the publisher. A researcher gets an idea, plans and carries out a study, writes a manuscript, and submits it to a journal. The research may have been funded by the government, i.e., you and me.

An associate editor or a member of the journals editorial board looks at the manuscript, and if it is deemed worthy, it is sent out to two or more people in the same field for peer review. This process may be repeated for papers that require revision.

All of the players in the above scenario—the researchers, most of the editorial board members except maybe the editor, and the peer reviewers—are paid nothing for their work. Factor in that the cost of producing a journal has plummeted in the computer era.

How much money do journal publishers make? Here are some impressive numbers from an article that appeared on a French website called "Rue89." The figures are for the year 2011 and are in euros. They include revenue from all science publishing, not just medicine.



As you can see profit margins range from 32% to nearly 42%. Elseviers profit of over €878 million converts to just over $1 billion.

To put that into perspective, the most recent figures for Apple Inc., arguably the most successful company in the world currently, show a profit margin of 20%.

The Rue89 piece was written as an exposé about the French governments having to pay Elsevier $172 million in subscription fees to access information generated by scientists who were funded by that same government.

But the French have nothing on us.

In his presidential address to the American Surgical Association, Dr. Layton F. Rikkers, editor emeritus of the Annals of Surgery said:

Nearly $10 billion is spent annually by [US] universities and governmental agencies for access to research findings that their scientists and clinicians give to publishers for free, that their faculty peer review for the alleged honor of doing so, and that are funded by taxpayer dollars and charitable trusts. It is unclear why library budgets continue to increase above the rate of inflation when nearly all the journals they now receive are delivered electronically in large packages from the few remaining consolidated publishing houses. Examples are Wolters Kluwers Ovid and Elsevier’s Science Direct each of which contain hundreds of journal titles. Some individual journals not available within these large collections, such as Brain Research, can cost libraries more than $20,000 annually.

There are more than 9000 open access journals, and 3.5 new ones per day are setting up shop. Instead of charging for subscriptions, open access journals are free to the reader, but the authors must pay "processing costs." Many of these publications have exorbitant fees with little or no true peer review.

Before submitting any paper to an open access journal, authors should be sure they understand the fee structure and check Bealls list of predatory publishers, which has recently been updated and expanded.

Dr. Rikkers feels as I do that print journals will gradually disappear. Post-publication peer review is already gaining momentum through blogs and sites such as PubMed Commons and PubPeer. Even major journals like the BMJ have established rapid response systems for immediate feedback to authors.

The heady days of 40% profit margins may soon be over, but for now big bucks are being made.

More about journals:

How are journal articles peer-reviewed?
How journal articles are peer-reviewed: Part 2
Journals, Open Access Journals and More Journals
What you need to know about some open access journals

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Costuming VS Getting Your Life Together

Photo by Future Photography by M3

As of late I have observed numerous individuals that are so passionate and focused on costuming that they unknowingly disregard the responsibilities of their personal life. I want to point out that there is certainly nothing wrong with being devoted to cosplay. Costuming is healthy. It is creative and takes hard work. To many, it is a form of self expression. To others, it can be therapeutic. Its fun and delightful to research a costume and put it all together. Sewing, painting, molding worbla, everything involved in creating a costume is bad ass. However if the craft has taken over your life to the point where you can hardly put food on the table, your living situation is not where it should be or majority of your paycheck is going to costume building yet you are creating Kickstarters for "life expenses", something is very, very wrong. Its time dear friends, to make a choice between costuming and getting your life together.



Ill be the first to admit that it completely and utterly sucks when you want to put a costume together but you just dont have the funds to do so. You feel stuck; like you have reached a dead end. The only thing you can do is make a U-Turn and try to find another way. That is not only an important lesson in costuming but in life. You have to make choices and sometimes those choices mean sacrifice and compromise. You need to change your perspective. What is more important? Spending hundreds of dollars buying supplies for your next costume or paying off your past due cell phone bill?  It boggles my mind when I come across someone on social media who is posting daily updates on all the supplies they purchased for their new costume and yet that same person will create a Kickstarter to pay their rent. If you didnt fork over your hard earned cash for supplies, you would have that money to pay your landlord or roomates. Is it really worth risking getting evicted just to make a costume? Is it worth loosing your home? And furthermore you are attending the next big convention out of state, thousands of miles from where you live. Pay your bills, my friend. Granted it stinks when you cant attend a show you have your heart set on but it will still be there next year and you can always live vicariously through your friends posting on social media. In many situations, it would be better for you financially to stay home. You will  be saving money on travel, hotel, food, costume building and shopping. You can pay your bills on time and may even have some money left over.

Ive observed many people who are stuck in a rut. They are accomplishing great things in costuming but their personal life is a mess.  They dont realize if they skipped a con or two or perhaps made a little less costumes this year, they would have more money in their pockets. Maybe you can finally upgrade your busted phone. Perhaps you can finally get those repairs your car so desperately needs. And maybe, just maybe, you can change your living situation and be independent.

Stop taking costuming so seriously. Redirect your focus from time to time. Do this only when you are financially able to. Stop sacrificing improving your life to attend a convention. Pick and choose because sooner or later, 10 years from now you ll be looking around wondering what the hell happened. You will not have made any progress and I dont want to see that happen to anyone and it pains me to witness it currently.  You can do better. You can progress in the real world and grow. I believe in you :)

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Do doctors charge too much

We all know that some doctors’ fees are excessive. I have blogged about this myself citing a neurosurgeon’s $117,000 charge for assisting on a case.

We also know that doctor bashing is a popular sport right now.

In an otherwise reasonable article about high-deductible health insurance on Vox.com, reporter Sarah Kliff’s second paragraph read as follows:

The bolded text was hyperlinked to a Washington Post piece about a study that showed wide variations in hospital charges for appendectomies in California. The study was not about physician fees. No matter how difficult the case was, no surgeon would ever have been paid $186,955 for performing an appendectomy.

Yesterday, I twice asked Ms. Kliff to please correct this grossly misleading paragraph. She acknowledged my request that evening, but as of 9 AM today, nothing had been changed.

Even if Ms. Kliff had correctly identified the hospitals as the culprits, using appendectomy as an example of why patients should shop for the lowest prices was a poor choice.

Nearly every patient with appendicitis does not know he has it until he has gone to an emergency room, seen an ED physician, and had some tests. I doubt most people in this situation would A) ask how much it’s going to cost to have an appendectomy and B) decide to go to another hospital for care. The fact is, hospitals are so secretive about their charges that a patient would be unable to comparison shop especially if the emergency department visit occurred outside of normal working hours.

Even trying to find out the charges for elective surgery remains difficult in 2015.

Physicians—particularly surgeons—have taken a lot of heat recently. We don’t need articles like this to inflame patients (and journalists) even more than they already are.

ADDENDUM 9:45 AM 10/15/15

The article was just changed. The bolded mistaken passage was corrected, but the next sentence (underlined in red) remains the same. Still blaming those "really expensive doctors."

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Medicare is changing the way it pays surgeons

Starting in 2017, Medicare will end global payments for operations. The current payment scheme combines preoperative, operative, and postoperative care into one fee. When the change occurs, each of those events will have to be billed separately—otherwise known as “unbundling.”

I missed this news when it first appeared late last year and thank one of my blog followers who calls himself Artiger for bringing it to my attention. An Advisory Board piece summarized the situation.

After analyzing a number of claims, Medicare came to the conclusion that it was paying for duplicate services. What a revelation! I could have told them that without a claims analysis.

For many years, certain surgical specialists have been delegating preoperative evaluations for “medical clearance” and postoperative management of everything but the incision to internists and hospitalists. Since the global fee was meant to include pre-and postop care, Medicare was indeed paying twice for the same service.

Representatives of the American College of Surgeons expressed concern that sicker patients would need more in-hospital postoperative visits thereby incurring more bills. [If they receive more care, maybe they should pay more.] They also worried that since postoperative care was covered under the global fee, patients might forgo office visits after surgery because of increased costs.

The unbundling of the global fee may have other unintended consequences. Since preoperative and postoperative care reimbursement will be separated from the fee for the operation itself, surgeons will be paid less for performing surgery.

Most surgeons would rather operate than make rounds and may look to perform more surgery to make up for the loss of income. This could end up costing Medicare more money.

With global payments, there is no incentive for a surgeon to keep a patient in the hospital longer than absolutely necessary. When the payment method changes, the exact opposite will exist. And surgeons who aren’t very busy might schedule more postoperative office visits to make up the difference caused by the reduction in the surgical fee.

This might all become moot anyway because Health and Human Services Secretary Sylvia Matthews Burwell has proposed that 30% of Medicare payments be converted to a non-fee-for-service model by the end of next year rising to 50% by the end of 2018.

According to a news@JAMA article, doctors may be given incentives to join Accountable Care Organizations. Quality indicators such as readmissions and infections currently applied to hospital fees might be imposed on doctors too. More bundled payments for acute care illnesses may be created. [This of course is the exact opposite of the plan to unbundle global surgery fees. Im getting confused].

One thing Im sure of is that none of this is making me regret that I retired.

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How much money can you make cosplaying

"How much money can I make cosplaying?"

Within the last few years, this question has been asked by a large group of people. Many seek to get into the hobby as a job; something they can be employed at. Many feel it is an avenue to not only internet fame but fortune as well.  So how much money does the average cosplayer make? What can you expect in terms of increasing your financial status? I have complied a list for those who are seeking an answer to their question.



If you want to know how much an average cosplayer makes, you have to ask them what their day job is. Yes, I said day job.

FACT: COSPLAY COSTS MONEY. If you are making your own costumes and props or if you are hiring someone to commission it for you, its going to cost money. You have to pay for it. Wigs costs money. Makeup and body paint costs money. Shoes, boots, the list goes on.

FACT: TRAVELING AND ATTENDING CONVENTIONS COSTS MONEY. Food, gas, hotel, round trip plane ticket, luggage, round trip train ticket, you get the idea. If you want to attend conventions in your area or across the country, get ready to save up. Its not cheap.

FACT: YOU CAN MAKE MONEY COMMISSIONING COSTUMES AND PROPS. I know many talented individuals who have a side business and make incredible pieces of art for paying costumers. Many of them do have day jobs. Others are so successful that it has become their primary job. These gifted men and women are costume and prop makers.

FACT: YOU CAN SELL PRINTS AND CALENDARS AND MAKE MONEY but dont expect to quit your job. Its side money at best.

FACT: YOU DONT GET HEALTH INSURANCE OR A 401K BY COSPLAYING.

FACT: SOME SHOWS WILL COMPENSATE YOU FOR BEING A GUEST BUT OTHERS WONT. I know a number of people who have attended a comic-con as a cosplay guest or judge but they paid out of pocket to be there. Not every show is going to pick up all of your expenses (hotel, plane ticket and food) however some of them will. It really depends on the convention organizers.

FACT: MAJORITY OF COSPLAYERS HAVE DAY JOBS.


FACT: SOME COSPLAYERS HAVE BEEN ABLE TO TURN THEMSELVES INTO A BRAND. This means that they not only sell prints, but items such as warbla and all ready made props and accessories you can purchase. They thought outside the box therefore their sales are higher compared to someone who only sells prints. They are more of a Cosplay warehouse. Can you quit your job and rely on online sales? Only if you turn yourself and your online store into a brand. Many women bill themselves as "full time cosplayer" however it is difficult to say if they are paying the rent/mortgage or if their significant other/spouse is. If they have a partner who brings in a forty hour per week paycheck, that explains why they can cosplay "full time" but realistically you cannot dress up and expect money to pour in.

Everything I have listed here is based on experience, observation and Intel.  

Hopefully this gives everyone a realistic perspective on how much money you can make cosplaying. 

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On the shoulders of giants

The following was sent to me by a professor who sits on the admissions committee of a medical school in the United States. Here’s what he asks prospective students during interviews.

Sir Isaac Newton said, “If I have seen further, it is by standing on the shoulders of giants.”

If you want to become an astronaut, I’ll bet you know who Neil Armstrong is. If you want to become a rock-star, you likely know who the Beatles were or who the Rolling Stones are. If you want to become President of the United States, you know who Barack Obama is. But you want to become a doctor, right? That’s why you’re here.

So, who are those giants of medicine? What famous scientists or doctors who have advanced the science of medicine can you name?

The following would not be acceptable:

Mehmet Oz, MD
Sanjay Gupta, MD (Medical reporter)
Phillip McGraw (“Dr. Phil”)

Here are some names that would count: Drs. Watson, Crick, and Franklin

You wouldnt believe the answers I get. For example:

Me (after an applicant couldn’t think of any names): "What do we do to milk to make it safe to drink?"

Applicant: "Put antibiotics in it."

Me: "What was your major in college?"

Applicant: "Microbiology."

Me: "OK, what is the PROCESS we use to make milk safe called?"

Applicant: Crickets...Crickets...

Me: "Ill give you a hint. It is named after a French scientist."

Applicant: Crickets… “I wasnt a history major.”

Me: “No, worse—you were a microbiology major. Let me give you another hint: His first name was ‘Luis’ (Loo-ee, pronouncing it best I can).”

Applicant: Crickets...

Me: “Okay, what is the process of heating milk at a high temperature, under pressure, to kill bacteria called?”

Applicant: “WAIT!!!! Pasteurization!!!!”

Me: “Great. So what is the guys name?”

Applicant: “Dr. Pasteurization!!!! Dr. Franco (after Id already told him the first name was Luis) Pasteurization.”

Me: Crickets...

Here are a few choice responses from other applicants: Patch Adams, David Perlmutter, anesthesia, the one who created penicillin, Bill Nye, Ben Carson, and [my favorite]—Jonah Salt (sic).

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