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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Its All About That Bass featuring Kate Davis

Greetings:

You gotta hear this......

Its All About the Bass featuring Kate Davis....

Amazing stuff...


http://youtu.be/iyTTX6Wlf1Y


Enjoy


Marc

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A “shallow water blackout” is a silent killer

In Jacksonville, Florida, a 50-year-old woman was found at the bottom of her backyard swimming pool. She was an experienced scuba diver who “often stayed at the bottom of the 9-foot deep end without oxygen to increase [her] lung capacity for future dives.”

Despite receiving CPR from her son, she could not be revived.

The Associated Press story about this tragic incident did not explain why a swimmer with her background drowned.

It appears to be a classic case of “shallow water blackout.” This phenomenon occurs when people hyperventilate before diving.

An increasing level of carbon dioxide (CO2) is what triggers the urge to breathe. Hyperventilating causes hypocapnia, a reduced amount of CO2 in the blood. If a swimmer uses up enough oxygen to pass out before the CO2 trigger point for breathing is reached, drowning will occur without notice. Victims are usually found at the bottom of the pool.

Here’s what it looks like in a diagram from Wikipedia:

A physician who lost her son to this little-known phenomenon started a websiteto heighten awareness of the problem. The site contains more information and stories about other drownings caused by shallow water blackouts.

Here is a video of a woman swimming laps of a pool underwater. Advance to the 0:50 point and watch what happens as she begins to slow down. [Addendum 8/13/15 12:50 pm: Warning. The video is graphic. It shows the unconscious swimmer being pulled from the water.]
 

A shallow water blackout may have been responsible for the death of Natalia Molchanova, the world’s foremost freediver, who went missing a few days ago.

Hyperventilating prior to diving is not recommended. Tell your friends.

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Watch How Indomie Took Mother’s Day a Step Further

Sunday 6 March 2016, marked the celebration of mothers in Nigeria. The day was filled with memories for mothers and their children who took out time to celebrate their favorite heroines and icons. For most brands it was a time to key into the trend and join in the celebration.

One brand however stood out with their campaign to celebrate mums like no other. Indomie took mother’s day a step forward by adding great emotions with how they chose to celebrate Nigerian mothers.


The campaign Thanks Mum for Every Special Moment. In a very emotional video message, Indomie got children to share and send their mother’s day good will messages to their watching mothers behind the scene. Watch as these kids put smiles on the faces of their mothers by saying the best things about their mum, courtesy of Indomie #MumLikeNoOther.

In addition to sharing the mother’s day spirit, Indomie is taking bold steps with their mother’s day CSR initiatives. The CSR activities is currently on-going in 18 key cities in Nigeria, where they are visiting different maternity and orphanage homes bearing branded gifts from the brand.

Visit our Facebook page https://www.facebook.com/indomieinstantnoodles/videos/1155408417816717/ , join the campaign and Indomie may just surprise your mum.

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More evidence that the manuscript peer review process is broken

To the surprise of almost no one, asking authors of research papers to submit names of potential peer reviewers for their manuscripts turns out to be a bad idea.

According to a recent New England Journal of Medicine article by Dr. Charlotte J. Haug, a number of research papers have been retracted because reviews were fabricated. Email addresses of suggested peer reviewers were not legitimate. The bogus email addresses were almost all created by authors of papers who then reviewed their own work favorably using fake identities. 

More about the problem can be found on the blog Retraction Watch.

This type of fraud is simple to do because anyone can set up an email address on Gmail or Yahoo mail using any name. Unless a reviewer has an academic email address, proving legitimacy is impossible.

However even if a reviewer has an “edu” address, how would an editor know that a suggested reviewer is not the author’s sister-in-law or a former mentor?

Every medical student who applies for residency knows that you don’t ask someone for a letter of recommendation unless you are sure that it will be favorable. Why would an author take a chance on recommending someone to review a paper without knowing that the review would be a good one?

I agree with the Dr. Haug that soliciting the names of possible reviewers from authors can save editors time and bother. Having spent three years as an associate journal editor, I have experienced the frustration of trying to find high quality reviewers or even a warm body of any quality to do the job.

I also agree with her that a root cause of this problem is the pressure on faculty to publish.

Another problem is that there are too many journals. In 2014, well over 5000 journals and 760,000 papers were included in Medline. The combination of “publish or perish” and superfluous journals leads to the proliferation of marginal papers.

The problem is not simply fake reviews. Since journal reviewers are not paid and have many other responsibilities, they may not thoroughly read papers or provide useful comments about manuscripts.

Some have suggested paying peer reviewers, but who would pay them? Certainly not publishers, even though they make tons of money. And paying might attract unqualified people looking to make a little extra cash.

What about post-publication peer review? It is already happening on blogs, on sites like PubPeer, and even on PubMed. However, the volume of papers published in medicine alone certainly precludes post-publication review of all of them.

Maybe it doesn’t matter. New journals are appearing every day. Most are “open access” and the charge authors “processing fees.” For many of these publications, processing fees do not include even a cursory manuscripts peer review.

With so many journals publishing just about anything for the right price, readers will have to do their own peer reviewing. Be skeptical my friends. 

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2015 Match Review

Continuing grim news for international med school grads and some US grads too

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every US medical school because 93.9% of the 18,025 graduates of US allopathic medical schools matched in a specialty.

But for the 1093 (6.1%) US graduates who didnt match things were not so bright. These applicants had to go through the Supplemental Offer and Acceptance Program (SOAP) which connects unfilled programs with unmatched students.

Because there were over 8600 unmatched graduates from schools all over the world vying for about 1200 unfilled first-year residency positions, even some US med school grads did not secure a position. One of these unfortunate souls tells her story in this blog.

The 7400 or so new MDs left out in the cold will not be able to pursue their careers. They will not progress into any specialty, nor will they be able to obtain licenses to practice medicine anywhere in this country. Those with substantial tuition debt will have no way to pay off their loans.

The percentage of unmatched US graduates has been relatively stable over the last five years, ranging from 4.9% to 6.3% while the number of first-year residency positions offered has steadily increased by nearly 4000 from 23,420 in 2011 to 27,293 this year.

Graduates of osteopathic medical schools didnt fare quite as well. Of the 2949 osteopathic school applicants, 610 (20.7%) went unmatched, but this percentage has steadily declined from a high of 28.3% in 2011.

International med school grads were much worse off; 2354 (46.9%) US citizens and 3725 (50.6%) non-US citizen graduates of international medical schools did not match. Both of these groups also had declining percentages of unmatched applicants. In addition, about 1900 US citizen graduates of offshore schools either withdrew or did not submit a rank list compared to almost 2700 non-US citizen international graduates who did likewise.

Reentering the match next year is an option, but spending a year outside of clinical medicine greatly reduces ones chances of finding an accredited position.

If you factor in the number of applicants who either withdrew from the match for did not submit a rank list. graduates of international medical schools have well below a 50% chance of matching.

In previous posts here and here, I have warned about the risks involved with attending an offshore medical school. If you are considering attending such a school, I urge you to look at the numbers and think long and hard about your decision.

Source: Advance Data Tables 2015 Residency Match

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That electric hand dryer study was bogus Heres why

Just about everyone I follow on Twitter commented and/or linked to an article about a study claiming that electric hand dryers spew bacteria all over people using restrooms.

The paper, which appeared online in The Journal of Hospital Infection, said that airborne germ counts near jet air dryers were 27 times higher than counts near paper towel dispensers, and counts near warm air dryers were 4.5 times higher. The authors also coated subjects hands with black paint and measured spatter patterns on surrounding walls and persons dressed in disposable coveralls. And a photo from the study shows the dispersal pattern from a warm air dryer.

So case closed—paper towels are better, right?

Im not so sure. Instead of reading an article about the paper or just the abstract, I obtained a copy of the whole paper. I also found some comments about it from a spokesperson for a hand dryer manufacturer.

What are the flaws in the study?


From the papers Methods section: "For each test, gloved hands [not bare hands] were first coated by immersion in a suspension of lactobacilli (107 cfu/mL) that were cultured from a proprietary yoghurt." FYI, 107 cfu/mL is a lot of bacteria—certainly more than most of us would get on our hands during an average trip to the restroom. Its the equivalent of putting your hands in liquid feces, except that lactobacilli are benign bugs.

After dipping the gloved hands in bacteria, they werent washed. Stick gloved hands in bacteria, dont wash them, and then stick them in an electric dryer. No doubt there will be dispersal of bacteria around the room.

Also from the Methods section: "For [another] test, gloved hands were coated in a solution of black water-based paint." Water-based paint on gloves is not the same as water on bare hands. Have you ever seen water all over the walls next to a warm air dryer? I havent.

The study was funded by the European Tissue Symposium (ETS). Although this sounds like some kind of scientific conference, it is actually a trade organization of companies that make paper towels. The senior author of the study, Dr. M.H. Wilcox, "has received honoraria from ETS for microbiological advice and travel expenses to attend an ETS meeting." He also co-authored a consensus statement sponsored by the ETS which happened to find that paper towels are the most hygienic way to try hands.

I have always preferred paper towels. I feel that my hands can be completely dried in far less time than when I use the electric dryers. The drying process helps to reduce bacterial counts on the hands. Some studies have shown that when using electric dryers, many people do not completely dry their hands because it takes too long. See the table below.

A 2012 review of hand drying methods from the Mayo Clinic Proceedings concluded that paper towels were better than electric dryers from a hygiene standpoint, and that paper towels should be used in hospitals. [Note: One of the authors of that study had been a consultant to a paper towel manufacturer.] Thats why you dont see electric hand dryers in patient care areas of hospitals.

I also hate the noise generated by electric dryers and the faster they are, the noisier they are. You can see the decibel levels of several devices in the table above.

The paper towels vs. electric hand dryers debate has been going on for years not only about hygiene, but also about which method is better ecologically.

Although I dont believe a word of the much-tweeted European Tissue Symposium study, I still prefer paper towels.

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Make 50 Every Day Doing This Amazing TRICK!!!!

Okay...Okay... I am sure you are crazy to know what i am talking about....

Well , let me just say , you guys know i always share what works for me because i always say we need to be our own boss not make rich other people. So i found this way to make money it is $50 everyday or probably every hour if you take action TODAY!!!

So let me introduce you guys to this amazing website > CHECK HERE AND SIGNUP NOW<

So this website CLICK HERE TO SIGNUP NOW!! is offering you $50 for each person you bring to them... THAT IS JUST INSANE!!!!!!! 

Now , let me tell you something , i am making money already doing that and i want to say i know for sure you guys can make money also. I will be sharing ways to get referrals way fast and YOU will get that information in my next post. 

Now, lets talk about this amazing website  CLICK HERE TO SIGNUP NOW!

They will pay you $50 for 2 friends that you will bring , they dont have to be your friend you can get referrals SO SO SOOOO fast and i will show you guys how in my next post. Just keep checking!

If you want to know more about this posts please subscribe to my blog, and you will receive my post and more every time i post something okay? 

Now , i want to say if you want to make money online you have to TAKE ACTION!!

So lets take action and CLICK HERE TO SIGNUP RIGHT NOW!!!

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Adfly Trick For 2015 SECRET THAT NO ONE KNOW

Adfly Trick For 2015 (SECRET THAT NO ONE KNOW)

I am NOT going to tell you like everyone else out there is saying... "Oh download a bot and auto click " that is CHEATING! adfly can banned your account and i have been making good amount of money with adfly to take that risk. 

So , i am here to tell you a trick that ive tried and yes it did work! PRETTY GOOD ALSO! 

Now let me tell you that for this trick you will need.

• Youtube Account
• Computer/Laptop
• Patience
• At least 3 hours of your time

That is all i am asking you for so this can actually work pretty good. , now let get started.

1. Get a youtube account , if you want to start from 0 you should just get a new account but remember you going to have to verify it and stuff. (Make it LEGAL!) all legal.

2.  Go to THIS SITE CLICK HERE and you will see that there is new phones each time a new phone comes up you will see it there. 

3. You going to get videos that will show reviews or even the looks of the phone and you will download the youtube video HERE and you will upload the youtube video to your channel

On the description you will put something like IF YOU WANT TO SEE THE FULL PHONE AND UNBOXING VIDEO PLEASE CLICK HERE <<< there you will put the page of the phones that i just gave you and (you are not lying, that website they always have the unboxing and reviews because they have connectiong with tmobile,verizon,atnt etc. 

So this trick does work , you just have to put yourself to work and it does work i did it and i keep making MONEY ! 

I LOVE ADFLY!!! been doing it since 2013 and i can happily say that you do make money if you put work and effort.! 

DO NOT CHEAT!!!! dont believe those who say download this auto clicker and you will make more money with adfly blablaahh.. DONT DO IT!!

GodBless.

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That time Skeptical Scalpel wasn’t skeptical enough

Yesterday I retweeted a link to “Live Action News,” a website with a video claiming that Planned Parenthood was selling fetal organs.

I had watched the video and read the accompanying article but failed to engage my skeptical radar. It turns out that the video was maliciously edited to portray Dr. Deborah Nucatola, Senior Director of Medical Services for Planned Parenthood, in the worst possible way. The video showed her “having lunch with actors posing as buyers who are interested in purchasing the body parts of babies who have been aborted” and discussing prices.

The website Media Matters describes some of the edits and explains why they are deceptive. It turns out that of the 150 minutes of the original footage, only 8 minutes were used in the "Live Action News" clip.

If I had watched the video more closely, I wouldn’t have needed Media Matters or the 150 minutes of original footage to see the flaws.

First of all, it begins with an introduction by a former ABC News anchor Connie Chung promising something shocking. But as you can see in the screen shot below in the lower left corner, it clearly says “ABC News 20/20 March 8, 2000.”

Another obvious clue is that the date and time stamp in the lower left-hand corner of the edited video itself is “2014 07 25.” In retrospect, it does not seem plausible that an anti-abortion organization would have sat on this inflammatory story for almost a year before releasing it.

In addition, the times differ greatly as the video progresses which obviously should have told me that major editing had taken place.





The "Live Action News website looks pretty bogus too.


I am very disappointed in myself for having fallen for this dishonest garbage.

It won’t happen again.

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Its that time of year again

Hopes are high; everyone is prepared; all the talk is over. The big day is finally here.

No, its not about the Super Bowl. Its about the American Board of Surgery In-Training Examination (ABSITE).

Every year at the end of January, all surgical residents take a five-hour, 250 question multiple-choice test. For many, it can be a watershed moment because their careers may be on the line.

I have written about the use of the ABSITE as a criterion for resident promotion. Whether you think it should be or not, it is used that way—sometimes as the only criterion. You can bet that in a few weeks, some residency programs will post notices saying they are looking for a categorical PGY-2 or 3 due to an "unexpected" vacancy for July 2015.

Another attending surgeon and I used to take in-house call the night before the examination so that all of the residents could take the test after a decent nights sleep.

Now the test may be given on different days so that the entire group does not have to take it at once.

One difficult situation I faced as a program director was when I had a good clinical resident who just could not do well on a multiple-choice examination. I had to decide whether keeping a resident who scored at the 10th percentile was worth the gamble. Scoring in the 10th percentile or less on a regular basis means that the resident has a good chance of failing the written board examination.

Of course, the very nature of percentiles is that 10% of those who take the test will finish in the 10th percentile or below. Also, the failure rate of the written board examination has hovered around 25% for many years.

The problem for programs is that the Residency Review Committee for Surgery mandates that 65% of a programs graduating residents must pass both parts of the board examination on the first attempt.

Of the many things I do not miss about practicing medicine during this turbulent era, the palpable level of anxiety surrounding the buildup to the exam and waiting for the dreaded results to come back rank high on the list.

I wish all residents who are taking the test the best of luck. I hope you were reading all along and not trying to cram a years worth of studying into the week before the test.

May you all score above the 50th percentile.

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More ratings—this time its residency programs

Can you really decide which surgical residency program is right for you using Doximitys Residency Navigator?

I dont think so, and heres why.

The rankings of residency programs were obtained by surveying surgeon members of Doximity. They were asked name the five top programs for clinical surgery training. When the survey was announced in June, I predicted that most respondents would probably overlook the word "clinical" and focus on the usual famous academic institutions.

I also pointed out that anyone not intimately familiar with a program would be unable to judge whether it is good or not and suggested that reputation would be the main driver of results.

In fact, that is exactly what happened. Of the top 40 programs listed, all are based at university hospitals, as are 66 of the top 70. Back in June, I speculated about the top five programs and got the first two correct but in the wrong order.

A 2012 survey of surgical residents with over 4200 responders (an 80% response rate) found that community hospital trainees were significantly more satisfied with their operative experience and less likely to worry about practicing independently after graduation. Wouldnt you then expect a few community hospital programs to be among the top 40 hospitals for clinical surgery training?

Proof that the surveys findings are not reliable is that every one of the 253 surgical residency programs in the country was mentioned by one or more of those who responded. This included one program that has been terminated by the Residency Review Committee for Surgery. At least it appears near the bottom of the list.

The number of voters who cited the lower ranking programs must have been very few, meaning the difference between the 200th and 240th program ranks is probably not statistically significant.

Some programs that were rated are so new that very few or no residents have graduated yet. How could anyone know if they are turning out competent clinical surgeons?

Board passage rates for programs, which are available online, were omitted for some and were not clearly identified as the percentage of residents who passed both parts of the boards on the first attempt only.

The percentile rankings of alumni peer-reviewed articles, grants, and clinical trials are displayed prominently. What do those data have to do with the research question—which residency programs "offer the best clinical training"?

So whats the bottom line?

You can put the Doximity Resident Navigator in with the other misleading ratings of hospitals and doctors. Applicants considering surgical residencies should not rely on it for guidance.

It has warmed the hearts of faculty and residents at highly rated programs, but I wonder how the OR lounge discussions are going at places where programs ranked lower than expected.

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Dont jump to conclusions about that JAMA surgical readmissions paper

On February 3, JAMA published a paper online about readmission rates after surgery. The focus of most tweets was on the most common cause for readmission—surgical site infections (SSIs)—in 19.5% of readmitted patients.

At first glance, this suggests that infection rates after surgery were 19.5%, but that is not so. The paper said that 19.5% of the readmissions were caused by infections.

Of 498,875 total operations reviewed, only 30,270 (6.1%) were readmitted for any reason, and only 5576 (1%) of all patients were readmitted for SSIs.

According to the full text of the paper, the authors had two main points:

One, "because most readmissions were attributable to well-described postoperative complications, readmissions after surgery are mostly a proxy measure for postdischarge complications and in effect penalize hospitals twice [my emphasis] for postoperative complications (ie, other pay-for-performance programs include postoperative complications such as SSI)."

Two, "the majority of hospital readmissions were related to SSI and ileus [non-mechanical failure of bowel peristalsis]. Identifying clinical interventions to reduce the occurrence of these complications to below current levels has been challenging."

An article about the paper in US News quoted an editorial by Lucian Leape who said "system-wide changes need to be made." One such system change, the Surgical Care Improvement Project (SCIP), has been ongoing for more than 10 years.

The paper confirms what I wrote in 2010 about SCIP and other process measures and points out that "Most hospitals in the United States have high adherence rates for the SCIP SSI-prevention process measures; however, compliance with these process measures has not been shown to be strongly associated with reduced SSI rates."

And I am unaware of a conclusive study showing that the incidence of postoperative ileus can be lowered by any intervention.

I agree with the comments of the papers authors who say, "It is important to note that many readmissions may be unavoidable and are actually the correct course of action for surgical patients. [My emphasis] Many complications should be treated in the inpatient setting, and surgeons should not be deterred from readmitting patients because of concerns about quality measure performance and resulting penalties."

Every effort should be made to lower the infection rates of all procedures. But this papers results should be viewed not with alarm, but rather as reassurance that the problem is not out of control.

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German airliner crash A system error with a system solution

From the Associated Press: Airlines around the world on Thursday began requiring two crew members to always be present in the cockpit, after details emerged that the co-pilot of Germanwings Flight 9525 had apparently locked himself in the cockpit and deliberately crashed the plane into the mountains below.

This represents an organizations typical response to a problem. The crash, which by all accounts was caused by a single deranged individual, has been perceived as the result of a “system error” and will be dealt with as such.

The idea that a flight attendant going into the cockpit whenever one of the pilots has to pee will prevent anything seems a bit absurd to me. How is a 5’2” 120 pound female flight attendant supposed to stop a 6’3” 210 pound pilot who is hell-bent on committing suicide by airplane?

When I tweeted a similar thought yesterday, someone suggested that she could simply sound an alarm and unlock the cockpit door. I suppose that’s true as long as the crazed pilot does not punch her in the face and knock her out or shoot her first.

After 9/11, a federal law was passed allowing pilots who were properly screened and trained to carry guns. If an armed pilot decides to commit suicide, an unarmed flight attendant will not be able to stop him or her.

According to a CNN story, Andreas Lubitz, the pilot who drove the plane into the mountain, had passed all medical tests before being hired. He recently had been given a medical leave note by a doctor. However, Lubitz ripped it up and threw it in a wastebasket in his apartment. He did not disclose the fact that he had been undergoing medical treatment to the airline. So much for self-reporting which is standard for pilots.

Why didnt the doctor tell the airline? I dont know. Do they have HIPAA in Germany?

The two people in the cockpit rule is smoke and mirrors. The airlines can now say that they have taken steps to prevent something like the Germanwings crash from happening again so dont worry, its still safe to fly. But as I have pointed out, a determined maniac will be able to easily overcome this system solution.

I am reminded of the proposals like arm the janitors, arm the teachers, or give them shields or scissors that always come forward after school shootings.

Footnotes:

1. "Two people in the cockpit” is not an FAA regulation but is said to be a standard policy for US airlines. Its purpose is not to prevent a suicide but to have someone available to let the other pilot back into the cockpit in case the pilot who did not leave passes out or is otherwise disabled.

2. The Germanwings incident represents an unintended consequence of reinforcing and locking cockpit doors after 9/11.

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