Pandemic pressures on journal publishing

COVID-19 has changed work on Annals of Internal Medicine.

The whole world has spent the past few months searching for solutions to the COVID-19 pandemic, and, naturally, one of the main places they've looked is medical journals.

Photo of Dr Laine by Matthew Weinberg
Photo of Dr. Laine by Matthew Weinberg

Add those heavy expectations to the challenges currently facing everyone in business and health care, and it's made for an intense time in journal publishing. To get a glimpse of the situation, ACP Hospitalist interviewed Christine Laine, MD, MPH, FACP, Editor in Chief of Annals of Internal Medicine and a Senior Vice President at ACP.

Q: How has the pandemic affected Annals' review and publication processes? How has it affected submissions, both related to COVID-19 and not?

A: We are getting many more submissions than we typically get, and we typically get a lot of submissions. In roughly the first month of the pandemic, we had about 1,000 manuscript submissions. For comparison, in 2019, we had about 4,500 for the entire year. So we're getting a lot of manuscripts. I haven't looked at the numbers to know whether the submissions on other topics have gone down. They haven't changed noticeably enough that I or any of the editors noticed. It isn't as though we're getting no manuscripts on other topics.

The other thing is that everybody wants these manuscripts reviewed as soon as possible. So we have a high volume, and we're trying to expedite things, and we don't have more editorial staff, and our reviewers who have expertise in the area are also getting more requests for reviews. The large majority of the papers that we get are not suitable for publication in Annals, but we still have to read them to make that determination. We don't necessarily send them out for external review if it's something that we're not going to publish. We're not going to burden our volunteer reviewers with having to read them.

Q: What are your thoughts on researchers' posting their COVID-19 research online without peer review?

A: I think it's potentially dangerous. One of the arguments for preprint servers is that they can feed scientific progress, because other researchers will be aware of what's going on and can use it to create their own hypotheses and to inform their work. But once it's on a preprint server it's widely available to the public, to journalists, and it makes me nervous, particularly in clinical medicine.

The preprint servers started in the physical sciences. Nobody is using an article in physics to inform patient care, so the danger of applying something that isn't valid is much less in physical sciences or even in more basic sciences. But when you're talking about clinical medicine, it's dangerous.

That said, in order for Annals to be competitive, we have had a policy even before the pandemic that being posted on the preprint server won't automatically exclude us from considering something for publication in the journal, but it may influence our priority. If the information is already sort of widely available, it may have a lower priority for us to publish it, but we haven't excluded it, like some journals do.

I think that the pandemic has unmasked some dangerous aspects of the preprint servers and the dissemination of non-peer-reviewed results. A lot of the hype about hydroxychloroquine came from a study that was subsequently retracted. And with other studies, when the results go through peer review, they're less exciting than they may have been on the preprint server. I do hope that there's less excitement about the ability to post non-peer-reviewed clinical research in a public venue after this pandemic. I think people who have been fervent advocates of it may realize that there are some adverse unintended consequences of it.

Q: Do you foresee any long-lasting effects of this crisis on journal publishing, or will things eventually return to normal?

A: My hope is that it makes researchers, the scientific community, and the public and policymakers more appreciative of the peer-review process—that it's not only delaying publication and release of findings, but improving findings. It's not a perfect measure, but where something is published does give you some signal of how much you can trust it. If something appears in the New England Journal of Medicine, a journal that has a very rigorous peer-review process, I think you can, as a clinician, have more confidence that it's right than if it appears in a small, author-paid open-access journal that nobody's ever heard about. And that's because the peer-review processes are different. My hope is that things change and people appreciate the scholarly publishing peer-review process.

But the other thing that can happen is that researchers can say, “If journals could be so quick during the pandemic, why can't they be quick after the pandemic?” The subscription-based journals have made all the COVID-related content publicly available, which we [at Annals] also do for 25% of our [other] content that we feel has public health importance. I think the push for author-paid open access may be greater. I think it definitely will be different. I'm just not sure which way it's going to go.

Q: What other effects have you seen from the intense media and public interest in COVID-19 research?

A: I think there may be a better understanding in the public. My master's degree is in epidemiology, and it was always hard to even explain to my mother what an epidemiologist was. After this, the average person knows that an epidemiologist studies disease in populations.

I think that people understand, probably, the difference between a randomized controlled trial and an observational study. It has educated the public on aspects of clinical research that they may not have paid much attention to previously. People know what an antibody, an antigen, a serologic test, what plasma is, all these things that are on the news every day. Hopefully it's educating the public in a positive way so that public health improves, and people have an appreciation for clinical research and why you can't just be using therapies because somebody thinks they might be a good idea but need rigorous evidence to make sure that we're helping people and not hurting them.