Accelerating access to biomedical evidence

Elsevier entry into fee-based open access: Not exactly the best evidence

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I read with great interest Peter Suber’s account in the watershed events section of SPARC Open Access Newsletter, issue #155 of Elsevier’s first author fee-based (gold) open access publication, the International Journal of Case Surgery Reports (IJSCR).  After all, I am the Library Liaison for Surgery at the Cushing/Whitney Medical Library, and this might be a journal to recommend.

International Journal of Surgery Case Reports

It is perfectly clear from the journal’s self-description that they intend to publish case reports, and case reports only:

The International Journal of Surgery Case Reports is an online general surgical journal dedicating to publishing case reports only which must be authentic, understandable, educational and clinically interesting to an international audience of surgeons and clinicians in related specialties.

One of the tasks that separates medical librarians from other types of librarians is our charge to assist the teaching of Evidence-based practice (EBP) to medical residents and fellows, nurses, and even public health students. Librarians mostly teach about how to search biomedical literature and “pan for gold” or filter a search result to separate out more scientific, less biased articles from the search result that a clinician will produce.  Then a clinician should appraise the discovered articles for validity and applicability.  So where am I going with this summary of the basics of EBP?

One of the first conceptual tools introduced in a EBP medical library searching class is the EBM Pyramid:

EBP Pyramid
So where are case reports?  Near the bottom. Why? A case report is usually a single clinical case, more likely to contain the bias of the author(s) who labeled the case significant and submitted it to the journal. These authors are probably likely to only report the successful case studies and not report nor publish the ratio of clinical victory vs. clinical failure.

So if all that Elsevier is promising to publish in the  International Journal of Case Surgery Reports (IJSCR) are interesting case reports, then emphasis will be more novelty than medical evidence or substance.  Here are some recent articles that confirm my expectation:

Notice the words “unusual” or “symptomatic” in many of the titles above. Certainly the authors presenting their cases offer evidence in their article for the use of these labels that either confirm uniqueness or similarity, yet they do so while bathed in the influence of their own scholarly bias, preferences, and experience.   In the EPB world, the case study is, unfortunately, the scholarly equivalent of gossip magazines in the patient waiting area: entertaining and informative in the thrill of the moment of reading, but not the best evidence for applicability to other patients needing clinical decision making. Of course, the “best evidence” for a similar unusual case may very well be one of these case studies, which is why I guess Elsevier launched this journal on the premise that something may be better than nothing, especially if authors are willing to pay Elsevier’s  publishing fee of £250/US$392.50/EUR 280/JPY 36,680 (exclusive of VAT/Sales Tax) for the privilege to make their case.
I’m sure some will have the opinion that we need all that ballast of uncritical cases in the base of the EBP pyramid in order to support all the more persuasive evidence to exist at the top.  But I don’t think that is what the metaphor of the this pyramid intends.
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Sat, March 12 2011 » Uncategorized

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