SPECIAL ARTICLE Advantages and Potential Dangers of Presentation Before Publication Third in a Series on Editorship

Neil M. Bressler, MD; Thomas J. Liesegang, MD; Andrew P. Schachat, MD; Daniel M. Albert, MD

n all fields of medicine, many investigators choose to present their research at scientific meetings before publication. In ophthalmology, a variety of organizations provide venues for such presentations, for example, at the annual meetings of the Association for Research in Vision and Ophthalmology or the American Academy of Ophthalmology. Presentations Iat scientific meetings provide an important venue for researchers to share their methods, results, and conclusions with some of their peers. Valuable feedback may result in the adoption of differ- ent methods, analysis of additional results, or restructuring of conclusions. The end result may be that the scientific community benefits as the work is refined and improved before publication.

POTENTIAL DANGERS OF redundant or duplicate publication and SCIENTIFIC PRESENTATIONS would be a copyright infringement by the journal under US law. The mission of the Scientific writers for the public (eg, news- newspaper or tabloid may be in conflict paper reporters) or for eye care profes- with the mission of the peer-reviewed sci- sionals (eg, writers for commercial pub- entific journal. Thus, the newspaper or tab- lications, sometimes termed “tabloids” or loid may not grant permission for publi- “throwaway” journals, usually with little cation, or may grant publication with or no peer-review process) may publish in- certain stipulations that may be in con- formation from scientific presentations. In- flict with suggested revisions from the peer- formation published in tabloids from review process. We are unaware of whether scientific presentations often includes “top- this concept has ever been the pretext for line” results or brief summaries that may a copyright dispute, but it could be. appeal to busy physician readers,1 but it Even if the research is subsequently usually does not include detailed meth- submitted for publication in a peer- ods or discussion of potential limitations reviewed journal with permission of the of the research methods. Routine publi- prior entity that holds the copyright, the cation of research results from scientific material would not be original, and, there- presentations in non–peer-reviewed for- fore, the scientific community may be less mats before publication in peer-reviewed likely to read the article in the journal. journals could potentially endanger the vi- Readers of peer-reviewed journals as- ability of peer-reviewed journals. sume that the material they are reading is How could that happen? If research original, peer reviewed, and not previ- is published in a newspaper or tabloid, then ously published (unless there is a clear that newspaper or tabloid retains the copy- statement to the contrary). If the scien- right to the material. Publication of the ma- tific community no longer needs to pur- terial in a journal after it has been pub- chase the services (publications) of peer- lished elsewhere without permission of the reviewed journals, the journals may not entity that holds the copyright would be be able to survive economically. What is so bad about not having peer- From The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Bressler reviewed journals? Why not just get and Schachat); Mayo Clinic, Jacksonville, Fla (Dr Liesegang); and University of printed results of scientific investiga- Wisconsin, Madison (Dr Albert). The authors have no relevant financial interest in this tions from sources that do not have peer article. review? Without a peer-review process

(REPRINTED) ARCH OPHTHALMOL / VOL 122, JULY 2004 WWW.ARCHOPHTHALMOL.COM 1045

©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 available for the scientific commu- and Schwartz,3 who noted that when randomized clinical trials are nity, the quality of scientific publi- data presented at scientific meet- reported on, a detailed presenta- cations may diminish (few people ings before a often use tion of the methods, results, and con- submit a perfect paper that is not im- formats that may exaggerate the clusions usually is to follow the Con- proved by the peer-review process). perceived importance of findings.3 solidated Standards of Reporting Peer reviews are provided by phy- Moreover, coverage of abstracts at Trials (CONSORT) statement.7 The sicians and scientists who presum- scientific meetings or coverage of specific information provided by ably have been trained to evaluate results in the peer-reviewed litera- these guidelines may expose poten- scientific methods critically and ture often receive substantial tial biases or weaknesses and could judge whether conclusions are war- attention in high-profile media affect the validity of the results or ranted by the methods and results because the information is new justification of the conclusions. Plat- reported by the ’s au- and available to the public for the form presentations usually do not thors. The authors of a manuscript first time. provide enough time or adequate submitted for publication in a peer- Unfortunately, the coverage is structure to present all of this infor- reviewed journal should benefit from often incomplete, inaccurate, or mation. The written publication is an unbiased evaluation by journal re- both. For example, when the Na- needed for such reports. The more viewers; these reviewers should tional Emphysema Treatment Trial complete reports may not be of in- bring additional expertise to the au- Research Group presented and pub- terest to a newspaper or tabloid but thors’ submission that presumably lished results on study participants are critical to the understanding of results in an improved manuscript who were at high risk of death after randomized clinical trial results, credited to the authors. Readers of lung-volume–reduction surgery, the which represent one of the stron- peer-reviewed publications also can title “Patients at High Risk of Death gest lines of evidence that impact benefit from peer review; specifi- After Lung-Volume–Reduction Sur- treatment of common conditions. cally, readers should recognize that gery”4 was interpreted as “Patients the articles they read in peer-re- [Are] at High Risk ...”rather than JOURNALS’ POTENTIAL viewed journals have undergone a “Patients [Who Are] at High Risk. SOLUTIONS TO MINIMIZE review independent of the articles’ ...”TheWall Street Journal head- DUPLICATE OR PRIOR authors, potentially resulting in im- line read, “Study Casts Doubt on PUBLICATION proved manuscripts based on these Surgery Used Against Emphy- unbiased reviews. sema,” and the article stated, “An in- To protect the viability of peer- Thus, publication of material creasingly used surgery...actu- reviewed journals in ophthalmol- from a scientific meeting in a for- ally did more harm than good in a ogy such as the American Journal of mat that is not peer reviewed be- group of patients with very severe Ophthalmology, the Archives of Oph- fore publication of the material in a disease.”5 The results in the peer- thalmology, and Ophthalmology, peer-reviewed journal threatens the reviewed publication had a differ- these journals follow the Ingelfin- viability of peer-reviewed journals; ent message: ger rule and its revisions, first pro- loss of peer-reviewed journals would . . . [W]e have identified a combina- posed in the 1970s by Franz Ingel- weaken the quality of literature avail- tion of physiological and radiographic finger, an editor of the New England able to the scientific community. characteristics in a group of patients with Journal of Medicine. The Ingelfinger The critical, independent, ex- emphysema that places them at high risk rule stated that the New England pert evaluation provided by peer- of death after lung-volume–reduction Journal of Medicine would not pub- reviewed journals usually is not a surgery and who also are unlikely to have lish a research report that already major concern of newspapers, tab- large improvements in functional sta- had been presented substantively loids, or, for that matter, the lay pub- tus or the quality of life as a result of this elsewhere.8 Presumably, the defini- procedure.4(p1082) lic. The process of organizing, re- tion of substantively must be deter- viewing, revising, and reporting Not only might coverage of sci- mined on a case-by-case basis by the medical research in full detail that entific presentations by newspa- journal’s editor. Extrapolating from results in a successful peer-re- pers or tabloids be incomplete or in- this rule, only original material that viewed journal submission is an in- accurate, but also a considerable has not been presented substan- tegral part of clinical research, es- number of abstracts or presenta- tively elsewhere will be published in sential to quality control.2 Without tions remain unpublished in any of most peer-reviewed journals, includ- journals that have peer review, pub- 25000 medical journals, suggest- ing the American Journal of Ophthal- lication could be determined by ing that they were judged not to be mology, the Archives of Ophthalmol- other, less scientific criteria, for ex- valid when subjected to a peer- ogy, and Ophthalmology. Authors ample, which industry supplies the review process.6 should not distribute e-prints, pre- greatest financial support to a par- Because oral presentations of prints, or reprints of an article into ticular tabloid, or which result ap- scientific studies are allotted lim- the public domain before publica- pears most sensational, regardless of ited time (often 8 to 10 minutes at tion in a journal. whether the sensational results have major ophthalmology meetings), the When authors submit mate- scientific validity. material presented at a scientific rial for publication in a peer- We agree with comments from meeting often represents only part reviewed journal, they must trans- a previous publication by Woloshin of the research story. For example, mit copyright of their material to that

(REPRINTED) ARCH OPHTHALMOL / VOL 122, JULY 2004 WWW.ARCHOPHTHALMOL.COM 1046

©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 journal. Authors also have the op- gate and prepare reports and poten- fore publication of the material? portunity and responsibility to re- tially make them more accurate and First, most scientific meetings do not port when material has been pre- understandable for the reporter’s require that information be re- sented at a scientific forum; journals readers. Writers who break this em- corded by any means, so a re- will publish this information as an bargo, though, risk losing the privi- searcher should not feel compelled acknowledgment. Submission of lege of receiving future embargoed to give permission to anyone to have presented material elsewhere simul- information. For ophthalmic clini- material be recorded at a presenta- taneous with submission to the jour- cal trials, this approach often al- tion prior to publication of the ma- nal (potentially resulting in a dupli- lows eye care professionals to re- terial being presented. Second, pre- cate publication) or publication of ceive the information at the same senters who want to avoid duplicate this material elsewhere before sub- time that the information is dissemi- or prior publication because they mission to the journal (prior publi- nated to the public by writ- plan to submit information to a peer- cation) threatens the viability of the ers for the press. For nonhuman reviewed journal should not share journal for reasons described previ- studies research, this approach also their slides, materials, or addi- ously. Also as explained earlier, loss disseminates new findings fairly, so tional information with newspa- of peer-reviewed journals likely that science writers for the press do pers or tabloids before publication. would not be desirable for authors not share the information before ac- If a science writer for a newspaper and readers of a manuscript. Publi- cess through the peer-reviewed jour- or tabloid asks for slides, materials, cation of the material (duplicate and nals is available. or additional information from a pre- prior publication) after transmit- In addition, when very rapid sentation, the presenter could ask the ting copyright to a journal without publication is judged (eg, by the Na- writer to make this request after the permission of the journal that holds tional Institutes of Health of the US information has been published in the copyright would be a copyright Department of Health and Human the peer-reviewed literature. Third, infringement under US law. Services) to be essential for scientific if the presenter is given a Some people perceive that the progress or public health reasons, of a planned publication by a news- controls over publication desired by some journals provide a structured paper tabloid, the presenter again the peer-reviewed journals provide expedited peer review and publica- could ask the writer to withhold the unwarranted influence for the edi- tion process (eg, Archives Express for information until after the informa- tors of these journals on the shap- the Archives of Ophthalmology). Fur- tion has been published in the peer- ing of public health policy.9,10 The thermore, Internet access for se- reviewed literature. Two of us rules against duplicate or prior pub- lected, copyedited manuscripts before (N.M.B. and A.P.S.) have made such lication may alter what scientists and their printed publications is provided requests successfully on numerous clinicians, desiring to publish, intheAmericanJournalofOphthalmol- occasions; usually the writers for choose to present at scientific meet- ogy and soon will be available in Oph- newspapers and tabloids want to ings and in interviews, before sub- thalmology. Summaries of selected maintain a positive relationship with mission of their manuscript. There- publications in Ophthalmology are also the presenter so that they can get an- fore, journals could be criticized as available through the American Acad- swers to questions that will assist indirectly controlling what and when emy of Ophthalmology’s EyeNet them in providing an accurate story important information related to magazine and Academy Express to their readers. Finally, editors, re- clinical care is disclosed. This ap- e-mail. These options provide a viewers, authors, and readers of peer- proach could restrict free flow of in- mechanism for an article or parts of reviewed journals who want to formation to the public. it to appear before the print publica- maintain the peer-review process Publishers of peer-reviewed tion without endangering the viabil- should report violations of restric- journals, including those of the ity of the peer-reviewed journal that tions on duplicate publication to the American Journal of Ophthalmol- might be threatened by other, less journals.11 Such violations could re- ogy, the Archives of Ophthalmology, structured approaches to disseminat- sult in public reprimand regarding and Ophthalmology, have under- ing scientific results in newspapers or copyright infringement at the least9 taken many steps to try to mini- tabloids. and may result in a presenter being mize such restrictions without jeop- subjected to greater scrutiny when ardizing the perceived benefits of SUGGESTIONS FOR future materials are considered for having peer-reviewed journals. To RESEARCH PRESENTERS publication in the peer-reviewed assist newspapers with their mis- AT SCIENTIFIC MEETINGS journals. sion of presenting new scientific in- In conclusion, presentations of formation in a timely fashion, pub- We believe that most eye care pro- research at scientific meetings are an lishers of peer-reviewed journals fessionals and researchers want to excellent forum to shape the re- often provide embargoed informa- preserve the peer review process of search and improve it through feed- tion to science writers with the un- scientific journals for the reasons de- back received. This article is not derstanding that the information not scribed earlier. What can present- meant in any way to discourage these be reproduced until after publica- ers of research at scientific meet- presentations. However, the present- tion of the peer-reviewed informa- ings do to preserve the mission of the ers at these meetings should be aware tion. This embargo process allows a peer-reviewed scientific journals of the potential problems that may reporter the opportunity to investi- when presenting information be- arise if the material presented is pub-

(REPRINTED) ARCH OPHTHALMOL / VOL 122, JULY 2004 WWW.ARCHOPHTHALMOL.COM 1047

©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 lished in a format that is not peer- Correspondence:NeilM.Bressler, 5. Johannes L. Study casts doubt on surgery used reviewed before publication in a peer- MD,DepartmentofOphthalmology,The against emphysema. Wall Street Journal. August 15, 2001:1. reviewed journal. With adherence to Johns Hopkins University School of 6. Schwartz LM, Woloshin S, Baczek L. Media cov- these recommendations, however, Medicine, 550 N Broadway, Suite 115, erage of scientific meetings: too much, too soon? those affected can maintain the use- Baltimore, MD 21205-2002 (nmboffice JAMA. 2002;287:2859-2863. fulness of scientific presentations and @jhmi.edu). 7. Moher D, Schulz KF, Altman D, for the CONSORT Group. The CONSORT statement: revised recom- the goals of newspapers and tab- mendations for improving the quality of reports loids, as well as the viability of peer- REFERENCES of parallel-group randomized trials. JAMA. 2001; reviewed journals. 285:1987-1991. 1. Rochon PA, Bero LA, May AM, et al. Comparison 8. Ingelfinger FJ. Shattuck lecture: the general medi- The previous articles in this series of review articles published in peer-reviewed and cal journal: for readers or repositories? N Engl J throwaway journals. JAMA. 2002;287:2853-2856. Med. 1977;296:1258-1264. were published in the American 2. Angell M, Kassirer JP. The Ingelfinger Rule revis- 9. Altman LK. The Ingelfinger rule, embargoes, and Journal of Ophthalmology (2003; ited. N Engl J Med. 1991;325:1371-1373. journal peer review: part 1. Lancet. 1996;347: 136:109-113) and Ophthalmology 3. Woloshin S, Schwartz LM. Press releases: trans- 1382-1386. (2003;110:2073-2074). lating research into news. JAMA. 2002;287:2856- 10. Altman LK. The Ingelfinger rule, embargoes, and 2858. journal peer review: part 2. Lancet. 1996;347: 4. National Emphysema Treatment Trial Research 1459-1463. Submitted for publication September Group. Patients at high risk of death after lung- 11. Lichter PR. Duplicate publication and copyright: 14, 2003; final revision received Janu- volume–reduction surgery. N Engl J Med. 2001; the role of authors and reviewers. Ophthalmol- ary 16, 2004; accepted March 9, 2004. 345:1075-1083. ogy. 1988;95:1601-1602.

ARCHIVES Web Quiz Winner

e stumped you last month! The correct answer to our March challenge was W orbital abscess due to infection following subtenon injection. For a complete discussion of this case, see the Clinicopathologic Reports, Case Reports, and Small Case Series section in the April ARCHIVES (Engelman CJ, Palmer JD, Egbert P. Orbital abscess following subtenon triamcinolone injection. Arch Ophthalmol. 2004;122:654-655). Be sure to visit the Archives of Ophthalmology Web site (http://www.archophthalmol .com) and try your hand at our Clinical Challenge Interactive Quiz. We invite visitors to make a diagnosis based on selected information from a case report or other feature scheduled to be published in the following month’s print edition of the ARCHIVES. The first visitor to e-mail our Web editors with the correct answer will be recognized in the print journal and on our Web site and will also be able to choose one of the following published by AMA Press: Clinical Eye Atlas, Clinical Retina,orUsers’ Guides to the Medical Literature.

(REPRINTED) ARCH OPHTHALMOL / VOL 122, JULY 2004 WWW.ARCHOPHTHALMOL.COM 1048

©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021