Last month, Larry Saidman summarized his thoughts upon stepping down from the helm of Anesthesiology, a post he held for 11 years. Only Henry Ruth, the founding editor of our Journal, served longer (1940–1955). This month, I have an opportunity to discuss my feelings upon assuming their mantle. How do I feel? Well, I'm not sure, largely because I haven't had the job very long. The workload doesn't bother me, and the idea of reading 100 manuscripts per month is actually attractive (what a wonderful education!). What I worry about most is the responsibility that goes with the job. First, I have the responsibility of living up to the record of the people who served before me. Second, I must meet the expectations of the talented clinicians and scientists who serve as editors and associate editors; I know how much pride they have in this Journal. Lastly, and most importantly, I am responsible to our 40,000 subscribers around the world-including the entire membership of the American Society of Anesthesiologists (ASA)-who look to Anesthesiology every month for the best clinical and laboratory science and practice information this specialty has to offer. It's a responsibility that can't be dodged or evaded. In addition, the editorial board of Anesthesiology, with the strong support of the ASA, has decided to retain a system with highly centralized “control” exercised by the editor-in-chief. That means “the buck stops here”-which is enough to give anyone pause. However, although I only have approximately 5 months of work under my belt, I already believe that this is the most enjoyable task I have ever undertaken. Several of my predecessors expressed the same sentiment. I guess the challenge and the reward go hand-in-hand.
What's going to happen to the Journal in the next 5 years? The glib answer is “not much.” The Journal functions extremely well, and neither I nor the editorial board has any interest in changing either its fundamental content or the editorial process. However, I also believe that some changes are needed. I joined the editorial board in 1989. In the years since, I have spent a great deal of time speaking with uncountable numbers of authors, ASA members, ASA officials, fellow editors, etc. regarding the Journal. Based on these discussions, I believe that our greatest “problems” vis-a-vis our readership and the membership can be summarized in two words:(1) communications and (2) education. These are the two areas in which I expect to see the greatest change.
This is the Journal of the entire ASA. Nevertheless, I sense that many members believe we have become too isolated, that we “never publish anything relevant.” Some potential authors seem to believe that “we don't want their work” even before we've seen it. I don't believe that either of these ideas are true, and I am tempted to brusquely dismiss them. However, I believe both ideas are symptoms of a two-way communication failure. I can deal with part of this problem by making myself and my office accessible to our readers and authors, and to ask for as much of your input as possible. Part of our response is “technical”: we have established a toll-free telephone number (1–800–260–5631), FAX lines (1–319–353–6817 and 1–319–353–6818), an e-mail address (email@example.com), and a new WebPage (www.Anesthesiology.org). The WebPage provides the current, updated Guide for Authors, along with downloadable submission forms and checklists. In the future, it will also include a variety of other items on the performance of studies, thoughts on writing manuscripts, etc. The page contains a form by which authors can inquire regarding the status of their manuscripts (although authors are also welcome to use any of the other above-noted means of communication-not to mention real mail). The page contains a searchable Table of Contents (with summary sentences and abstracts) for all Anesthesiology articles, beginning with Volume 85 (July 1996). We anticipate being able to update the contents of this page perhaps a full month before you receive your issue by mail. As time passes, other “archival” material will be added to the page, including ASA practice guidelines, selected review articles and editorials, abstracts of the annual meeting (perhaps), etc. Within the next year or two, I hope to institute a means to facilitate the electronic submission of letters to the editor, and I am exploring the development of a new, carefully edited forum that will allow readers to comment about an article and question its authors (with questions and replies appearing on the WebPage). Obviously, the list of potential features is nearly endless-and I would welcome the thoughtful comments of any of our readers regarding material that you believe would be truly useful. From a more old-fashioned standpoint, I would also be pleased to talk to various groups and societies about the Journal, the editorial process, etc. I obviously can't spend all of my time on the road, but will try as hard as possible to accommodate reasonable requests to speak. My goal is to help you to know as much as possible about what we do and why we do it.
The second-and much more difficult-problem is education. Since the inception of this Journal, many people have complained about the “esoteric” nature of its articles, an issue Dr. Saidman addressed last month. As those who know me realize, I strongly reject this idea. New knowledge and new ideas are often difficult to comprehend; to publish only articles that everyone can easily understand or instantly apply to their clinical practice might be popular-but it would rapidly result in our conversion from a scientific Journal into a continuing education newsletter. However, as an active researcher, I also realize that something unique has occurred in recent years. When my teachers and I were residents, anesthesiologists were trained to be excellent clinical physiologists and pharmacologists. Because the focus of research in those days was on these subjects, we often found ourselves much better able than physicians in other specialties to read and understand the literature. This situation has changed; the forefront of science in the 1990s has moved beyond descriptive whole organ/whole animal physiology. The focus is now on mechanisms and on the cell itself. Researchers are now interested in nuclear transcription factors, messenger RNA, families and subfamilies of receptors, ion channel configuration changes, etc. They use tools that were unknown 15 years ago: patch clamping, gene cloning, knockout and transgenic mice, polymerase chain reactions, Northern blots, antisense oligonucleotides, etc. It is no longer sufficient to say “agent x depresses myocardial contractility”; researchers need to know what part of the contractile process is affected. Even clinical science has changed-the rules and statistics needed to perform (and understand) a first rate clinical trial are far beyond what the usual anesthesiologist learned in school. We are no longer satisfied with a clinician's report of “how I anesthetized the last 20 patients with X.” Instead, we demand a randomized clinical trial to “prove” that this technique is really different or better than another.
This change is intimidating (perhaps even more to those of us who are doing research), but the questions being asked are not new. Only the tools are new. The problem is the growing gap between what we are taught in our training programs (physiology and pharmacology) and the science we encounter in the Journal. It is tempting to take a nihilistic approach and conclude that this work is somehow “irrelevant” to the practice of anesthesia. Nothing could be further from the truth; to take that approach is to abandon our future. What is “irrelevant” today is common practice tomorrow. Nevertheless, many of our readers do not understand many of the articles we publish. Part of the burden for correcting this rests with the reader-self education is the unending responsibility of any physician. However, the Journal also has an important educational duty. We believe in the importance of publishing the best science available-but we also realize that we need to do a better job of interpreting this science for the nonscientists, and to provide at least a portion of the material needed for self-education. In the past 5 years, Dr. Saidman made an enormous (and successful) effort to move us in this direction. We now have summary sentences in the Table of Contents, and Highlights that serve as mini-editorials. Since 1994, we also have had the section “This Month in Anesthesiology,” which is a combined effort by the editor-in-chief and an experienced science writer (Gretchen Henkel) to summarize key articles in readily understandable fashion. This process is going to continue and grow. We intend to supplement it with more review articles (both short and long), and we will be using our WebPage for additional educational efforts. You, the readers, can help, primarily by telling us what you need to learn.
There are also some serious problems confronting Anesthesiology and all of the journals in our specialty. For many decades, investigators and industry have had a mutually fruitful-albeit sometimes troubled-relationship. The difficulties this relationship poses for the Journal were wonderfully summarized by Dr. Saidman in an editorial written in 1994. In the opinion of many of us, these difficulties continue-and, in recent years, seem to have become more complex. Most importantly, some corporations seem to have become more involved in not only the funding of research, but in experimental design, data analysis, and even in the writing of manuscripts. This might be a minor problem except for the fact that this involvement is often unknown to reviewers, editors, the editor-in-chief and, hence, to the readers. As a result, the integrity of all aspects of the scientific process may be jeopardized. The editorial board of this Journal, along with both Dr. Saidman and myself-and, hopefully, the editors of other journals in our specialty-will be devoting a growing amount of our time and effort to examining and addressing these problems. Readers should look forward to one or more future editorials dealing with this issue, as well as changes in Journal policy.
I would like to close with one final remark to our authors. Winston Churchill once said that “…. Democracy is the worst form of government except all those other forms that have been tried from time to time.” Many might argue that the same applies to the peer review process. The job of the editor-in-chief, as well as our editors and reviewers, is to ensure that our readers are well served-and sometimes that is hard on authors (it's also hard on the editors, but that's another story). However, this is nothing new, and I can assure our authors that they are not alone and have not been selected for unique treatment. Consider the following sentence written by Thomas Jefferson:
We hold these truths to be sacred and undeniable that all men are created equal and independent, that from that equal creation they derive rights inherent and inalienable, amoung which are the preservation of life, liberty, and the pursuit of happiness.
It is obviously not the sentence we have come to admire. Recently, Bill Bryson discussed both Jefferson's travails and the editorial process when he noted:“The sentence took on its final resonance only after it had been through the hands of the Committee of Five and then subjected to active debate in Congress itself. Congress did not hesitate to alter Jefferson's painstakingly crafted words. Altogether it ordered forty changes to the original text. It deleted 630 words, about a quarter of the total, and added 146. Like most writers who have been subjected to the editing process, Jefferson thought the final text depressingly inferior to his original, and, like most writers, he was wrong.”
I look forward to hearing from, and working with, all of you in the years to come.
Michael M. Todd, M.D., Anesthesiology Editorial Office, Department of Anesthesia, The University of Iowa, 6546 John Colloton Pavilion, 200 Hawkins Drive, Iowa City, Iowa 52242–1009, Electronic mail: firstname.lastname@example.org.