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1.
Rochon  PABero  LAMay  AM  et al.  Comparison of review articles published in peer-reviewed and throwawayjournals. JAMA. 2002;2872853- 2856
PubMedArticle
2.
Angell  MKassirer  JP The Ingelfinger Rule revisited. N Engl J Med. 1991;3251371- 1373
PubMedArticle
3.
Woloshin  SSchwartz  LM Press releases: translating research into news. JAMA. 2002;2872856- 2858
PubMedArticle
4.
National Emphysema Treatment Trial Research Group, Patients at high risk of death after lung-volume–reduction surgery. N Engl J Med. 2001;3451075- 1083
PubMedArticle
5.
Johannes  L Study casts doubt on surgery used against emphysema. Wall Street Journal. August15 2001;1
6.
Schwartz  LMWoloshin  SBaczek  L Media coverage of scientific meetings: too much, too soon? JAMA. 2002;2872859- 2863
PubMedArticle
7.
Moher  DSchulz  KFAltman  Dfor the CONSORT Group, The CONSORT statement: revised recommendations for improving the qualityof reports of parallel-group randomized trials. JAMA. 2001;2851987- 1991
PubMedArticle
8.
Ingelfinger  FJ Shattuck lecture: the general medical journal: for readers or repositories? N Engl J Med. 1977;2961258- 1264
PubMedArticle
9.
Altman  LK The Ingelfinger rule, embargoes, and journal peer review: part 1. Lancet. 1996;3471382- 1386
PubMedArticle
10.
Altman  LK The Ingelfinger rule, embargoes, and journal peer review: part 2. Lancet. 1996;3471459- 1463
PubMedArticle
11.
Lichter  PR Duplicate publication and copyright: the role of authors and reviewers. Ophthalmology. 1988;951601- 1602
PubMedArticle
Special Article
July 2004

Advantages and Potential Dangers of Presentation Before PublicationThird in a Series on Editorship

Author Affiliations

From The Johns Hopkins University School of Medicine, Baltimore, Md(Drs Bressler and Schachat); Mayo Clinic, Jacksonville, Fla (Dr Liesegang);and University of Wisconsin, Madison (Dr Albert). The authors have no relevantfinancial interest in this article.

Arch Ophthalmol. 2004;122(7):1045-1048. doi:10.1001/archopht.122.7.1045

In all fields of medicine, many investigators choose to present theirresearch at scientific meetings before publication. In ophthalmology, a varietyof organizations provide venues for such presentations, for example, at theannual meetings of the Association for Research in Vision and Ophthalmologyor the American Academy of Ophthalmology. Presentations at scientific meetingsprovide an important venue for researchers to share their methods, results,and conclusions with some of their peers. Valuable feedback may result inthe adoption of different methods, analysis of additional results, or restructuringof conclusions. The end result may be that the scientific community benefitsas the work is refined and improved before publication.

POTENTIAL DANGERS OF SCIENTIFIC PRESENTATIONS

Scientific writers for the public (eg, newspaper reporters) or for eyecare professionals (eg, writers for commercial publications, sometimes termed"tabloids" or "throwaway" journals, usually with little or no peer-reviewprocess) may publish information from scientific presentations. Informationpublished in tabloids from scientific presentations often includes "top-line"results or brief summaries that may appeal to busy physician readers,1 but it usually does not include detailed methods ordiscussion of potential limitations of the research methods. Routine publicationof research results from scientific presentations in non–peer-reviewedformats before publication in peer-reviewed journals could potentially endangerthe viability of peer-reviewed journals.

How could that happen? If research is published in a newspaper or tabloid,then that newspaper or tabloid retains the copyright to the material. Publicationof the material in a journal after it has been publishedelsewhere without permission of the entity that holds the copyright wouldbe redundant or duplicate publication and would be a copyright infringementby the journal under US law. The mission of the newspaper or tabloid may bein conflict with the mission of the peer-reviewed scientific journal. Thus,the newspaper or tabloid may not grant permission for publication, or maygrant publication with certain stipulations that may be in conflict with suggestedrevisions from the peer-review process. We are unaware of whether this concepthas ever been the pretext for a copyright dispute, but it could be.

Even if the research is subsequently submitted for publication in apeer-reviewed journal with permission of the prior entity that holds the copyright,the material would not be original, and, therefore, the scientific communitymay be less likely to read the article in the journal. Readers of peer-reviewedjournals assume that the material they are reading is original, peer reviewed,and not previously published (unless there is a clear statement to the contrary).If the scientific community no longer needs to purchase the services (publications)of peer-reviewed journals, the journals may not be able to survive economically.

What is so bad about not having peer-reviewed journals? Why not justget printed results of scientific investigations from sources that do nothave peer review? Without a peer-review process available for the scientificcommunity, the quality of scientific publications may diminish (few peoplesubmit a perfect paper that is not improved by the peer-review process). Peerreviews are provided by physicians and scientists who presumably have beentrained to evaluate scientific methods critically and judge whether conclusionsare warranted by the methods and results reported by the manuscript's authors.The authors of a manuscript submitted for publication in a peer-reviewed journalshould benefit from an unbiased evaluation by journal reviewers; these reviewersshould bring additional expertise to the authors' submission that presumablyresults in an improved manuscript credited to the authors. Readers of peer-reviewedpublications also can benefit from peer review; specifically, readers shouldrecognize that the articles they read in peer-reviewed journals have undergonea review independent of the articles' authors, potentially resulting in improvedmanuscripts based on these unbiased reviews.

Thus, publication of material from a scientific meeting in a formatthat is not peer reviewed before publication of the material in a peer-reviewedjournal threatens the viability of peer-reviewed journals; loss of peer-reviewedjournals would weaken the quality of literature available to the scientificcommunity.

The critical, independent, expert evaluation provided by peer-reviewedjournals usually is not a major concern of newspapers, tabloids, or, for thatmatter, the lay public. The process of organizing, reviewing, revising, andreporting medical research in full detail that results in a successful peer-reviewedjournal submission is an integral part of clinical research, essential toquality control.2 Without journals that havepeer review, publication could be determined by other, less scientific criteria,for example, which industry supplies the greatest financial support to a particulartabloid, or which result appears most sensational, regardless of whether thesensational results have scientific validity.

We agree with comments from a previous publication by Woloshin and Schwartz,3 who noted that data presented at scientific meetingsbefore a peer review often use formats that may exaggerate the perceived importanceof findings.3 Moreover, coverage of abstractsat scientific meetings or coverage of results in the peer-reviewed literatureoften receive substantial attention in high-profile media because the informationis new and available to the public for the first time.

Unfortunately, the coverage is often incomplete, inaccurate, or both.For example, when the National Emphysema Treatment Trial Research Group presentedand published results on study participants who were at high risk of deathafter lung-volume–reduction surgery, the title "Patients at High Riskof Death After Lung-Volume–Reduction Surgery"4 wasinterpreted as "Patients [Are] at High Risk . . ." rather than "Patients [Who Are] at High Risk. .. ." The Wall Street Journal headline read, "StudyCasts Doubt on Surgery Used Against Emphysema," and the article stated, "Anincreasingly used surgery . . . actually did more harm than good in a groupof patients with very severe disease."5 Theresults in the peer-reviewed publication had a different message:

. . . [W]e have identified a combination of physiologicaland radiographic characteristics in a group of patients with emphysema thatplaces them at high risk of death after lung-volume–reduction surgeryand who also are unlikely to have large improvements in functional statusor the quality of life as a result of this procedure.4(p1082)

Not only might coverage of scientific presentations by newspapers ortabloids be incomplete or inaccurate, but also a considerable number of abstractsor presentations remain unpublished in any of 25 000 medical journals,suggesting that they were judged not to be valid when subjected to a peer-reviewprocess.6

Because oral presentations of scientific studies are allotted limitedtime (often 8 to 10 minutes at major ophthalmology meetings), the materialpresented at a scientific meeting often represents only part of the researchstory. For example, when randomized clinical trials are reported on, a detailedpresentation of the methods, results, and conclusions usually is to followthe Consolidated Standards of Reporting Trials (CONSORT) statement.7 The specific information provided by these guidelinesmay expose potential biases or weaknesses and could affect the validity ofthe results or justification of the conclusions. Platform presentations usuallydo not provide enough time or adequate structure to present all of this information.The written publication is needed for such reports. The more complete reportsmay not be of interest to a newspaper or tabloid but are critical to the understandingof randomized clinical trial results, which represent one of the strongestlines of evidence that impact treatment of common conditions.

JOURNALS' POTENTIAL SOLUTIONS TO MINIMIZE DUPLICATE OR PRIOR PUBLICATION

To protect the viability of peer-reviewed journals in ophthalmologysuch as the American Journal of Ophthalmology, the Archives of Ophthalmology, and Ophthalmology, these journals follow the Ingelfinger rule and its revisions, firstproposed in the 1970s by Franz Ingelfinger, an editor of the New England Journal of Medicine. The Ingelfinger rule stated that the New England Journal of Medicine would not publish a researchreport that already had been presented substantively elsewhere.8 Presumably,the definition of substantively must be determinedon a case-by-case basis by the journal's editor. Extrapolating from this rule,only original material that has not been presentedsubstantively elsewhere will be published in most peer-reviewed journals,including the American Journal of Ophthalmology,the Archives of Ophthalmology, and Ophthalmology. Authors should not distribute e-prints, preprints, orreprints of an article into the public domain before publication in a journal.

When authors submit material for publication in a peer-reviewed journal,they must transmit copyright of their material to that journal. Authors alsohave the opportunity and responsibility to report when material has been presentedat a scientific forum; journals will publish this information as an acknowledgment.Submission of presented material elsewhere simultaneous with submission tothe journal (potentially resulting in a duplicate publication) or publication of this material elsewhere before submission to the journal (prior publication)threatens the viability of the journal for reasons described previously. Alsoas explained earlier, loss of peer-reviewed journals likely would not be desirablefor authors and readers of a manuscript. Publication of the material (duplicateand prior publication) after transmitting copyrightto a journal without permission of the journal that holds the copyright wouldbe a copyright infringement under US law.

Some people perceive that the controls over publication desired by thepeer-reviewed journals provide unwarranted influence for the editors of thesejournals on the shaping of public health policy.9,10 Therules against duplicate or prior publication may alter what scientists andclinicians, desiring to publish, choose to present at scientific meetingsand in interviews, before submission of their manuscript. Therefore, journalscould be criticized as indirectly controlling what and when important informationrelated to clinical care is disclosed. This approach could restrict free flowof information to the public.

Publishers of peer-reviewed journals, including those of the American Journal of Ophthalmology, the Archives ofOphthalmology, and Ophthalmology, have undertakenmany steps to try to minimize such restrictions without jeopardizing the perceivedbenefits of having peer-reviewed journals. To assist newspapers with theirmission of presenting new scientific information in a timely fashion, publishersof peer-reviewed journals often provide embargoed informationto science writers with the understanding that the information not be reproduceduntil after publication of the peer-reviewed information.This embargo process allows a reporter the opportunity to investigate andprepare reports and potentially make them more accurate and understandablefor the reporter's readers. Writers who break this embargo, though, risk losingthe privilege of receiving future embargoed information. For ophthalmic clinicaltrials, this approach often allows eye care professionals to receive the informationat the same time that the information is disseminated to the public by sciencewriters for the press. For nonhuman studies research, this approach also disseminatesnew findings fairly, so that science writers for the press do not share theinformation before access through the peer-reviewed journals is available.

In addition, when very rapid publication is judged (eg, by the NationalInstitutes of Health of the US Department of Health and Human Services) tobe essential for scientific progress or public health reasons, some journalsprovide a structured expedited peer review and publication process (eg, Archives Express for the Archives ofOphthalmology). Furthermore, Internet access for selected, copyeditedmanuscripts before their printed publications is provided in the American Journal of Ophthalmology and soon will be available in Ophthalmology. Summaries of selected publications in Ophthalmology are also available through the American Academyof Ophthalmology's EyeNet magazine and Academy Express e-mail. These options provide a mechanism for an articleor parts of it to appear before the print publication without endangeringthe viability of the peer-reviewed journal that might be threatened by other,less structured approaches to disseminating scientific results in newspapersor tabloids.

SUGGESTIONS FOR RESEARCH PRESENTERS AT SCIENTIFIC MEETINGS

We believe that most eye care professionals and researchers want topreserve the peer review process of scientific journals for the reasons describedearlier. What can presenters of research at scientific meetings do to preservethe mission of the peer-reviewed scientific journals when presenting informationbefore publication of the material? First, most scientific meetings do notrequire that information be recorded by any means, so a researcher shouldnot feel compelled to give permission to anyone to have material be recordedat a presentation prior to publication of the material being presented. Second,presenters who want to avoid duplicate or prior publication because they planto submit information to a peer-reviewed journal should not share their slides,materials, or additional information with newspapers or tabloids before publication.If a science writer for a newspaper or tabloid asks for slides, materials,or additional information from a presentation, the presenter could ask thewriter to make this request after the information has been published in thepeer-reviewed literature. Third, if the presenter is given a preprint of aplanned publication by a newspaper tabloid, the presenter again could askthe writer to withhold the information until after the information has beenpublished in the peer-reviewed literature. Two of us (N.M.B. and A.P.S.) havemade such requests successfully on numerous occasions; usually the writersfor newspapers and tabloids want to maintain a positive relationship withthe presenter so that they can get answers to questions that will assist themin providing an accurate story to their readers. Finally, editors, reviewers,authors, and readers of peer-reviewed journals who want to maintain the peer-reviewprocess should report violations of restrictions on duplicate publicationto the journals.11 Such violations could resultin public reprimand regarding copyright infringement at the least9 and may result in a presenter being subjected to greaterscrutiny when future materials are considered for publication in the peer-reviewedjournals.

In conclusion, presentations of research at scientific meetings arean excellent forum to shape the research and improve it through feedback received.This article is not meant in any way to discourage these presentations. However,the presenters at these meetings should be aware of the potential problemsthat may arise if the material presented is published in a format that isnot peer-reviewed before publication in a peer-reviewed journal. With adherenceto these recommendations, however, those affected can maintain the usefulnessof scientific presentations and the goals of newspapers and tabloids, as wellas the viability of peer-reviewed journals.

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Article Information

Correspondence: Neil M. Bressler, MD, Department of Ophthalmology,The Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115,Baltimore, MD 21205-2002 (nmboffice@jhmi.edu).

The previous articles in this series were published in the American Journal of Ophthalmology (2003;136:109-113) and Ophthalmology (2003;110:2073-2074).

Submitted for publication September 14, 2003; final revision receivedJanuary 16, 2004; accepted March 9, 2004.

References
1.
Rochon  PABero  LAMay  AM  et al.  Comparison of review articles published in peer-reviewed and throwawayjournals. JAMA. 2002;2872853- 2856
PubMedArticle
2.
Angell  MKassirer  JP The Ingelfinger Rule revisited. N Engl J Med. 1991;3251371- 1373
PubMedArticle
3.
Woloshin  SSchwartz  LM Press releases: translating research into news. JAMA. 2002;2872856- 2858
PubMedArticle
4.
National Emphysema Treatment Trial Research Group, Patients at high risk of death after lung-volume–reduction surgery. N Engl J Med. 2001;3451075- 1083
PubMedArticle
5.
Johannes  L Study casts doubt on surgery used against emphysema. Wall Street Journal. August15 2001;1
6.
Schwartz  LMWoloshin  SBaczek  L Media coverage of scientific meetings: too much, too soon? JAMA. 2002;2872859- 2863
PubMedArticle
7.
Moher  DSchulz  KFAltman  Dfor the CONSORT Group, The CONSORT statement: revised recommendations for improving the qualityof reports of parallel-group randomized trials. JAMA. 2001;2851987- 1991
PubMedArticle
8.
Ingelfinger  FJ Shattuck lecture: the general medical journal: for readers or repositories? N Engl J Med. 1977;2961258- 1264
PubMedArticle
9.
Altman  LK The Ingelfinger rule, embargoes, and journal peer review: part 1. Lancet. 1996;3471382- 1386
PubMedArticle
10.
Altman  LK The Ingelfinger rule, embargoes, and journal peer review: part 2. Lancet. 1996;3471459- 1463
PubMedArticle
11.
Lichter  PR Duplicate publication and copyright: the role of authors and reviewers. Ophthalmology. 1988;951601- 1602
PubMedArticle
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