“Live as if you were to die tomorrow. Learn as if you were to live forever.”
When we set out to attend the first meeting of the World Association of Medical Editors in India, we intended to represent Plastic and Reconstructive SurgeryGlobal Open and present the Journal and our programs to editors from all over the world. We also knew we would have the microphone a lot: a premeeting workshop on the editor’s perspective and either moderating or serving as a panelist on more than 5 sessions combined. We aimed to share what we knew about working with publishers, using digital media to promote journal content, setting up and administrating a journal, and more. But, and looking back it certainly seems so myopic, we did not anticipate that we would learn 10 times more than we were sharing. But, pleasantly, that was the case: we learned from our global colleagues in the lecture halls and at the dinners, breaks, and receptions; we learned from other panelists and moderators on the stage, and we learned lessons about life and publishing in the streets of Agra and New Delhi.
APPETITE FOR LEARNING
When visiting abroad, the first thing that Westerners typically recall is the food. Indian cuisine is rich, flavorful, aromatic, and delicious. Food is a cornerstone of so many cultures worldwide. But with fruit vendors peddling their coconuts and nuts at every market and the smells of curries, tikkas, paneer, and sweet desserts permeating the air before, during, and after mealtime, Indian culture seems to embrace food even more than we expected. We did not leave the country hungry. The corollary lesson we learned was that---as Westerners---our appetite for knowledge is so small. Everyone we met had a true and insatiable appetite for knowledge. From the anecdotes relayed, questions asked, and general state of medical journalism around the world, it is obvious that the one thing that people want more of in this information-rich age is more knowledge, especially when it comes to their health. That is why the global open access journal is such an incredible epiphany worldwide. Open access is becoming the byline for how physicians learn, communicate, and enhance patient safety outcomes and patient care. The depth and breadth of true validated open access journals like PRS Global Open, PLOS Medicine, and countless open access journals from MedKnow and other publishers are really positively affecting healthcare globally.
Now we understand why the open access mandates by National Grant Organizations like the National Institutes of Health, the Wellcome Trust, and others are truly effecting change as much as or even more than direct-to-consumer aid. People are accustomed to giving funds directly to affect the consumer in healthcare but that is truly analogous to giving a hungry person fish, rather than giving him a fishing rod and teaching him how to sustainably and perpetually do this for himself. In this case, the free open access journal articles are the rod, and the fish that our readers can catch on their own is the increased knowledge that people can assimilate and benefit from directly. This is really what PRS Global Open is doing: we are providing plastic surgeons and affiliated specialists worldwide with open access literature to educate themselves and directly, sustainably to improve patient outcomes and safety. But, as unique in North America as our journal was when launched in the field of plastic surgery, our time in India at the World Association of Medical Editors congress only made it that much more clear how much we are simply following the lead of global open access journals who have been providing knowledge in this fashion for years. Physicians in larger communities and in remote locations world over may or may not have access to traditional print or online journals as seen in North America. But with open access freely available to readers anywhere online or on a phone, the previously restricted knowledge is now truly open for enhanced communication and learning. It is no wonder that citation rates for article processing charge-funded open access journals equaled the citation rates for subscription journals by 2005.1 It’s the wave of the future….but now.
With the knowledge that the average attention span of a middle-aged person in 2015 is about 8.25 seconds2 (which, as we learned in a phenomenal WAME session, is less than that of a goldfish), people are hungry for and consuming this information at increased rates. We have to be able to provide it not only as freely and accessibly as the readers need it but also as quickly and rapidly as they can consume and rebroadcast it. Open access is the only delivery mechanism that can satiate the world’s cravings—and the good news is that the end result is better care and better patient safety and outcomes. As plastic surgeons, that’s always been what we strive for, and why we will continue to follow the world’s open access example with PRS Global Open.
OPEN MARKETPLACE OF IDEAS
We had the opportunity to visit a few open-air markets and flex the kind of negotiation skills an American only gets to use when buying a car (Figs. 1, 2). But, what we quickly learned was that whether you’re in a flea market or a small storefront selling silks and souvenirs, or a fancy showroom for white marble or Indian carpets, there are no set prices; there is a true give-and-take and relationship building every negotiation. It quickly became clear from learning from the group of world editors who gathered in New Delhi that there are no set prices for medical knowledge in the new age. It’s a true paradigm shift: yes, there are bottom lines to meet, and staff to pay, but in the negotiation-like, sharing-based model of this new age, biomedical communication is no longer a 1-way street. Not only do we need to open up dialogue with our readers by way of digital media, social media, and other as of yet unforeseen technologies but also we need to share our content with new and unfound readers while also sharing our readers with other journals.
In this very competitive world, the journals that succeed will be the ones that share the medical knowledge openly. They will be the winners, because they will ultimately, positively affect human health in the developed, developing, and emerging communities all over the world. With this open trade of ideas and goods, everything is negotiable and there is a true multidirectional and multilayered two-way flow of communication. It’s such a foreign concept to those only publishing in the closed/subscription-based model, where “what’s mine is mine and yours is yours.” Even with our subscription-based journal, PRS, we have taken great steps to be more open by offering open access publishing options and providing several free articles per month and to be more open in terms of communication with our social media efforts. But in the new Journal world, sharing is the true key—taking knowledge from one market stall to the next—that’s why we eagerly invite you to leave our Web site and visit the pages of our International Partner Journals and we welcome their readers openly. Directing traffic away from a proprietary Journal Web site would be considered “bad business” not even 10 years ago. But it is today’s reality: this is the give-and-take, ebb and flow of the open-air and open-access market. It is all part of expanding and making medical knowledge more accessible, available, and free, and therefore more discoverable.
While in India at the WAME meeting, we were quickly reminded of the passion and pride everyone feels for their regions, countries, and their local journals. On a larger scale, this kind of patriotism can cause strife, but in the medical publishing and editing communities, this pride is very positive and very important. It is a pride that Americans can readily identify, relate to, and respect; it is also very humbling and almost immediately causes one’s horizons to broaden. This nationalistic or community-based pride may seem counterintuitive, as the medical and plastic surgery globe is shrinking and it appears to truly be a small world, after all. But, now that the whole of the earth’s knowledge is open to any consumer and physician on earth, that “home-town” home-journal pride becomes even more important. It is that pride that allows the good journals to get better and to separate from the imitators, predators, and lower quality journals. The fact that the Pakistani Journal of Medicine and the Indian Journal of Plastic Surgery are as easily accessible and discoverable as Nature or Medicine means that the weight of the search-engine optimization spotlight could just as easily fall on me or my WAME colleagues, as it could on the “big players.” The Internet and search engines have limited the playing field for medical knowledge. We have to realize it and embrace it. We have to make sure that everyone who wants access has access and that when they land on our journal, our articles are relevant, our sites are intuitive, and the pride we take in our work truly shines through in each article.
At the WAME meeting, we had an opportunity to see sharing-turned-into-collaboration and smaller world in action. Before our travels to India, a young plastic surgeon emailed the senior author (RJR) and told him that he had read several PRS abstracts and his book. He went online to the Web site of his frequently read Journal that PRS Global Open had recently started an international partnership with. Because of the reciprocal linking agreement between our journal and the Indian Journal of Plastic Surgery, he found PRS Global Open and reached out to Rohrich, encouraging him to read his own articles on rhinoplasty in the Indian Journal of Plastic Surgery, which Rohrich did. They continued communicating through email about a few of the studies, and when it was shared that PRS Global Open would be coming to India, this young plastic surgeon flew 2 hours to Delhi to just meet Dr. Rohrich regarding plastic surgery for 20 minutes. Without the reach of open access journals and the sharing culture that allows for such wonderful reciprocal linking programs like our International Affiliates program, the 2 surgeons would have likely not read each other’s articles or met in person. But, by meeting in person and sharing knowledge, the senior author and the young Indian plastic surgeon made global plastic surgery a little bit more tightly knit. By sharing global open access literature through such a reciprocal linking platform, for plastic surgery, affiliated subspecialties, and nonaffiliated medical disciplines, we at PRS Global Open are allowing for local and global plastic surgeons to have the same access to our literature as nonplastic surgeons and vice versa. Through such a platform, knowledge will be shared, assimilated, and propagated, and we can all work together to share our techniques and experiences to improve patient care, safety, and outcomes.
Overall, the greatest thing about traveling to represent plastic surgery globally is that it gives you an incredibly different perspective: one that is humbling and one of admiration for other cultures and other journals and the people who bring them to life. We were amazed at the drive and passion that some of our international colleagues and friends have to do the right thing for their specialty and for their journals when they have limited resources compared with what we do. It was very humbling and exhilarating and inspiring to meet so many altruistic editors from emerging countries who were so passionate about doing the right thing for the readers, their fellow physicians, and consumers at great sacrifice of time and energy.
It is eye opening and made us realize that we are more complacent and take things for granted; the best souvenir we took home was to be even more thankful for the gifts and resources that we have and a newfound passion to take a page from their books and their journals and move forward in their footsteps: more passionately, more creatively, and more openly.
We were fortunate enough to visit the Taj Mahal (Fig. 3): a truly amazing structure and a magnificent passion project of love that cost the Mughal Emperor Shah Jahan both time and treasure. That’s what many of the journal editors whom we met in India are almost building: testaments to the love of their fields of medicine that will enrich the country and the world and stand the test of time. The world editors we met show some amazing personal focus and dedication to disseminate knowledge. We hope that the world and local medical communities will come to the support of these editors and their missions; they need help from reviewers, editorial boards, and authors to grow and evolve the world journals as well. We all must not be too focused on one thing or we can neglect other factors too…much like how the building of the Taj Mahal almost bankrupted the country. As we move forward in this next stage of medical publishing, we all need to have a balance taking into account the mission, the goals, and sustainability. We can learn from the Taj Mahal that with great effort and vision, and some self-sacrifice, you build a structure that is a beacon for light and an inspiration for years to come (Fig. 4); we can also learn that the builders and visionaries can—and should—all be willing and able to ask for and accept help when needed. That’s what these editors are doing in this part of the world, and what we’re trying to do for PRS Global Open.
In conclusion, we truly learned from our trip to India as a global medical community, that together we’re stronger. We have many lessons to learn from each other, and we should be open to change and dialogue. To move forward, you have to have an insatiable appetite for knowledge, you have to be part of the “open-air market,” 2-way street of communications, have pride and passion in your work and the mission, accept differences and capitalize on similarities, always be willing to ask for help in reaching your goals, and always be ready to learn. There is so much that we can continue to learn from each other to better serve our authors and readers worldwide. It is a truly amazing world of global medicine, and we in plastic and reconstructive surgery are now more ready than ever to be part of it.
“The best way to find yourself is to lose yourself in the service of others.”
Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
1. Solomon D, Laakso M, Bjork BC. “A longitudinal comparison of citation rates and growth among open access journals.” J Infometrics 2014;7:642650.