Changing With the Times

Several medical journals have written to me recently, each one proudly announcing how their impact factor improved. Impact factor is a measure of the average of how many times articles in the journal are cited in other journal articles—the higher the impact
factor, the more prestigious the journal. Journals like having a high impact factor, because scientists like publishing their work in the best journals, and impact factor is a quantitative measure of how good the journal is.

But if all the journals have a higher impact factor, has anything really changed? Journals seek to improve their quality, but when there is a specific measure for quality, there may be more emphasis on improving the measure, not the overall quality of the journal. A journal could go to a lot of effort to get authors to send the journal articles describing the best double-blind, placebo-controlled trial of cutting-edge new medicines. Another approach journals could take would be to focus on getting more citations by encouraging authors to cite the journal’s existing papers. That might be a quicker and easier way to raise impact factor than to get scientists to send the journal the most important, best research studies. The resulting increase in impact factor might look good, but it wouldn’t reflect a meaningful difference in journal quality.  Impact factor could be going up simply because there are more scientists writing more articles that cite other articles.

Humans are more uniquely able to adapt than medical journals. Whatever incentives are imposed on us, we change our behavior in response. We are resilient. There could even be a pandemic, and we would find a way to adapt. Oh, yeah...Been there, done that.

Global warming presents enormous challenges. Creating incentive structures to modify human behavior—across countries—that would meaningfully limit the effects of humans on the environment (and not just make some measure look better) seems like a tall order. To whatever extent the climate changes, I am sure there will be ways we will adapt. In this issue, we explore how dermatologists can adapt and reduce our impact on climate change (page 29). While it might seem like a far-off problem, climate change will require a more meaningful difference in our habits and behaviors than simply buying “green” products. If we can work together to change how we do things as a specialty and as a population, we could proudly announce our improvements too.

Steven R. Feldman, MD, PhD
Chief Medical Editor