Introduction and Preamble
There are times when I think the story of my life could be entitled “Taking the path of least resistance.” Certainly, that as the case when, in 1981, the president of National College of Chiropractic, Dr. Joseph Janse, asked for a volunteer to help out an administrator, Dr. Roy Hildebrandt, who was ill but who also was the editor for a somewhat new chiropractic journal called the Journal of Manipulative and Physiological Therapeutics. Dr. Hildebrandt had recently achieved the impossible: he had had the journal included in Index Medicus, the then weekly publication of new scientific papers and information and which to that time had never included a chiropractic journal. Dr. Janse had first asked a colleague of mine to take this role on, but he deferred, preferring to work in the postgraduate arena. I therefore volunteered.
Fast-forward almost 44 years. I am now an older administrator and faculty member, slowly moving toward retirement, and one who spent his entire career as a faculty development specialist and biomedical journal editor. Over the course of my career I edited a number of chiropractic publications (table 1), created several of them, served as associate editor on a number more and on editorial boards of others, and am regularly asked to review papers from a variety of both medical and chiropractic publications.
Over nearly 44 years I have seen the evolution of chiropractic research and publication. From early days, when colleagues such as Reed Phillips and John Triano had to publish under their PhD degrees and not list their DC ones, to today, where we have a vibrant publication record and research enterprise, much has happened. I’d like to take the opportunity to reflect on what I have seen.
Technology
Let’s begin with technology. When I first began working with the JMPT, authors would mail us typed manuscripts. We would make copies to mail to reviewers, all of which took time. Once the review process was complete, I would edit the paper and then hand it to a secretary, who would retype the entire document. On a typewriter. If we made a mistake, we might have to retype the entire document. Once we had all the papers for an issue ready, which might amount to over 200 pages of retyped paper, we would mail it to our publisher. They would generate what were called galley proofs, single columns of text that literally had to be cut into pieces and stuck of whiteboards the size of the printed page. I did this; I cut up galleys and laid them out, making sure that tables and figures were set properly in the layout. Of course, this layout happened after we mailed the galleys to authors so they could correct errors. If they found errors, new galleys were made. Once we sent in final copy, the issue was printed and mailed.
Imagine how profound it was to obtain first an IBM Selectric typewriter, which could allow you to correct mistakes on a line-by-line basis. You had a small screen in which one line of text appeared. You could correct it and then it would print; rinse and repeat these hundreds of times. And then the world changed; I got my first Apple Macintosh computer in 1985. You had full-page screens on which you could edit before printing. Wow! Five-and-a-quarter inch floppy disks stored an entire issue! And the later 3 ½" disks stored so much more!
The real game changer was the internet. It was no longer necessary to write overseas colleagues to get copies of papers, as we had done in the past. Now, we could begin to locate them online, making writing and preparing papers so much easier. And as time went on, the technology improved even more; we use here at JCC the Scholastica platform for processing papers, allowing us the chance to produce pdf versions of papers (which we produce in-house) and html versions as well. You can read papers on your phone now or on your screen. I’ve also worked in the Open Journal System, another platform for journal publication. And I am skipping over years of incremental advance. And this is only the technology of producing the papers in print and online.
Subscriber vs. Author Pays Models of Publication
The internet opened up so many other possibilities. Journals now could be hosted online, and over time more and more were, and because more were competition began for manuscripts and some journals became known as predatory. In the newer model of journal operations, the open access model, authors paid for publication, instead of subscribers. The idea here was to make available papers to wider audiences. Let’s contrast subscriber models to open access. In the subscriber model, the only people who can access your full paper are those who have paid subscriptions. The funds to operate the journal come from those subscriptions (plus any association funds if the journal is provided by an association). Thus, for some chiropractic journals, that might mean 4000 people can easily access the work. However, keep in mind that a significant amount of scientific research is funded by the government, through NIH or HRSA or other agencies. That means tax dollars, which are provided by the public through income tax. But then, the public- who funded the research- cannot access it without paying again. In some cases, the government is now requiring even subscription-driven journals to make public scientific research within one year of initial publication. And in this model, you give up the copyright in lieu of the journal accepting the costs of doing the work to publish your paper- it does cost money to do that.
In the open access model, which is also known as the author pays model, the author pays a publication fee, but does not give up copyright and thus retains the rights to his or her work. In addition, since the journal is open access, the paper once published is available to literally anyone with an internet connection, making the dissemination of that paper much easier and potentially more distributed. Now, if you happen to be a private practitioner, the idea of paying, say, $1400, may sound absurd and expensive. If, on the other hand, you are a grant-funded researcher, that same amount can be built into your grant, which often runs into the hundreds of thousands of dollars so is a very small price to pay for getting your paper out to a wide audience.
Predatory Journals
But, one can easily see the risk here. Journals can be created for the sole purpose of obtaining the funds you provide them in order to publish your paper. Quality control is nonexistent. Novice authors, looking to begin advancing in their careers, become easy targets for unscrupulous editors and organizations. These are known as predatory publishers.1,2 Entire lists have been published listing predatory journals; suits have occurred, the lists were pulled.3 By now, most of us are tired of the relentless requests to submit papers to journals we have never heard of, usually with exceedingly polite letters inviting you to submit based on your well-known past history. I now have to teach students in my evidence-based practice course how to differential good journals from bad, and this is not the easiest thing to do. And many of us have received invitations to review papers from these same journals. This leads to another development in publishing.
The Challenge of Peer Review
Peer review is a cornerstone of scientific publication. It provides editors with expertise that can help identify shortcomings and flaws in good scientific research. After all, an editor cannot be an expert in all areas of his or her discipline. In the past, peer review was a blind process. That is, authors were not made aware of whom reviewed their paper, and reviewers were blinded to who the author(s) was. This was done to minimize personal bias and animus, to hid that from the reviewer. But in a profession such as chiropractic, where we have less than 100 full-time researchers across the US colleges, everyone knows what everyone is doing; it is much harder to blind someone from, say, appear on pediatric surveillance, since we have only a couple of people doing regular work in that area. Thus, one attempt to resolve this issue was to move toward transparency.4,5 Now, no attempt to blind either author or reviewer is made, so if there is bias, it can be recognized. In fact, many journals now allow authors to suggest their own reviewers.
However, in the explosive growth of online publication, the need for peer reviewers is growing exponentially. It is becoming harder and harder to find good reviewer willing to put in the time for this service. I am experiencing this personally. I service as an associate editor for other journals, and often need to locate peer reviewers for papers not specifically chiropractic in nature. I often need to contact 30 people or more to find just 2 people willing to accept the review offer. And I have myself turned down requests to conduct peer review of papers, since I receive on average 2 such requests every week. This is freely done service, and there has been discussion about somehow remunerating peer reviewers.6 In my case, I am offered reduced or waived fees for publishing in an open access (author pays) journal. This also leads to worry that quality in peer review is declining.7,8 Thus, this is an area of intensifying concern.
The Growth of the Checklist
Checklists are now pervasive. A checklist is simply a list of criteria a paper should meet to be considered a quality paper, in the sense that is has met what consensus says are the required elements of a specific type of paper, such as a case report or clinical trial.
Artificial Intelligence (AI)
AI has already profoundly altered the landscape of many industries and scientific publication will be no different. This journal has already published one paper that used an AI engine to help generate text, and the industry has responded by ensuring that transparency occurs when AI is used. Should AI be listed as an author? At present, the consensus is that it cannot, and I agree with this.17 We need to remember that large-language and neural-processing models for AI do not think; they cannot comprehend what the produce and cannot create logical connections.18
What I see happening is 2-fold. The first is that we will learn to use AI engines to search the literature. For those of us in academia, we have good exposure and experience in searching databases such as pubmed, but these still require specialized expertise. I think that we will find more and more of out colleagues turning to AI to locate good information. The problem here will be separate wheat from chaff, to find the strong evidence-based information among the weaker sources. AI may not do that for the user.
The second will using AI to draft initial drafts of papers. A strong prompt may yield a “strong” paper, one that can be modified by the user to a submittable manuscript. I have played with AI for this purpose, though I would not myself use it to generate a manuscript. But I wanted to see how well it might do. I asked it to write a positive article about chiropractic, focusing on strong evidence in favor of spinal manipulation for low back and neck pain. I asked it to prepare a paper to summarize the writing of one of our fiercest critics. It did both admirably, though it is hard for me to say if these would have passed a review without a request for revision. Buchanon concludes that “it is essential to use it responsibly and maintain research integrity,” a statement in his paper that he freely admits was prepared by AI.19
The Journal of Contemporary Chiropractic has already published at least 1 paper in which ChatGPT was used.20 We made sure to publicly note that fact for readers, as transparency is critical.
Conclusion
As I look around the full spectrum of chiropractic, I am astonished at how far we have come in such a brief period of time. When I entered the profession as a student in 1976, the only book I could find in the library was an anti-chiropractic screed. We were essentially banned from hospitals. Today, we have positions in hospital settings, in the VA, in multidisciplinary roles, in educational leadership, and more. We have a longstanding record of high-quality research, university-based programs including the new one at University of Pittsburg, and some of the finest researchers are seen as the best the world has to offer. One of our own has held leadership roles in national healthcare; another travels the world fighting for our practice rights across many countries.
We are mature, and with maturity comes wisdom and the ability to see where we still need to do work. Publication is important to that work, and it will be interesting to see how the nature of publication changes in a digitally connected world. I hope I will be around to see it.