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The Journal of Vascular Surgery: 1982 to 1990

1996; Elsevier BV; Volume: 23; Issue: 6 Linguagem: Inglês

10.1016/s0741-5214(96)70224-0

1097-6809

D. Emerick Szilagyi,

Aortic aneurysm repair treatments

On June 16, 1982, at the Boston meeting of the two national vascular societies (Society for Vascular Surgery [SVS] and International Society for Cardiovascular Surgery [ISCVS], Michael E. DeBakey, MD, as a guest, presented to the joint council a proposal that created a great deal of interest and surprise. Dr. DeBakey asked the joint council to consider undertaking support for the establishment of a new journal that would limit its contents solely to papers that dealt with clinical and experimental studies of vascular diseases of surgical interest. Both the interest and the surprise had historical antecedents. The concept of publishing a periodical dedicated to vascular surgical problems had long occupied the interest of leading members of both Societies. The first test of the practicality of the idea was probably undertaken by the membership of the ISCVS in 1965, when at the urging of several members of the executive council, the President (who happened to be me) mailed out questionnaires to all members requesting their opinion about changing the forum of publication used by the Society from the Archives of Surgery to a newly established journal. Seventy-five percent of the respondents wanted no change. In 1974 after a most exhaustive discussion among the members of the executive committee of the ISCVS, the same problem was again taken up, with the involvement of the SVS. After much discussion and debate, the question was placed in the hands of a committee composed of members of both societies. The committee drew up a concise questionnaire and mailed it to the 684 members of both Societies, requesting expression of preference or refusal for a new American Journal of Vascular Surgery. Seventy-three percent showed no interest in the proposed publication, so the proposal was never carried out. These events, known to most of the members of the joint council, were the basis of the surprise that Dr. DeBakey's proposal stirred up. At first glance, because of the previous failures, the idea of reviving the concept of a vascular journal did not seem realistic. Yet a lively interest also arose because it was realized that in the intervening decade vascular surgery had undergone profound changes. In 1965 and even in 1975, the majority of vascular operations were performed by surgeons who practiced both general and vascular surgery, and their natural inclination was to publish in general surgical journals, both because of familiarity with the organs and also, with only partly professed interest, because of the exposure such publication provided. By the advent of the 1980s, high-quality studies dealing with vascular problems appeared in large numbers in general surgical journals. Surgery and the AMA Archives of Surgery at least once every year had one issue completely devoted to vascular topics, as they published the presentations on the yearly programs of the two vascular societies. In 1965 there might have been a serious doubt whether a peer-reviewed, high-quality periodical devoted purely to vascular problems could be published even four times a year because sufficient material of this type was very likely lacking. By 1975 worthwhile studies appeared in sufficient numbers to fill comfortably a quarterly or bimonthly vascular journal. In 1982 the publishable material appeared to be abundant. It is quite understandable that in spite of past experiences Dr. DeBakey's proposal seemed exciting. Dr. DeBakey's request for cooperation followed in the wake of a proposal he received from the publishing company Masson, probably the most prestigious French scientific publishing firm, which had subsidiaries in the United States. Masson envisioned a close association with the SVS and ISCVS, expecting to become the official publication of these societies. This course, needless to say, meant the exclusive rights to the publishing of the papers of the programs of the two vascular societies. In a letter to the SVS and ISCVS dated June 16, 1982, the French company laid out a detailed program for constituting an editorial board, offered a plan of frequency of publication, and offered a schedule of division of finances. Incidentally, the financial offering was rather meager. Dr. DeBakey's presentation, after he answered a number of questions and left the meeting, sparked a very lively and prolonged outpouring of opinions. In general, the opinions leaned in favor of accepting the idea of a new vascular journal, but there were some cautious words about possible dangers in a financial involvement. Eventually, however, a motion to consider the establishment of an independent periodical owned by the two vascular societies was accepted. This, of course, meant the withdrawal of consideration of associating with Masson. A very important and perhaps decisive piece of information during the discussion that may well have turned the tide of arguments in favor of accepting the challenge of a new publication was the information by Dr. John L. Ochsner (then president-elect of the ISCVS), who had previous experience on the editorial board of the journal to which the copyright was owned by the American Association for Thoracic Surgery. He pointed out that involvement with the journal did not create financial problems, but, on the contrary, it became a source of revenue for the society. An ad-hoc committee on journal publication was appointed to explore the feasibility of a journal, with Dr. John L. Ochsner as chairman. The members were Drs. Ronald J. Baird, Calvin B. Ernst, and D. Emerick Szilagyi. During the following weeks, the members of the committee explored all of the practical aspects of publishing such a journal. In these explorations, Mr. William T. Maloney (president of Professional Relations and Research, Inc.) was of important assistance. The committee met on October 2, 1982, at O'Hare Airport in Chicago to summarize its recommendations. Soon unanimous agreement was reached that the establishment of a journal was feasible and that its launching would be recommended to the joint council. After weighing many names as possibilities, an editorial staff was recommended, with Dr. Michael E. DeBakey as editor-in-chief and Drs. D. Emerick Szilagyi and Jesse E. Thompson as senior editors (Fig. 1). Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)A tentative list was also drawn up of members of the advisory editorial board, which was to be submitted to the joint council for approval together with the composition of the editorial staff. An indefinitely renewable 3-year term was recommended for the members of the editorial staff and a single 6-year term for the members of the advisory editorial board. Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT)Fig. 1Editors of the Journal of Vascular Surgery: Top, Dr. Michael E. DeBakey; middle left, Dr. D. Emerick Szilagyi; middle right, Dr. Jesse E. Thompson; bottom left, Dr. Calvin B. Ernst; and bottom right, Dr. James C. Stanley.View Large Image Figure ViewerDownload (PPT) The remaining project for the ad-hoc committee on journal publication was the selection of a publishing firm. With the assistance of Mr. Maloney, the C. V. Mosby Company of St. Louis was selected. On April 23, 1983, in Atlanta, the committee members and Mr. Maloney met with the representatives of C. V. Mosby and agreed to a contract drawn up by the committee's attorney. The contract assured financial support for the editorial office by C. V. Mosby and a 50% share of the net revenue of the journal. This document was circulated to the members of the joint council and was ratified by mail. On January 15, 1983, the report of the ad-hoc committee on journal publication was presented by its chairman, John L. Ochsner, to the joint council. The report was accepted as presented. To oversee the financial aspect of the functioning of the editorial staff, the joint council appointed an ad-hoc committee on publication. As will be seen presently the agenda and membership of this committee underwent changes in the subsequent years. The newly appointed editors wasted no time in meeting with the members of the committee on publication of the two vascular societies on June 17, 1983, just 2 days after the confirmation of their appointment. A number of policy questions were discussed and decided. The Journal would have the array of content generally adopted by scientific publications: independently submitted articles, articles from the programs of Societies with the inclusion of discussions, review articles, editorial comments, historical vignettes, abstracts of articles from other peer-reviewed journals, book reviews, and letters to the editor. It was decided that during the first year the Journal would appear bimonthly, with a page content of 120 to 150 per issue. The senior editors would prepare a detailed list of instructions for prospective contributors. The primary contributors to the Journal would be the members of the two national Vascular Societies, but submission from select regional vascular societies would also be accepted for review. C. V. Mosby was requested to circularize institutions of the appropriate character for the dissemination of the news of the appearance of the new publication. They eventually mounted a 13-item promotional program, which was expensive, but fairly effective. The principle was accepted that all submitted manuscripts would be first scrutinized by the three editors, who would decide whether consultation with the advisory board was needed. This practice resulted in a good deal of waste of time in processing and eventually was modified. The interpaging of advertisements would be unacceptable. The text of all advertising material would have to be approved by the editors. Strangely enough, during the first meetings of the editors, no particular attention was paid to the location and equipment of an editorial office. It was tacitly assumed that the office of the editor-in-chief would serve as the central processing place and that the processing work would be done by the chief editor's office personnel. The work of the senior editors would likewise be done in their own offices with their own office help. This simple approach appeared to be satisfactory during the first 2 or 3 months of 1984, the first year of publication. It soon became evident, however, that a more practical arrangement for efficient handling of the processing of manuscripts would be necessary. As the volume of submissions increased, it was realized that the prereview part of the editing process (including the logging of manuscripts received, preparing copies for review, and correspondence with contributors and the publishing house) should be located in one place. It was also recognized that this aspect of the editorial work required a good deal of time, which the editor-in-chief, with his extensive duties as dean and chancellor, could not afford. It was agreed that the prereview administrative duties would be transferred to the Henry Ford Hospital in Detroit. I was about to terminate my operating-room activities and had more time to devote to editorial work. It was agreed that the responsibility for the final approval of submissions for publication would remain with the editor-in-chief. The main office was transferred to Detroit in March 1984, and a routine was developed that allowed the editor-in-chief to judge the manuscripts after they had passed through the routine evaluation process. The method of processing the submitted manuscripts went through a trial and error period, but eventually a satisfactory method evolved. The manuscripts actually fell in two categories: those from the SVS and ISCVS programs in one, and those from the regional society programs and independent submissions in the other. The manuscripts from the national Societies were scrutinized by the senior editors and sent for review by the members of the editorial board only if they seemed to need corrective changes, which most of them did. In the second category, all independent submissions and papers from the regional societies were peer-reviewed not only by the senior editors but also by at least two assigned members of the advisory editorial board. When all the reviews were in hand, I synthesized all the opinions and sent the result to the author with clear recommendations for changes whenever and wherever necessary. If the requested changes were satisfactorily made, acceptance was granted, but otherwise the paper was returned for further correction or was rejected. Some of the data regarding the processing of the manuscripts are informative. When the reputation of the Journal had been firmly established in 1986, 90% of the papers needed moderate to heavy revision. The average number of days for review by the editors was 21 days, and for the completion of the corrections and changes by the authors, 30 days. In all categories, however, the range of these time intervals was rather wide. The rejection rate was between 15% and 20% for manuscripts from the national Societies and 60% for the independent submissions. These rates remained quite constant. The composition of the editorial staff underwent some changes between 1985 and 1990. In 1985 Dr. Jesse E. Thompson resigned from his office of senior editor for health reasons. In the same year Dr. James C. Stanley joined the staff as associate editor. Several months later Dr. Calvin B. Ernst joined Dr. Stanley as associate editor, a position they each held until 1990, when they took over the editorship together. Dr. Norman R. Hertzer also served as associate editor in 1989 and 1990. Michael E. DeBakey retired from his chief editorship at the end of 1988, and I took his place as principal editor, with the simple title of editor. In hindsight, it seems an expectable phenomenon that subscribers did not immediately rush to the new Journal. From past experience briefly alluded to earlier, it was to be expected that the publishing habit of the surgeons who performed vascular procedures would change slowly. The extensive campaign launched by C. V. Mosby to familiarize the public with the new Journal was effective, but a simple selling method (more or less the same as “peddling”) also contributed to the popularization of the Journal. I visited the meetings of all the prominent regional vascular societies and demonstrated the new Journal, leaving copies for inspection and answering questions. I still have a copy of the Journal of Vascular Surgery marked “check it but do not take it.” The Journal, however, had a winning card for the success of its introduction. About 940 members of the two societies received the Journal as part of their membership privileges. Here we had a captive readership, who then served as an ethical propaganda machine. Friends and acquaintances coming into contact with the issues of the Journal owned by members undoubtedly often became interested and joined the readership. At the end of 1983 (just before the Journal became a printed reality), only 8 unsolicited articles had been submitted, but the first two issues of the Journal did not suffer from a dearth of material because they had the contributions from the programs of the two vascular societies: the SVS papers were published in the January issue and the ISCVS papers in the March issue of the Journal. Readership grew apace. At the end of 1984, the editors could report that the subscribers numbered 5244, of which 4602 were paid and 4205 were from the United States. The ratio of about 20% foreign subscriptions remained quite constant. At the same time, the manuscript count was 202 independent submissions and 64 from the two Societies. The numbers continued to increase, and in 1989 the total circulation was 7595, a 47.4% increase from 1985. In the same interval, the number of printed pages per year increased from 952 in 1985 to 1616 in 1987. It is not difficult to find the explanation for this growth. The Journal filled in an essential gap in the information network in the world of vascular surgeons, and the results suggest that it filled the gap well. If it did so, its success was in a large part the result of the devoted service of a highly competent advisory editorial board (Fig. 2). The Journal started as a bimonthly publication and continued as such during 1984 and 1985. Since January 1986 it has been published monthly. The relationship between the Journal and the publishing firm C. V. Mosby (now Mosby Year Book) was one of the pleasant features of my time as editor. This was mainly the result of the genial management style of Mr. A. Jerome Freeland, who was the senior vice president at Mosby in charge of journal publication. Efficient, knowledgeable, and unfailingly cooperative, he provided outstanding publishing administrative support for the editors striving for academic excellence. The only disturbance in this interrelationship was slight and passing, and it concerned the monitoring of advertisements, an important source of revenue for the Journal and its owners. For several years the editors scrutinized in detail the text and graphics of advertisement copy before adopting it to be printed, a task that became increasingly more onerous, and once or twice led to disagreement between an editor and the person in charge of advertisement processing at Mosby. Eventually this benign but fruitless “censorship” was discontinued, and the custom of all major medical periodicals was adopted, that is, a clear and widely displayed disclaimer of responsibility for the contents of advertisements. The first unpleasant event about publication occurred even before the appearance of the first issue of the Journal. The background of the incident surfaced when the editors were puzzling over the best name for the new publication. Eventually we all agreed that Journal of Vascular Surgery, suggested by Dr. Michael E. DeBakey, was the most appropriate. This choice was a natural one because according to the search carried out by our librarians no journal of this name existed anywhere in the world. In fact, there was no peer-reviewed journal dedicated to vascular surgery at all in the English-language literature. On July 3, 1983, however, Mosby received a sternly phrased letter from an attorney of “The Angiology Research Foundation.” No one of our acquaintance had heard of this organization, which published a quarterly magazine called “Vascular Surgery.” This organization decided that we had chosen for our new journal a name that would be confusing and would diminish the literary value of their publication. They threatened with a lawsuit. Our attorney pointed out that when they chose the name “vascular surgery” they merely resorted to the use of the designation of a discipline, which cannot be copyrighted. After a few more exchanges between the attorneys, this slight disturbance quieted down and eventually evaporated. In the life of every editor, the threat of accepting an article that had been previously published elsewhere is a nightmarish possibility. This fraud is extremely difficult to avoid. With many thousands of scientific publications in the world, it is obvious that surveillance of the previous appearance of a manuscript that has been submitted for consideration is impossible. Fortunately, the domain of vascular surgery is still relatively small on the large scale of the entire medical scientific world, and it is relatively difficult to hide a vascular article that has already appeared and make it seem new. Nevertheless, we had three instances in which attempts were made to convince us to publish duplicate material. In two instances the attempt was discovered while the manuscript was under review. Dr. James S. T. Yao seemed to have a particular talent to do this type of detective work because he had an enormous overview of surgical publications as the editor of the Yearbook of Vascular Surgery. We can thank him for discovering the two acts of fraud. In the third case the previously published, somewhat similar version of an accepted manuscript was discovered before shipping it to the printer. The manuscript was returned to the author. Later the author submitted a manuscript with substantially enlarged case material and an entirely new text. This article was eventually accepted. To make a fair judgement of the value of a piece of scientific writing is a very demanding task. The method that is used to accomplish this judgement, the peer review, is a relatively recent development. In the early years of scientific publications very often articles were assessed by a single person, usually an outstanding scientist who established the journal. It has been said, for instance, that the great Rudolph Virchow decided entirely on his own what to publish in his famous archives. At first thought, it would seem logical to believe that several minds can make a more reliable judgement of a piece of writing than a single mind. This reasonable assumption is at the heart of the concept of peer review. In this system a product of scientific literary provenance is analyzed and its value weighed by two or more persons who are recognized as experts on the subject of the essay they have been chosen to assess. Although this approach seems to come close to the ideal of objectivity, it has been criticized primarily on two accounts. One criticism is that members of a panel of such reviewers may actually harbor unfriendly personal views of the author. Another objection is that the reviewers have an opportunity when they look at a piece of original work to expropriate ideas and use them for their own purposes. None of these critical remarks could be justly applied to the use of the peer review in processing the manuscripts submitted to the Journal of Vascular Surgery. The group of reviewers are closely acquainted with each other, and any prejudicial behavior would be readily detected by a colleague. As to expropriating ideas, the risks of this type might exist in publications in which ground-breaking observations from sophisticated laboratories are published, perhaps in the process of development. The Journal of Vascular Surgery, however, is not concerned with this type of research. The only type of difficulty with the review process that the editors met from time to time, but fortunately very rarely, would involve the writer who resented the disposition of his paper and argued that the motives of the reviewers were prejudicial and that he was not treated fairly. I remember only two cases of this type, and both complainers seem to have been unbalanced individuals. The choice of the members of an advisory editorial board has sometimes been criticized for unfairness. There are various methods by which to choose new members to such a board, and the one I selected seems to have avoided harsh criticisms. When a vacancy occurred on the editorial board, I would write to each remaining member and ask him to submit three new names for membership on the board. Then I would collect the opinions and rank them. The person or persons who were most frequently mentioned would rank highest and would be recommended for appointments. With the striking financial success of the Journal, one would hardly expect editorial problems in the fiscal field (the Journal in the late 1980s produced a net revenue in the mid-range of six figures, equally divided between the societies and Mosby). Yet among the difficulties with which the editors had to contend, the financial support of the editorial office was one of the most persistently nagging. The difficulties stemmed from the unorthodox, almost unique interrelationship of the Journal with the agencies of the vascular societies whose responsibility it was to provide the financial support of the editorial office. With the possible exception of two or three, all scientific periodical publications that deal with clinical problems are owned by corporations who pay for the services of the editor or editors according to a business contract. The communication regarding fiscal matters is between the editor and a single second party, the owner-publisher. In the case of the Journal of Vascular Surgery, the publication is owned by two independent scientific societies acting through a committee, the composition of which changes almost every year. Interchange of views under such conditions is bound to be difficult at times. During 1983 and 1984, that is to say at the very beginning of the existence of the Journal, there was no structured financial support. A rather meager monthly stipend was disbursed from the combined fund of the two societies by the office of the executive director (Mr. William T. Maloney). After the approval of the report of the Ochsner committee, which marked the beginning of the actual existence of the Journal, a committee on publication was approved, made up of the recorders and treasurers of both societies. Communication between this committee and the editorial office was not smooth because the committee was often unclear about its duties and responsibilities. At my request in 1985, under the chairmanship of Dr. Malcolm O. Perry a committee drew up a set of guidelines (that can be regarded as de facto bylaws), which defined clearly the relationship of the committee on publication and the editors. Some bumps still remained on the road of communication because whenever expensive new equipment was needed as the work of the editorial office grew more complex, long negotiations were often needed before approval was granted. The executive director often smoothed out these difficulties and proved very helpful. In general, from this time on no serious disagreement occurred about disbursements for the maintenance costs of the editorial office. At this point it should be mentioned that the honoraria of the editors was on a very modest scale, but this fact was not a reason for controversy until 1989, when I requested an increase. This created a debate at the meeting of the joint council that was only resolved after an hour and a half of argument. A modest raise was granted. The bylaws of the committee on publication assigns to it the authority to recommend new editors for approval by the joint council. This authority created a small crisis in 1988, when the second 2-year period of appointment of the editor expired. The cause of the problem was that the term of office, through a process that is not clear, between 1984 and 1988 had been reduced from two 3-year to two 2-year periods. According to this rule, the editor's second and last term of office expired at the end of 1988. The chairman of the committee on publication then in office solved the problem by convincing the committee to recommend a 2-year extension of the term of the editor. This recommendation was accepted by the joint council, which also resolved that after the termination of this 2-year term the length of service of the editor would be 3 years, renewable once. In 1989, the bylaws of the committee on publication was revised, granting more authority to the committee over the editorial staff and reaffirming the 3-plus-3-year restriction on the term of service of the editor. The immovable adherence to the limitation of the editorial term of office raised some questions among people acquainted with the practices of other similar organizations. One hopes that the routine now observed at the Journal of Vascular Surgery is not the result of a philosophy such as professed by a chairman of the committee on publication, who in 1989 went on record to affirm that he was in favor for short terms for the editor because this practice allows passing around this highly appreciated and honorable position among deserving people. He also went further to justify his proposal by asserting that a short term avoided the danger of abuse of the position by the occupant. He did not clarify the nature of the possible abuse. The fact of the matter is that the job of an editor, and certainly that of the editor of the Journal of Vascular Surgery, is not a tour of leisure but grinding hard work requiring distinct qualifications. It should not be bestowed as a reward for dutiful service to the Society. As to the risk of malfeasance in office, the position is most unlikely to offer opportunity for mischief, and if by some extraordinary chance it did, remedy would be readily at hand, regardless of the length of tenure. I completed my duty as an editor at the end of 1990. The joint council appointed the two associate editors, Drs. Calvin B. Ernst and James C. Stanley, as editors with equal authority and responsibility. With rare skill and devotion, the new editors not only successfully maintained the tradition of excellence of the Journal but increased readership and the financial security of the enterprise. Their second 3-year appointment will benefit the Journal until the end of 1996.