I would like to first point out, before we even get started: after my last post, I had a minor Zoom-based showdown with the HR department about some professionalism modules I was refusing to complete and I got in pretty big trouble. In case you are interested, I stood my ground like the dumpster-inhabiting dipshit I am and ended up NOT HAVING TO DO THE MODULES. F**K YEAH.

Anyway.

Normally, I’d start this off by apologizing for my absence complaining that fellowship is too busy and I don’t have time to write about the trials and tribulations of taking tox call, but in reality one of the main reasons I haven’t been writing is because I’ve been busy writing. As a fellow, a big part of my day-to-day includes trying to get various little projects written up and published. Unfortunately, because of the nature of the job – overdoses and poisonings, mostly – most of our research is of crap quality, because you can’t ethically poison people and see if various treatments will fix them.

At least, you shouldn’t.

The majority of our research are either case reports (here is a patient who drank 90 cans of camp stove gas and did not die, here is a small child who ate a tube of wart remover because it looked like Go-Gurt) or the dreaded “retrospective chart review.” This latter category means your fellow hoovers up a bunch of mostly irrelevant data from the electronic medical record and then spends an incessant number of bored, overcaffeinated hours staring at an Excel spreadsheet, unless of course said fellow is able to pawn the work off on a medical student or other slave. The fellow then begs a statistician who actually understands the middle third of scientific papers to analyze their data (most of us have a tenuous-at-best grasp on the math involved in even the simplest calculations), and then we write about what we found, which is usually nothing of interest.

Scientific writing used to be cool, actually. Scientists would write somewhat casually, include funny quotes, and speak frankly about their challenges. Example:

These days, scientific writing is about as engaging as the Terms of Service of your iTunes upgrade.

Anyway. I frequently complain about dry science, but in today’s missive I would instead like to scream into the void about a related frustration: publishing in general and the massive scam it has become.

Academic publishing is the main way we fellows and faculty manage to get promoted: by publishing meaningful science, we can point to our work and say, “See? I have advanced my field and brought prestige upon my employer. Give me a better title and an improved parking space.”

Academic publishing nowadays, however is a rotten, corrupt corpse that stinks of decomposing garbage. It is riddled with predatory journals that exist only to steal money and produce absolutely nothing of value to anyone. The overwhelming, vast majority of articles that get published in any given month contribute zero things to their field.

It’s so much worse than just being useless words on a page, like this blog. Publishing companies rake in hundreds of millions of dollars from the authors themselves, along with their institutions that pony up exorbitant subscription fees for what amounts to a simple paywall. Here’s how it works:

1. Author writes scientific article, likely with the objective merit of a microwaved fish. Most of my publications are in this category.
2. Author submits to their scientific journal of choice.
3. A journal editor, who usually works for a small stipend and the prestige factor, skims the abstract and sends the paper out to related experts to review the article. This “peer review” represents the main gatekeeping step in publication, and is the purported reason that a given article is supposed to be worth something. These peer reviewers are usually paid the industry standard fee of $0. They are paid in goodwill and prestige.
4. If accepted by peer review, the good journals will then publish the article on their website. With the exception of the largest and most important journals, most publications do not even print paper issues anymore, a smart move because it makes your major overhead expense limited to the cost of maintaining a website. This is approximately $25 a year for this blog. Just as a reference.
5. Before publishing online, the non-top-tier journals, which again represent the overwhelming vast majority of published scientific literature, will say, “Congratulations! We are accepting your article for publication. Be proud of your achievement. Please pay the Article Processing Charge to proceed.” This APC will cost, depending on the journal, anyway from a few hundred to a few thousand dollars. The author is then expected to pay out of pocket for their own article to get published.
6. The most predatory journals, which typically have names like “World’s Extreme Journal of Ecobiopharmaterrocology,” pretty much exist only as money-making ventures siphoning off junior authors like me. They will accept any article, no matter how shitty, as long as the author pays the APC. No peer review needed.
7. The author then can list the article on their CV, gain prestige, and climb the ladder, even though their article might be as useful as a mosquito bite. Volume is what matters on a CV, not quality.

If you’re keeping track, journals thus collect money from:

• Academic institutions, who pay tens to hundreds of thousands of dollars annually to subscribe so their researchers can cite articles in their own crappy publications;
• Individual subscribers who lack friends with institutional access
• The authors themselves.

This last bit is the part that blows my mind, especially because these journals HAVE NO PRINT OVERHEAD. They have basically zero paid employees besides maybe three or four that operate the website and do all the article formatting. The peer review process: pro bono. The editors: on stipend. The authors: paying the journal, rather than the other way around.

The craziest part of this process is probably that we, the highly trained intelligent apex professionals that we are, have… rolled over and accepted this as okay. In many cases, we pay the article processing charge because we calculate it is more valuable to us to add the citation to our CV than it is to hang on to the $1200 it costs to publish in the World Journal of Bullshit Medicine Open. This is because we have, collectively, the financial skills of a lawn mushroom and a similar degree of respect for our own time.

How does this make any sense!? It is absolutely bananas that we, the physicians and scientists of the world, have not risen up and gently placed the heads of the publishing houses (who shall remain nameless, as their lawyers are expensive) on staph-riddled pikes. It is crazy that we tolerate this in the name of academic advancement. My lawyer friends will not even open Microsoft Word or an email client unless they are on retainer. We’re over here publishing crap to avoid perishing in the wilderness of academia. It’s absolutely wild.

And yeah, I’m still a fellow. Here’s Otis trapped under the bed because he has the brains of a bag of rice.