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The journal of last resort.

Publish or perish. It is a truism, a mantra, and a way of life for many who aspire to a career in academics. This has led to continually increasing numbers of co-authors and “how-I-spent-my-summer-vacation”– quality papers being created and submitted to medical journals. It is difficult for peer-reviewed journals to find reviewers for these manuscripts because often no one is willing to admit that they are a “peer” to the authors of these mediocre (or borderline or “me too”) studies. Even with this process, some have characterized the quality of peer-reviewed papers as “perfectly awful.” With acceptance rates that often approximate 15% or less for high-impact journals, authors are then forced to repeatedly reformat and submit their manuscripts to a seemingly unending parade of progressively weaker journals until they find one willing to publish the study. The conclusion to be drawn from this is apparent; we can solve this by publishing more articles. Another reason to increase the number of venues for publication is that it is now clear that a number of drug companies have published favorable trials on their products but withheld unfavorable results. To achieve complete transparency, it has recently been suggested that all trials should be published, irrespective of bias or financial conflicts or how poorly they are done. The already overwhelmed physician will then be able to evaluate the complete literature and its quality for each new medication, device, or treatment. How physicians can do this between seeing patients every 15 minutes and after being up all night in surgery or managing unpredictable emergencies has yet to be determined. Perhaps this could be accomplished through bombardment with more unsolicited daily e-mail alerts, but that would interfere with one’s ability to get timely updates from Nigerian scammers. The real issue is what medical journal editor is willing to publish such obviously flawed studies and who wants to read this stuff? Not us up to now, or so we thought. We were originally under the naïve and mistaken impression that the purpose of every paper published was to improve patient care. We thought there were research articles that should never be published because they were of poor quality and would do more harm than good. The study that falsely attributed autism to childhood vaccinations and was later retracted is an example. Consequently, we previously favored a “three rejection strikes and you are out” approach, relegating manuscripts with invalid results to the Journal of Improbable Research or the Journal of Universal Rejection. However, we now realize in this era of “openness” and “anything goes” that publishing only high-quality studies is an old-fashioned and outdated concept. With the proliferating number of questionable medical journals, it is now clear: good, old-fashioned nonsense can become publishable, distributable, and immortal. Therefore, we propose a more simple solution for this lack of appropriate outlets in which to publish meritless and low-quality papers: the creation of The Journal of Last Resort. This journal will be online only and join the growing ranks of for-profit open-everything journals. A Google search using the term “open journal” returns roughly 929 million results. To avoid being lost in the crowd with other fly-by-night open journals, this new journal would be indexed with all of the major search engines, including Google, Bing, Ask, the Directory of Open Access Journals, ebay, Amazon, Angie’s List, and PornHub. We tried to contact Yahoo but were unable to reach them, possibly because we were using a Motorola phone. For reasons that are unclear to us, we have so far been unable to arrange for indexing in the National library of Medicine Index Medicus. To further separate From the Departments of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, and the University of Utah School of Medicine, Salt Lake City, Utah.