Artículos de Reflexión

Will the controversy about publishing in Spanish or in English be solved on the basis of academic merits?

Jorge Antonio Aldrete*

SUMMARY

This article discusses the meager attention given in the anesthesiology textbooks to the original contributions made by Latin American colleagues in this medical discipline, in addition to the factors that may have encouraged this unwonted neglect. One of the reasons could be that these innovations were published in journals with limited readership abroad, though other articles were published in well-known English journals, but were inappropriately referenced. The new parameters include the assessment of the new articles on the basis of "Evidence-based medicine" criteria requiring the prior submission of the protocol and making comparisons among various groups of against other subjects. Thus, success is only possible with a more stringent statistical analysis. A new criterion has emerged recently based on the number of bibliographic references to the title and the authors of the article that determines the level of interest of readers in the particular publication. This interest is called the "impact factor" of the article among the group of readers. The probability of success and the dynamic conditions that may attract the attention of a larger number of readers, particularly in other countries, will depend on the quality of the papers published by the Revista Colombiana de Anestesiología (Colombian Journal of Anesthesiology) and the level of interest generated in the potential readers.

Keywords: Language, publishing, essays, editorial policies (Source: MeSH, NLM).

INTRODUCTION

A review of the contributions made by Latin Americans to medicine in general and anesthesia in particular, evidences the ignominious reality of the fact that any contribution published in its original language, be it Spanish or Portuguese, in a local medical journal, runs the risk of being practically ignored or remain unknown. In some cases, important achievements by Latin Americans are neglected because their innovations were published in local newspapers or journals. Following are a few of these examples:

a. Pacifico Pereira (1), from Brazil, excised a sublingual osteoma from the lower jaw in 1886 using ether as topical anesthetic agent, though there could have been some inhalation of the same agent as well, in addition to topical freezing due to ether vaporization.

b. C. Restrepo (2), from Medellín, Colombia, performed mouth-to-mouth respiration alternating with sternum and ribs compression to treat a respiratory arrest.

c. En 1891, Teodoro Castrillón (3), upon measuring the barometric pressure in Bogotá, Colombia (2640 m or 8660 ft) suggested that anesthetic agents like ether should be accompanied by air or oxygen; the same author described a case of external myocardial stimulation (probably due to defibrillation) following a cardiac arrest during anesthesia, with successful resuscitation.

d. In 1899, in Rio de Janeiro, the "narcotizers" Fajardo and Pereira anesthetized Maria with chloroform, while Couto and Leal anesthetized Rosalina and thus enabled the surgeon Alvaro Ramos to separate the conjoint twins (4).

e. Luis Bernal (5), from Medellín, Colombia, suggested a protocol for cardiac arrest during anesthesia:

1. Stop the administration of anesthetic.

2. Place the patient in Trendelenburg position.

3. Blow air through a tracheal tube, 7 to 10 times/min

4. Open up the chest and massage the left ventricle.

f. De Souza (6), from Río de Janeiro, Brazil, described back in 1944, the adaptation of a small balloon to one of the arms of a three-way valve, the other arm connected to a needle hub; the balloon was inflated with air, connecting it to the needle lumen and as the needle was advanced, when the bevel entered the epidural space, the balloon was immediately deflated, indicating that the needle was in the right position. In the rest of the world, this ingenuous adaptation is attributed to Macintosh (7), who in 1950 published a similar instrument.

It can be argued that most of these cases were published in local journals at a time in which distribution was quite limited and thus the news had little dissemination. This is understandable.

However, the following examples illustrate innovations that were published in international journals but were disregarded when reviews on special techniques were written. For instance, the paper by García Herreros (8), a Mexican military doctor who published 110 cases of regional intravenous anesthesia in the journal of Anesthesiology in 1946, but was not mentioned in a later review (9).

Similarly, we find papers on regional anesthesia in pediatric patients that were published in international journals but did not receive the recognition deserved: Spiegel (10) published in Anestesia & Analgesia, in 1962; Fortuna (11), in the British Journal of Anaesthesia, in 1964, and Baquero & Vásquez, in 1965 (12) in the Revista Mexicana de Anestesiología. The latter published individually their experiences with caudal anesthesia in pediatric patients. Moreover, in 1975 Melman et al. (13), from Mexico, presented their experience with caudal anesthesia in infants at the International Anesthesia Research Society (IARS) Congress and were admonished. Thirty years later, when the technique began to be used in Europe and in the U.S., these authors were not recognized (14) in a review article on the topic. The assumption is that neither the book editor, nor the authors of the papers, reviewed the literature previously published on that particular subject matter.

Let us assume that the de novo information published in local journals and in Spanish is probably not widely disseminated -the first cases-(1-6); however, with regards to the later cases mentioned, included in English journals and with a broad circulation (10-13), their omission is totally unjustified.

Probably this debate is also applicable to the publication of textbooks on anesthesiology (14) written in Spanish, by local authors, versus the classical books (written in English), since the texts written in a foreign language may simply be translated. The arguments are varied:

a. Notwithstanding the fact that most of the medical literature is written in English, it becomes mandatory to provide an adequate and recognized forum to the Latin American authors (15).

b. Every resident and trainee must have available a textbook they can fully understand, particularly those who do not master the English language.

c. Practicing colleagues need a reference book.

d. It is important to preserve one's identity, since the working conditions, the idiosyncrasy of the people, the available materials, the emotional reactions, the financial resources, the believes, the stoicism, are all different from those of other nations and other ethnic groups (16).

Though unintended, the authors that wrote in Spanish were then asked to be guest speakers in other Latin American countries (17). Furthermore, the promotion of a scientific journal published by every society of anesthesiology, implies the guardianship of a large number of studies, observations and reports to ensure the acceptance of abstracts or complete articles in the Index Medicus, so that they can be published also in English with Abstracts in other languages (French, Portuguese, etc.), in addition to keeping them in a data base that will eventually include compete articles published in the last five years (18,19).

ARGUMENTS IN FAVOR AND AGAINST ACCEPTING ENGLISH AS THE ONLY SCIENTIFIC LANGUAGE

Certainly most scientific journals are published in English; furthermore, other countries speaking different languages, such as Belgium and the Scandinavian countries, have accepted English as the language in which most of the scientific papers are written. On the other hand, countries like Germany and Japan have some journals in their own language and others in English. There are other options like the Revista Colombiana de Anestesiología, (The Colombian Journal of Anesthesiology) that publishes all its articles in both English and Spanish, while the Revista Argentina de Anestesiología, (Argentinean Journal of Anesthesiology), the Revista Chilena de Anestesiología (The Chilean Journal of Anesthesiology) and the Revista Brasileña de Anestesiología (Brazilian Journal of Anesthesiology) publish the abstracts in English and Portuguese. The Revista Mexicana de Anestesiología (Mexican Journal of Anesthesiology) accepts articles both in Spanish and English. Other journals publish is Spanish only.

If English is accepted as the only language for scientific publications, this will probably lead to:

a. Overlook the Spanish language (used by almost 500 million people) in the scientific community.

b. Hinder the dissemination of contributions made by some Spanish-speaking scientists.

c. Deprive the Spanish-speaking scientists from participating at appropriate and recognized fora (20).

d. Force the students of medicine and other scientific disciplines to study mostly with foreign textbooks that exclude their region's typical diseases such as malnutrition or parasitic conditions.

Additionally, contributions from Spanish-speaking authors are seldom included and they tend to use many Anglicisms in their writings (tests rather than pruebas, complacencia rather than distensibilidad or algología rather than algiología [21]).

Furthermore, the decision to only publish in Spanish may have farreaching implications, such as:

a. Translating scientific articles is expensive and often the result is not ideal (for instance, literal translations like "enfermedades locomotoras" (for locomotive diseases) rather than enfermedades músculo-esqueléticas).

b. Any writer who does not write in English will be destined to bibliographic oblivion.

c. Despite the importance of the content, publishers will tend to reject the article.

d. Not enough Spanish glossaries and dictionaries is a drawback.

e. Imbalance in the amount of online medical repertoires.

f. He repertoires offering definitions bring about confusion.

g. Errors are made in the Health Virtual Library.

h. Some times the translation into another language is not exactly equivalent.

Those of us who were against accepting English as the only language to publish scientific articles were surprised to see the front page article published on June 2nd, 2006 by Usa Today "Spain offers bonds to study English". The article said: "the Spanish Government of J. L. Rodríguez Zapatero offered a subsidy of 1300 Euros to young students (18-30 years old) who wished to study English, noting that only 20% of Spaniards spoke the language, in spite of the flourishing tourism and a fast growing economy"1. So, if this the position of our motherland, where do we stand against this paradox?

REALITIES

There is no doubt that the last half of the century has experienced an important transformation in the medical and scientific literature in general, particularly in anesthesia-related journals, with regards to the European and Far East authors, suggesting an increased communication with those regions, and a larger number of authors who have learned English and master the language to the point of being able to write sophisticated articles or avail themselves of specialized and competent translators.

Some of the apparent improvements in the quality of the publications include:

a. The requirement to proof the meaning and truthfulness of the results obtained through the statistical analysis of the data obtained, that usually entails better protocol planning and inclusion of a larger number of study subjects in order to achieve a "significant" difference (22).

b. Protection of patients exposed to rigorous procedures.

c. Proving that the research animals were managed and treated "humanely" and within a sound environment and in adequate facilities.

d. Introduction of the meta-analysis system aimed at doing a pre-analysis to determine whether the groups compared have enough subjects for an adequate comparison and if the analysis of the results was consistent with the study planned for. (23,24).

e. The scrutiny of the studies published on a particular topic, using evidence-based medicine methods for comparison, some times fails to confirm the theories or techniques initially considered as the "management of choice", when in fact the initial studies were poorly planned and the number of subjects was insufficient, while the outcomes were analyzed with inadequate statistical methods for the particular study (25,26).

f. Systematic reviews using the Cochrane method have revolutionized the methods to validate a particular clinical approach when based on inappropriately conducted studies (27,28).

ARE CLINICIANS ABLE TO DO SCIENCE?

The answer is elusive because the question is insidious, and we tend to respond with a conditional yes, since several people believe that it is a difficult if not impossible goal to achieve. On the other hand, we shouldn't neglect the fact that the requirements imposed by the drafting and selection committees of journals are increasingly rigorous. In some cases the protocols have to be submitted to the approval of a special committee prior to the start of the study so that eventually the papers are admitted (18,19,29-31).

I don't know whether such question may indeed be honestly answered since the acceptance of an evidence-based medical approach has not only provided us with a different method for scrutiny, usually requiring expert analysts almost exclusively devoted to this activity. Ironically, it is worth remembering that some medical writers who were unhappy with the previous methods of scientific scrutiny said that the only truths were "lies and statistics". I won't dare to predict what will be said in twenty-five years about these new methods of scrutiny used on clinical studies of series of patients that result in accurate or imaginary scientific interpretations (32).

We must keep in mind that in the course of the last year several examples have been identified of published trials that were inadequately interpreted, hence requiring the authors to publicly accept their mistakes (22 publications in one case [33], and 6 publication in another [34]). These ramblings have not only revealed that the meta-analysis does not unveil fraud and that the scientists - industry partnership leads to "fabricating" data accepted by the manufacturers, but also that the editorial process is not yet protected against fake data, phantom studies or interpretations influenced by equipment or drug manufacturers, from which they cannot get divorced as long as they depend on their commercial advertising.

These facts lead us to look back on the medical journals considered as scientific fora; certainly most of them have fallen in this trap and hence we must come to grips with the reality. The truth is that there is a mutual dependency and hence both sides have their own merits. For instance, according to today's acceptance criteria, Sellick's (35) key paper suggesting to apply pressure on the cricoid to occlude the esophagus and prevent regurgitation into the pharynx probably should have never been accepted; however, this publication probably saved the lives of thousands and thousands of patients receiving anesthesia with a potentially full stomach. His article was published in Lancet in 1960, in just half a page, with no illustrations, comparisons or statistical analyses; however its clinical benefit exceeds that of 90 % of the elegant publications that fall into oblivion due to the lack of clinical application.

This shows that publishers are expected to have the criteria to identify any potentially useful material even if it does not meet all the require- ments and to reject those articles written by professional scientific writers where everything is so perfectly consistent that the veracity of the information may be questioned (33,34) because, after all, we must accept that medicine is not an exact science.

ACADEMIC PROGRESS DEPENDS ON HOW OFTEN ARTICLES ARE QUOTED IN THE WORLD LITERATURE

An apparently quantitative method has emerged in the last few years to qualify the "quality" of the articles published: determining how many times is the first author or the article mentioned in the literature seems to establish the probable "impact" of such article on other scientists that read and used the article as a reference in one of their papers or in the specific scientific discipline.

Another system is the assessment of the journal's impact using specifically the Science Journal Ranking of Average Impact Factors, which grades the journal from 0 to 20 assessing all of the articles included in the journal. Another recently suggested rating system is the Popescu Index that uses different parameters and grades merits from 0.0 to 1.0; both are published yearly. Table 1 includes the grades assigned to the most widely read journals.

These indexes not only impose a system of competition among several journals, but indirectly as well among the authors of the articles published by those journals. However, the readers' appreciation shows inconsistencies. Naturally, there is a competition among the academic institutions and universities to which these authors belong. Indirectly, these indexes affect the professors of those institutions since one of the criteria for faculty promotions and to justify research sponsorship, appointments to faculty positions, assessment of curricula and even Nobel price winners is the number of publications and their scores.

Such measurements of academic validity are subject to criticism because when judging a contribution to a medical discipline, broader criteria should be used and consideration should probably be given to the economic limitations faced by researchers in developing countries. The latter, in addition to their efforts to accomplish their tasks, depend on their personal characteristics and their individual merits. Furthermore, some topics may even be just "a fad" with a short-lived interest difficult to predict in the area of medicine. Fortunately there is common sense that defeats the test of time, so we shouldn't be influenced by fleeting trends.

SOLUTIONS AND SUGGESTIONS

In a way, we should never loose sight of common sense and insist that we keep alive our national journals that are the clinical and scientific media, in addition to serving the communication needs of professional, personal and political interests and keep us informed about congresses, visits or shows. Some additional suggestions include:

a. Accepting papers of national and international authors.

b. Accepting papers on related disciplines; i.e. physiology, pharmacology, anatomy, veterinary medicine, etc.

c. Accepting papers in other languages for translation into Spanish.

d. Classify articles by sections.

e. Include a "Letters to the Editor" section in the Journals.

f. Translation should be free of charge.

g. Provide practical training to colleagues interested in publishing.

h. Publish the abstracts of posters presented yearly.

The following suggestions are addressed to those colleagues interested in making original and scientific contributions:

a. Research the subject matter at length.

b. Make a comprehensive review of the relevant literature.

c. Select a detailed protocol.

d. Consult with experts.

e. Measure whatever is measurable.

f. Always compare against one or two systems, drugs, etc.

g. Present a poster as a preliminary effort at a posters session or congress.

h. Submit a paper to an international congress.

i. Publish the paper in an English journal.

j. Submit a fragment of the paper before a national journal, as long as you previously inform the editor.

Needless to say that we must be regularly informed about any changes that may arise in the evaluation methods for scientific papers and about the requirements of each particular journal to assess any papers submitted to their consideration. Those colleagues interested in their academic advancement should always be informed about the various classifications or categories of the journals they would like to submit their papers to for publication.