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Editorial - Year2014 - Volume29 - Issue 2

I read an editorial in the January issue of Plastic and Reconstructive Surgery that left me quite concerned about the trends currently emerging among medical journals, a subject that requires extensive debate in our specialty. In the article, Rod J. Rohrich and Daniel Sullivan debate about trends in medical journals and the paths that publishers are taking to pursue these trends.

Many of the top U.S. daily newspapers are ceasing to print their classic paper versions and are offering subscribers only a digital version, which can be accessed via computer, tablet, or mobile phone anywhere in the world.

Weekly, we receive emails from journals asking us to send them scientific articles, so that they can acquire content and establish credibility. The vast majority of these new journals are Open Access. Open Access journals have been around for almost 20 years and they represent an undeniable global trend in the medical literature. There are 7,706 publications listed in the Directory of Open Access Journals, with almost 800,000 published articles. All these journals are available on PubMed, and extrapolations indicate that 60% of all content of scientific journals will be published in Open Access journals by 2019. One of the first Open Access journals in medicine, the Journal of Medical Internet Research, was established in 1998 and today has an Impact Factor of 4.7.

Clearly, fighting this trend means "stopping in time," as in the past when some doubted the impact that would be made by computers. Newer generations have made the virtual environment their main source of knowledge and entertainment.

These Open Access journals represent a new business model. Some benefits of Open Access publishing include free and unrestricted access to scientific content for anyone who has an Internet connection. Libraries worldwide will save a fortune in comparison to their current spending on subscriptions to printed publications.

A main argument in favor of Open Access publication involves free dissemination of information, particularly for research sponsored with public funds. Publication in Open Access journals has become a requirement of a large and growing number of development agencies and research institutions, which argue that if public money was spent to fund research, the results should be available to the public.

As of December 2011, 170 research institutions and 51 development agencies made it mandatory to publish in Open Access journals, and that number is growing rapidly. In July 2012, the United Kingdom requested that all research funded by its main funding agencies be made openly and freely available to the world (via Open Access) within six months of its publication.

The Open Access model has both similarities and differences to the traditional print model:

1) Open Access research is reviewed using the same criteria and templates as the traditional print model.

2) The author or the sponsoring agency will often pay to have the article published in the Open Access model, but the content of the entire content is then made freely available worldwide to anyone with Internet access at no cost to the reader.

3) In the digital Open Access model, the article is available for consultation online less than three weeks after its approval, while in print form, it may take up to six months to reach the subscriber.

The journal Plastic and Reconstructive Surgery launched its PRS-GO (Global Open) Open Access version to permit free access to its publications by plastic surgeons around the world.

The fundamental question asked by all Brazilian plastic surgeons is: Can and should the researcher publish "Before and After" images in Open Access scientific journals, because anyone with access to a computer can view and copy intimate photos of patients undergoing plastic surgery? I was invited to join the PRS-GO and have an article accepted for publication in Open Access electronic form. I requested to delay publication until receiving the opinion of our Federal Medical Council, as the article will include photos taken before, during, and after a rhinoplasty procedure. I noted that I have written consent from the patients and the magazine is of a scientific nature, but it is freely accessible to anyone.

The written response of the Federal Medical Council was that if the manuscript is published, I WILL be punished by the Council. From a philosophical point of view, there are reasonable grounds for that decision. How would a child who had a cleft lip or other malformation feel if his cruel classmates found pictures of him before and after surgery? Bullying is a reality and it is possible that parental permission, given by parents happy with the result, could still result in harm to the child by ignoring his or her right to medical privacy?

Will Brazil's plastic surgeons be impeded in their efforts to publish in high impact factor international journals offering Open Access? They will certainly lose in the natural evolutionary trend of medical journals.

Prof. Dr. Gal Moreira Dini
Professor of Plastic Surgery, UNIFESP-EPM and PUC-SP.
Member of Editorial Board of PRS-Global Open.


1. Bryn Mawr. Classical Review. Available at: Accessed August 29, 2012.

2. Postmodern Culture. Available at: Accessed August 29, 2012.

3. Psycoloquy. Available at: Accessed August 29, 2012.

4. The Public-Access Computer Systems Review. Available at: Accessed August 29, 2012.

5. Journal of Medical Internet Research. Available at: Accessed August 29, 2012.

6. Antelman K. Do open-access articles have a greater research impact? Coll Res Libr News 2004;65:372-382.

7. Eysenbach G. Citation advantage of open access articles. PLoS Biol. 2006;4:e157.

8. Rohrich, Rod J. Sullivan, Daniel. Trends in Medical Publishing: Where the Publishing Industry Is Going. Plastic and Reconstructive Surgery, Number 1, Volume 131; January 2013.

PhD - Affiliate Prof., PG Supervisor, Head, Rhinoplasty Department, Discipline: Plastic Surgery - UNIFESP

Institution: Universidade Federal de São Paulo - Escola Paulista de Medicina e PUC-SP.

Corresponding author:
Gal Moreira Dini
Street Vicência Faria Versage, 318
Sorocaba, São Paulo - CEP: 18031-080

Article received: March 6, 2013
Article accepted: March 10, 2013


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