- Email: [email protected]
Textbook-based impact factors could be better (but don't be absolutely sure of it)!
J AM ACAD DERMATOL
Letters 183
VOLUME 54, NUMBER 1
The current over-the-counter hydrocortisone label does not mention use on the face, although it does warn against contact with the eyes. The label instructs consumers to stop use if their condition worsens or if it clears up and occurs again in a few days; however, our survey did not assess whether consumers were in compliance with that specific instruction, which might have given clues to our correspondents’ concerns. Overall, our survey indicated that prolonged use on the face was rare. At the most only 0.18% of those surveyed had used over-the-counter hydrocortisone on their face for longer than 14 days, and one third of those had consulted their doctors about hydrocortisone use, so their use may have been physician directed or physician approved. There were no reports of use on the face for more than 2 weeks in any children. Over-the-counter labels direct appropriate use by consumers, and our survey showed that users of over-the-counter hydrocortisone generally followed the labeled instructions and warnings. Thus, if all over-the-counter corticosteroid products warned against use on the face, such a warning likely would be heeded widely. By US law, therapies are designated over-thecounter unless there are sufficient reasons—mainly concerns about safety—to restrict their availability by requiring a prescription. Indeed, over-the-counter topical hydrocortisone has an enviable safety record with extensive use. Thus other low-potency topical steroids, with proper labels (that our work suggests will be well followed), might become over the counter in future. Whether this would significantly increase the percentage of the population that uses over-the-counter topical steroids, or merely shift some use from hydrocortisone to other low-potency topical steroids, is unknown. Regardless, a wellwritten label has a strong impact on consumers’ patterns of use, and proscribing extended application on the face is reasonable. Charles N. Ellis, MD Department of Dermatology University of Michigan Medical School 1500 E Medical Center Dr Ann Arbor, Michigan Disclosure: Dr Ellis has been a Visiting Professor at the Food and Drug Administration and has served as a consultant to manufacturers of topical corticosteroids. GlaxoSmithKline Consumer Healthcare was the sponsor of the study to which this letter refers.
REFERENCE 1. Ellis CN, Pillitteri JL, Kyle TK, Ertischek MD, Burton SL, Shiffman S. Consumers appropriately self-treat based on labeling for over-the-counter hydrocortisone. J Am Acad Dermatol 2005;53:41-51. doi:10.1016/j.jaad.2005.08.039
Textbook-based impact factors could be better (but don’t be absolutely sure of it)! To the Editor: As a subscriber of The Blue Journal, I was fascinated by the ‘‘clinical influence’’ it exerts according to the reformed impact factor introduced by Jellinek, Desousa, and Bernhard.1 I myself2 have defended that citations in major textbooks should be the mainstay of evaluation of authors (journals, institutions, etc). However, in my opinion,2 a denominator is necessary to overcome the ‘‘mass effect’’ influx depending on financial and editorial power, as well as on personal acquaintances. An apt denominator would be provided by the total number of papers published by/in that given author(s)/journal/institution2: if I have published 500 papers, among which 5 have been quoted in some major, well-referenced dermatology textbook, I am clearly not so valid a clinical innovator as that less prestigious colleague, who had 4 out of his/her 20 published articles cited (0.20 0.01)eat this point one could ask why such a colleague should be still considered ‘‘less prestigious’’ than me. The problem of self-references could be easily solved, in that they would be excluded from the numerator of journalistic grading indexes: this would also reduce pressures from editors of journals to cite papers from their publications, a fact that anybody involved in scientific research has personally experienced more than onceepersonally, thrice at least, and always from Europe-based journals. Indeed, it is true (and worrying) that in several European countries, promotions and grant funding are based on the impact factor1 (although this principle is frequently and scandalously infringed).3,4 As a consequence, reformed indexes with denominator would not be welcome. For instance, when I simply decided to send the above quoted letter2 for publication (a trivial fact that would imply no practical consequences by itself), I was harshly reproved by some colleagues that such ‘‘subversive ideas’’ (sic!) could put many respectable careers built on the overall number of publications at risk of being emptiede have Jellinek et al1 experienced something similar? There is an overt conflict between those who consider that ‘‘textbooks represent the opinion of only a few authors and often emphasize older articles’’2 and those who reason ‘‘that textbook
184 Letters
J AM ACAD DERMATOL JANUARY 2006
chapters are written by experts in specific fields who read and judge almost everything that has been published about a given topic [. . .], summarize this information, and cite important up-to-date, as well as landmark older ones’’.1 It goes without saying that many scientists would lean to this last viewpoint, provided they were warranted that editors and compilers of chapters in textbooks would not join into secret cliques to systematically cross-cite their relatives, friends, lovers, and favoritesea definite phenomenon called copinage (something between ‘‘comradeship’’ and ‘‘complicity’’) by French authors,5 and plain mafia in proper Italian. Alas, too often, well-designed reforms are only apparently sweeping . . . Giovanni Luigi Capella, MD Private practice, Dermatology & STD Milan, Italy
Reprint requests: Giovanni Luigi Capella, MD Via Sauli Sant’Alessandro 7, 20127 Milan, Italy E-mail: [email protected] REFERENCES 1. Jellinek NJ, Desousa RA, Bernhard JD. The clinical influence of the JAAD. J Am Acad Dermatol 2004;50:470-4. 2. Capella GL, Stern RS, Arndt KA. ‘‘Significant’’ scientific productivity should be weighed against the expenses necessary to finance it (letter and reply). Arch Dermatol 2000;136:266-7. 3. Gerosa M. Competition for academic promotion in Italy. Lancet 2001;357:1208. 4. Manzini P. Il CIPUR si costituisce parte civile. CIPUR NotizieUniversita` Oggi 2001;32:1-3. 5. Revuz J. Pourquoi publier? (impact, carrie`re . . .). Nouv Dermatol 1997;16(suppl 3):S19-20.
doi:10.1016/j.jaad.2005.04.051
Letters 183
VOLUME 54, NUMBER 1
The current over-the-counter hydrocortisone label does not mention use on the face, although it does warn against contact with the eyes. The label instructs consumers to stop use if their condition worsens or if it clears up and occurs again in a few days; however, our survey did not assess whether consumers were in compliance with that specific instruction, which might have given clues to our correspondents’ concerns. Overall, our survey indicated that prolonged use on the face was rare. At the most only 0.18% of those surveyed had used over-the-counter hydrocortisone on their face for longer than 14 days, and one third of those had consulted their doctors about hydrocortisone use, so their use may have been physician directed or physician approved. There were no reports of use on the face for more than 2 weeks in any children. Over-the-counter labels direct appropriate use by consumers, and our survey showed that users of over-the-counter hydrocortisone generally followed the labeled instructions and warnings. Thus, if all over-the-counter corticosteroid products warned against use on the face, such a warning likely would be heeded widely. By US law, therapies are designated over-thecounter unless there are sufficient reasons—mainly concerns about safety—to restrict their availability by requiring a prescription. Indeed, over-the-counter topical hydrocortisone has an enviable safety record with extensive use. Thus other low-potency topical steroids, with proper labels (that our work suggests will be well followed), might become over the counter in future. Whether this would significantly increase the percentage of the population that uses over-the-counter topical steroids, or merely shift some use from hydrocortisone to other low-potency topical steroids, is unknown. Regardless, a wellwritten label has a strong impact on consumers’ patterns of use, and proscribing extended application on the face is reasonable. Charles N. Ellis, MD Department of Dermatology University of Michigan Medical School 1500 E Medical Center Dr Ann Arbor, Michigan Disclosure: Dr Ellis has been a Visiting Professor at the Food and Drug Administration and has served as a consultant to manufacturers of topical corticosteroids. GlaxoSmithKline Consumer Healthcare was the sponsor of the study to which this letter refers.
REFERENCE 1. Ellis CN, Pillitteri JL, Kyle TK, Ertischek MD, Burton SL, Shiffman S. Consumers appropriately self-treat based on labeling for over-the-counter hydrocortisone. J Am Acad Dermatol 2005;53:41-51. doi:10.1016/j.jaad.2005.08.039
Textbook-based impact factors could be better (but don’t be absolutely sure of it)! To the Editor: As a subscriber of The Blue Journal, I was fascinated by the ‘‘clinical influence’’ it exerts according to the reformed impact factor introduced by Jellinek, Desousa, and Bernhard.1 I myself2 have defended that citations in major textbooks should be the mainstay of evaluation of authors (journals, institutions, etc). However, in my opinion,2 a denominator is necessary to overcome the ‘‘mass effect’’ influx depending on financial and editorial power, as well as on personal acquaintances. An apt denominator would be provided by the total number of papers published by/in that given author(s)/journal/institution2: if I have published 500 papers, among which 5 have been quoted in some major, well-referenced dermatology textbook, I am clearly not so valid a clinical innovator as that less prestigious colleague, who had 4 out of his/her 20 published articles cited (0.20 0.01)eat this point one could ask why such a colleague should be still considered ‘‘less prestigious’’ than me. The problem of self-references could be easily solved, in that they would be excluded from the numerator of journalistic grading indexes: this would also reduce pressures from editors of journals to cite papers from their publications, a fact that anybody involved in scientific research has personally experienced more than onceepersonally, thrice at least, and always from Europe-based journals. Indeed, it is true (and worrying) that in several European countries, promotions and grant funding are based on the impact factor1 (although this principle is frequently and scandalously infringed).3,4 As a consequence, reformed indexes with denominator would not be welcome. For instance, when I simply decided to send the above quoted letter2 for publication (a trivial fact that would imply no practical consequences by itself), I was harshly reproved by some colleagues that such ‘‘subversive ideas’’ (sic!) could put many respectable careers built on the overall number of publications at risk of being emptiede have Jellinek et al1 experienced something similar? There is an overt conflict between those who consider that ‘‘textbooks represent the opinion of only a few authors and often emphasize older articles’’2 and those who reason ‘‘that textbook
184 Letters
J AM ACAD DERMATOL JANUARY 2006
chapters are written by experts in specific fields who read and judge almost everything that has been published about a given topic [. . .], summarize this information, and cite important up-to-date, as well as landmark older ones’’.1 It goes without saying that many scientists would lean to this last viewpoint, provided they were warranted that editors and compilers of chapters in textbooks would not join into secret cliques to systematically cross-cite their relatives, friends, lovers, and favoritesea definite phenomenon called copinage (something between ‘‘comradeship’’ and ‘‘complicity’’) by French authors,5 and plain mafia in proper Italian. Alas, too often, well-designed reforms are only apparently sweeping . . . Giovanni Luigi Capella, MD Private practice, Dermatology & STD Milan, Italy
Reprint requests: Giovanni Luigi Capella, MD Via Sauli Sant’Alessandro 7, 20127 Milan, Italy E-mail: [email protected] REFERENCES 1. Jellinek NJ, Desousa RA, Bernhard JD. The clinical influence of the JAAD. J Am Acad Dermatol 2004;50:470-4. 2. Capella GL, Stern RS, Arndt KA. ‘‘Significant’’ scientific productivity should be weighed against the expenses necessary to finance it (letter and reply). Arch Dermatol 2000;136:266-7. 3. Gerosa M. Competition for academic promotion in Italy. Lancet 2001;357:1208. 4. Manzini P. Il CIPUR si costituisce parte civile. CIPUR NotizieUniversita` Oggi 2001;32:1-3. 5. Revuz J. Pourquoi publier? (impact, carrie`re . . .). Nouv Dermatol 1997;16(suppl 3):S19-20.
doi:10.1016/j.jaad.2005.04.051