EDITORIAL: Sports medicine in 2017 – do we know where we are going?
In my lifetime as a clinician I have seen many changes in the perception of what constitutes progress in sports medicine. Over the years there have been many different approaches to how to become a better sports medicine professional.
I started my surgical training in the mid-1970s, at a time when residency programmes were still relics of the Second World War. This meant that as young residents we spent most of our long hours in the OPD, and dedicated much of the rest of our time to the operating theatre. In addition, we were sometimes advised to ‘update’ our medical knowledge by reading classic clinical textbooks – mostly about surgical techniques – many of which were 10 to 20 years old. At that time, hands-on training was non-existent.
In the early 80s, publishing clinical results in scientific journals became a staple for good practitioners. These results were not as good as we believed them to be. However, education was still the preserve of our most wise elderly colleagues, experts in their field whose authority was beyond questioning.
Slowly, English became the common tongue for communication in medical fields and in the early 1990s good medical practice was supported by three academic pillars: clinical work, research and education. Publishing and presenting results at conferences around the world became the model. Impact factors and citation numbers became as much identifiers of a physician’s capability as their rapport with their patients. The prosperity and funding of universities became dependent on the publication output of their academic staff.
The 21st century has truly globalised medical practice and research, for better and for worse. Clinicians have become more aware of treatment outcomes, the question of medical responsibility has become a prominent one and protocols have become part of daily life. Traditional scientific journals now compete for space with an explosion of new multimedia channels. The risk is that ‘savoir faire’, based on sound and extensive clinical experience plays second fiddle to research with polished language, flashy infographics and viral reach, but little in the way of actual substance or clinical value. One could consider it ‘showbiz sports medicine’, with practitioners spending more time on social media than in clinics. One wonders how these new ‘rock stars’ find time to see their patients between all their invited conference appearances, expert panels and consensus statement contributions.
These trends have also given rise to a new sports medicine subspecialty – the professional sports scientific medical writer, sometimes with a tendency toward ‘copy and paste’ papers of limited value to clinicians. Unwary journal editors with a lack of up-to-date clinical experience may be blinded to the fact that intense flurries of research into hot new topics may not be what their clinical readership requires, not to mention that studies may not have been conducted in the rigorous manner required to translate research into practice effectively.
Meanwhile publishing company CEOs rub their hands with glee as an endless stream of scientific content from all over the world flows into their corporations, at no cost to them. Their $10 billion-a-year industry is flourishing on the backs of researchers and their institutions.
With 2016 behind us, we can note the alarming divide between clinical and research work is still clear in the sports medicine community – which has only served to benefit publishing companies. There is much real and relevant work to be done to help clinicians understand how nuances of the world of research benefit their own practice – or not. Meanwhile universities and researchers are looking for their slice of the cake which without them cannot exist – and rightly so.
For this reason, Aspetar Sports Medicine Journal is proud to offer some monetary incentive for authors whose work we publish as well as offering all our content, including print, free of charge. While this is clearly not a model which is likely to catch on, something must be done to make the current publishing environment fairer and more relevant to clinical outcomes. We await a progressive solution from our fellow sports medicine publishers; particularly those with long, distinguished traditions and high impact factors.
Best wishes in 2017.
Nebojsa Popovic MD PhD
Image by Jason Howie