Page 7 - ISAKOS 2018 Winter Newsletter

The ancient Romans cured this arrogance, by having slaves behind them in their triumphal chariots, whispering in their ears “remember, remember, you are also mortal!” And for us, JISAKOS would serve the same purpose, through its Classic articles.
Something Different
Being the “new kid on the block” did give us some advantages. We were the first “digitally-born” orthopaedic sports medicine journal, designed for a faster moving world, where immediate access was becoming the norm. Other journals have had to adapt themselves to this new world, often with reluctance. But we were born into it. We were mobile-friendly. Our articles were published online, as soon as they were finalized. Our Journal had all the sophistication of the media-savvy younger generation. Of course we still provided bi-monthly paper-copies, which ISAKOS members can bind in rich leather, and gaze at lovingly during their retirement. But we had started fast-moving, and we aim to keep up the pace.
This idea of pace is important, because clinical developments in orthopaedic sports-medicine have accelerated in recent years. JISAKOS has to keep its readers abreast of the latest research and evidence-based guidelines. It also has to explore the different approaches to diagnosis and treatment, to rehabilitation and prevention, to follow-up and the sequelae of injuries. We have to explain how patients respond to treatments, and how findings can translate into practical applications. In all this, our members should be able to identify themselves with their journal: “this is what my society has selected, as important for me to study, in my scarce and valuable time”.
Healthcare is rapidly changing. As healthcare providers we have to face that challenge, and change with it. Better than that, we ought to take the lead. We should encourage prevention, and endorse patient-power. “Why do it?” is becoming as important as “How to do it”. Patient selection in surgery decision-making is one of the themes in our State-of- the-Art articles. Clarity of indication might enable us to ‘do the right thing’, and avoid unnecessary surgery. But then there is ‘doing the right thing right’. Can we ensure quality-of-care just by following guidelines? If so, who gets to decide what counts as “quality”, and who should be setting those guidelines? Should it be governments, or insurance companies, or healthcare providers like us, or the patients themselves, through PROMS (Patient Reported Outcome Measures)?
And then there is Patient Safety. Is the ultimate solution a black-box in every Operating Room? Or is volume the decisive factor? But then, how many procedures create a good surgeon?
One of our global problems is the inexorable rise of healthcare costs. Growing populations and new technologies play their part, but also a widening of indications. The regional differences are otherwise difficult to explain. In the last 10 years, for example, the total health expenditure has more than doubled in all European countries. If we don’t make these choices ourselves, the choices will be made for us.
Human All Too Human
We surgeons work with our hands, but we also pride ourselves on being “scientific”, and following something called the “scientific method”. We firmly believe that this is how “good” science and good technology is achieved (and “bad” science is thwarted). What this boils down to is that articles must be peer-reviewed, before they can be published. That is, everything has to be passed – as well-researched and well-argued, hence probably correct – by influential and experienced people. These peer-reviewers have an important task, so they need to be neutral.
But what if they are subtly influenced by other motives? What if they are really thinking: “I don’t agree with this, because it is unfashionable”, or even “it goes against my own ideas, and it will threaten my own reputation, if it turns out to be correct”, or “there is simply no money in this approach, the funding is all for the other side”.
We may not know much about the philosophy-of-science, but we do know that people are always people (“Human, all too human”, as Nietzsche puts it). And that the system we employ might actually be delaying good ideas, unorthodox ideas – even suppressing them completely – and simply because they are unfashionable.
We can observe the power of orthodoxy and money, when it comes to Climate Science. Whatever your personal opinion about Anthropogenic Global Warming (AGW), you would have to admit that, when scientists start fiddling the figures, and trying to suppress the unorthodox by bullying, there is likely to be something wrong.
That’s why our systematic reviews followed PRISMA guidelines, and why we chose our JISAKOS reviewers with such care. We deliberately chose them to welcome the unorthodox (you can find their names on the journal website). I am sure you will agree that a journal that deliberately dares to be unorthodox – and dares to give youngsters their chancethat this journal might just have the advantage...
Our Compass
On the cover of JISAKOS there is a dial, which suggests our global reach. But to me it also suggested a compass. I was born a Dutchman, a mariner from a maritime nation, and my ancestors had sailed around the world. I know the importance of a compass, as a guide through uncertainty, as a guide to safe anchorage.
JISAKOS ORIGINAL RESEARCH
ISAKOS NEWSLETTER 2018: VOLUME I 5