As with patients’ online “research” of their conditions and treatment options, “the rise of predatory journals in [the] internet era gave birth [to] another problem of searching relevant authentic information in a vast sea of heavily contaminated, fake, plagiarized, or manipulated data in the name of biomedical researches,” according to an article by Sharma and Verma.

Although many of us still physically flip through the most recent issue of our favorite journals, few use their shelves of back issues when looking for answers to specific questions. When I moved to Texas, I couldn’t give away my 16-year journal collection. Why? Today, searches are available online. Abstracts for the vast majority of orthopaedic journal articles are instantly available. What if you need the whole article? You may be subscribed to the journal with login access to full text. Or you can pay $30 to $50 per article to download others. Increasingly, free, open access, full-text articles present themselves during such searches. Can we trust them? Although the net impact of the internet on access to information has been positive, there has been a concomitant rise of garbage information. How do we tell the difference?

What is open access?

As most of you know, open access refers to scientific work of any kind that is freely available and distributed online. The term is applied most frequently to academic journal articles, but book chapters, monographs, instructional videos, and other products also may be open access.

Open access stands in contradistinction to the still dominant, predicate model of publication, in which a journal subscription or download fee is required for a reader to access content. With open access journals, the costs of peer review, editing, and publication are borne by the authors, their academic institutions, or research sponsors. The system offers two key advantages:

Readers avoid high costs for access and subscription to journals.

Authors are offered timely and wider dissemination of new information, especially in the developing world.

One study found 89 percent more full-text downloads for open access papers compared to more typical subscription-based articles. Some authors may believe that increased readership may translate into increased citations, but that has not yet been proven. It is important to note that the productivity and impact of individual scholars and scientists often are measured via the h-index (or Hirsch index). Roughly speaking, the index seeks to value the number of papers that have been cited a given number of times. The goal of the index is to address the limitation of simple citation counts, which do not account for the quality of the publications in question.

You might not realize that most elite journals now also offer open access publishing options. As you flip through a journal, you may find that content is a hybrid between “free” and subscription only. According to one report, more than a third of orthopaedic journals offer authors the opportunity to pay to publish their articles as open access.

The rise of online, open access journals has more than doubled the number of scientific titles. This rapid proliferation can easily confuse even experts as to the bona fides of a given publication. Adding to the confusion are many hundreds of predatory journals. It is important to note that although most predatory journals are open access and web-based, not all web-based and open access journals are predatory. Some open access–only journals, such as PLOS One, from the Public Library of Science, are highly respected. Also, many orthopaedic subspecialty societies are developing their own open access, online-only journals.

What is a predatory journal?

The term “predatory publishers” was coined by University of Denver, Colorado medical library science specialist Jeffrey Beall in 2010. He also created the first “blacklist” of suspect journals.

The publications indiscriminately accept and publish ostensibly scientific content in order to “gain monetary benefits in the form of article processing fee or publication fee,” according to an article by Robert E. Bartholomew. The fees typically are not disclosed upfront. In fact, article submission or processing fees may be much lower than those for “elite” journals. Yet, after acceptance and before publication, the costs start to mount and can range from $1,495 to $2,900.

Predatory journals build on the promise of open access by offering a rapid review process and quick publishing. Yet, in reality, most corrupt the peer-review process, which is either absent or minimal in nature. They typically do not follow standard ethical policies recommended by the World Association of Medical Editors, the Committee on Publication Ethics, the International Committee of Medical Journal Editors, and the Council of Science Editors. Most have no specific policies, for example, on conflicts of interest.

How common are they? Rupp et al., reported that in the past four years, the number of predatory orthopaedic journals increased by 600 percent. In one review of emergency medicine journals, 150 titles were identified. Of those, 55 were open access and 25 were considered “likely predatory.” In 2015, Shen and Björk performed a “longitudinal study of article volumes and market characteristics” of predatory journals. They identified 8,000 likely predatory journals. The articles published by those journals increased from 53,000 in 2010 to 420,000 in 2014. They further reported that three-quarters of the corresponding authors and publishers were from Asia and Africa, whereas the percentage of European and North American publishers reached 8.8 percent and 17.5 percent, respectively.

How did such journals become so common? First, predatory publishers rely on the frustrations of researchers seeking to publish their work in a timely manner. In one study of National Institutes of Health–funded clinical trials registered with ClinicalTrials.gov, the median time to publication after trial completion was 51 months (and only 68 percent of the trials’ results were ever published). At the very least, open access journals in general, and predatory journals in particular, do not require that articles be bundled into printed issues or have backlogs of accepted content awaiting space in print.

Some authors have pointed out that, in certain cultures, “criticism [is not considered] helpful, even if it is constructive. Hence, peer review is often misunderstood as a ‘barrier’ toward the ultimate goal of publishing,” according to Ravindran et al. Additionally, many international authors express frustration with acceptance rates or language editing requirements at traditional, subscription-model journals. Macháček and Srholec analyzed publications in Scopus from 2013 to 2015 and found that more than 10 percent of the articles in predatory journals were from India and Nigeria compared to less than 1 percent from Japan and the United States.

In other cases, submitting authors fall prey to hijacked or simply confusing journal names. For example, Springer publishes the Journal of Economics and Finance, which could easily be confused with the newer Journal of Finance and Economics. The American Society for Engineering Education publishes the Journal of Engineering Technology but not the Global Science and Technology Forum’s GSTF Journal of Engineering Technology. Additionally, the online presence of predatory journals is often a “highly sophisticated and mirror image webpage of reputed indexed mainstream journals.”

Among the dozens of spine journals, Lippincott publishes Spine; Elsevier publishes The Spine Journal; and OMICS International, headquartered in Hyderabad, India, publishes the Journal of Spine. Lippincott’s journal is the oldest, dating back to 1977, and has at least 12 affiliated societies, including the Cervical Spine Research Society. The Spine Journal is the official journal of the North American Spine Society and currently offers the highest impact factor of the spine subspecialty journals. OMICS International, on the other hand, publishes more than 700 open access journals across many areas of scientific and engineering inquiry along with sponsorship of more than 3,000 conferences. I do not know that the Journal of Spine is predatory, but it is not listed in the Directory of Open Access Journals, and it was the first academic publisher sued by the Federal Trade Commission for alleged deceptive practices.

Many predatory journals are “fly-by-night.” That is, new journals are started every day and often have a very short lifespan, making them impossible to track. Even when they are identified, very few active responses have been undertaken by either conventional publishers or academia. This muted response may be due, in part, to threats of litigation. Mr. Beall’s list was suddenly deleted from his website in January 2017, perhaps due to such risks. Others have reported similar, aggressive tactics from predatory publishers, who may rely on differing legal structures in their home countries.

Additionally, the publishers use aggressive “spam” email campaigns to solicit articles. We can laugh off most spam messages, but, as Chris Bono noted, it is common because it works.

The internet offers easy access to a world of scientific content that previously required trips to the library. As orthopaedic surgeons, we have become accustomed to reading the “prestigious” journals, such as the Journal of Bone & Joint Surgery and the Journal of the AAOS. However, the subscription fees for subspecialty journals are very expensive, and per-article fees typically range from $25 to $40. These and other factors increasingly drive readers to open access journals. While there are some terrific open access journals, many of these titles are new and less familiar. Recognizing quality science from the increasing sea of “background noise” has become difficult with the rise of predatory journals.

In part two of this editorial, we will examine the negative impacts of these journals and some “tells” to differentiate legitimate from predatory publishers.

Eeric Truumees, MD, is the chair of the AAOS Now Editorial Board; editor-in-chief of AAOS Now; and an orthopaedic spine surgeon in Austin, Texas, where he is also professor of orthopaedics at the Dell Medical School, University of Texas.