360 climbs a mountain

I have just had the most incredible experience. Could there ever be a better event for an Editor-in-Chief? There I was, halfway up an Alpine mountain, the sun scorching the back of my neck. And there it was. Yes, it, it, it. In the side of a fellow mountaineer’s rucksack, strapped in by the buckles that are normally used for walking poles, was a tightly rolled copy of, wait for it… Bone & Joint³⁶⁰. I could barely believe my eyes. Of course, its owner was walking fast and I was walking slowly and my camera was down in the valley, but that is not the point. He was past and away before I could holler but my spirits lifted, the dull ache in my knees disappeared, and I half skipped, half stumbled to find mobile reception so that I could tell London. You see, this is why 360 exists. For the snapshot easy read of the key global orthopaedic literature. Yet even I had not imagined it would find its way into a rucksack and certainly not halfway up an Alp. But it did, and it was and I am delighted.

A huge amount has happened since the last issue of 360, including an incredible response to the publication at the EFORT meeting in Berlin. Those who were there will remember the near crowd control that was required at the Journal stand. More than 500 of you visited in less than a few hours. It was excellent to see so many new faces and many old friends, too. Thank you all for your support. In these days when publishing is taking such a knock, 360 is bucking the trend. Long may it remain that way.

Then there has been the US Supreme Court support for the Patient Protection and Affordable Care Act, so-called Obamacare. Allan Mishra from California has written a most thoughtful letter on the topic, which you will find within these pages. Indeed, you will find views on all manner of issues in our Mail³⁶⁰ pages, from Hong Kong, Australia, the US and UK.

The UK is 360 ‘s homeland, and over here hospitals have started to go broke. I was astonished to learn that our healthcare costs might rise to 52.5% of GDP by 2100 if allowed to grow unfettered. Basically, we are living too long, our rocketing population being a feature of reduced deaths rather than increased births. There is nothing special about the UK. Our costs roughly parallel those seen throughout the OECD. It is statistics like these that encourage all our governments to annoyingly tinker.

Part of an Editor-in-Chief’s job is to keep up to date with what topics are in the news and attracting the most orthopaedic attention. Near the top of the list presently is viscosupplementation for OA of the knee, where a large meta-analysis from Switzerland has suggested this has a clinically irrelevant benefit and an increased risk for serious adverse events.¹ Oh dear. Meanwhile, metal-on-metal is also still hitting the headlines as yet another prosthesis is banned from our use. The US Food and Drug Administration (FDA) have issued at least 145 orders for post-marketing surveillance to 21 manufacturers of metal-on-metal hips, which is not a good sign. Yet what is the topic of greatest interest to orthopaedic surgeons globally today? If my sources are correct, and I have no reason to doubt them, it is not joint replacement or back pain or tumours or DDH. It is not even metal-on-metal. It is barefoot running,² something I have tried only once and have regretted ever since. Clearly I will have to try again.

But with all this research being undertaken globally, can we trust what we read? Enter at this point our August Feature articles. Both have frightened me. Research fraud is a huge problem and is often swept under the carpet. Believe me, when an accusation is made to an editor that a paper is fraudulent, a long and uphill task begins to either clear the innocent or prove the case. Our two Feature authors have looked at the problem from different perspectives. Harvey Marcovitch writes brilliantly, was the editor of a major paediatric journal and the chairman of the Committee on Publication Ethics (COPE), one of the first ports of call for any editor who is faced with a claim of fraud. Then there is Shanmuganathan Rajasekaran from India’s Coimbatore. Raja, as we know him, is an orthopaedic household name and heads up one of the most research-productive units in the land. He writes fantastically well, too, and tells us of the realities of ‘Publish or Perish’ and why, perhaps, some might be tempted to fabricate, falsify, plagiarise or frankly lie. Do read these Features. If you are not open-mouthed in astonishment by the time you have finished, I salute you.

So enjoy this issue of 360. It has taken much effort to prepare. And if you are headed to the Alpine mountains, roll your issue up tightly and stick it in the side of your pack. You might just motor past a struggling Editor-in-Chief and you will, I promise, make his day.

My very best wishes to you all.