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Table of Contents    
Year : 2015  |  Volume : 63  |  Issue : 5  |  Page : 807-808

Are Indian neuroscience clinicians perishing without publishing?

Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

Date of Web Publication6-Oct-2015

Correspondence Address:
George C Vilanilam
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.166564

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How to cite this article:
Vilanilam GC, Sudhir B J, Kumar K K, Abraham MA, Nair SN. Are Indian neuroscience clinicians perishing without publishing?. Neurol India 2015;63:807-8

How to cite this URL:
Vilanilam GC, Sudhir B J, Kumar K K, Abraham MA, Nair SN. Are Indian neuroscience clinicians perishing without publishing?. Neurol India [serial online] 2015 [cited 2020 Mar 28];63:807-8. Available from:


We applaud the Herculean efforts of V.S. Madhugiri who in his article quantifies the 5 year research and publication output of Indian neuroscience institutes and uses it as a measure for assessing and accrediting clinical training in neurosciences.[1] Madhugiri's work is a laudable attempt at “scientometry”in Indian neurosciences, which is the evaluation of progress in science by measuring individual or institutional contributions to science using indicators such as publication volume and citation frequency.It is a traditional belief that busy medical practitioners seldom have time for academic pursuits.But times are changing and the borders that divide a clinician/surgeon from a researcher/scientist are fast getting blurred. In a “resource challenged”nation like ours, a clinical neuroscience practitioner (neurologist/neurosurgeon) needs to critically balance his “clinical”responsibilities with his academic research pursuits[2] to stay afloat and not perish in a “scientometric”world.[3] While competing with the “crème de la crème”on a global platform, Indian neuroscience practitioners often do not measure up despite supreme clinical skills and surgical talent due to “scientometric deficiencies.“

Fallacies of citation performance and “h”index

Citation based scientometry assumes that authors cite references with the sole motivation of “giving credit where it is rightfully due.”But the reasons for citation of articles are varied and not often related to the scientific content or clinical impact. The citers' behavior and their motivations are complex.[3],[4] The citers' behavior depends on his/her ability to comprehend and appreciate another researcher's work. Review articles and research done in “fashionable subspecialities”attract more citations. The citation behavior of researchers, length of the article, reputation of the institute/researcher, accessibility of articles, errors in citation counting, publication frequency, field of research, changing research paradigms, limitations of the science citation index database, nationality and language barriers, publication lag etc., can all influence citations. Sponsored studies and planned releases that often leave a “citation trail”can falsely inflate citations.[3]

The h-index of Hirsch[3] has a drawback in that it keeps increasing even if the researcher has stopped publishing significant papers. The “age-decaying h-index“ (contemporary h-index)<Superscript_Italic> </Superscript_Italic>corrects this drawback and identifies researchers who have a very significant output during the current period.[4],[5]


As prestige and power in the scientometric world depends on the impact factor and citations, it has been abused and manipulated. Hence, López-Cózar aptly coined the term “impactitis,”describing the altered behaviour of researchers to boost impact factors like inflated self-citations, omitting citation of rival researchers (“citation amnesia”), forming unholy alliances with other researchers to boost each other's impact factor, multiple publications (“auto-plagiarism”), divided publication, etc.[6]

Surprisingly, fraudulent research in anesthesia that has been retracted by high impact journals continues to be cited at least for the ethical aspect and has a high citation index.[7],[8] A recent surge in ethical concerns has made the “ethics clearance”in some institutions a long drawn process even for “low ethical concern”retrospective studies. These institutes with stringent ethical protocols can be left far behind in the “citation rat race.”

Pareto's economic principle that “80% of the world's wealth is owned by 20% of the people”could be extrapolated to an institution's scientific publication profile also. Hence, low performers in “highly ranked”institutions could piggy-back on the high achievements of “the publication stalwarts”and continue to remain relevant. Also, lopsided development of certain subspecialities with subsequent high impact publications could rank an institution higher, despite “unwholesome”resident training that is deficient in the less developed subspecialities.

“Paralysis by analysis”

The basic aim of clinical research is to establish higher “standards of care”and enhance “practice parameters.”However, when research is done purely with the intent of enhancing “scientometric measures,”the basic purpose of research is defeated. A plethora of data and research findings that do not have meaningful research lessons could cause the phenomenon of “paralysis by analysis,”which is the state of over-analysis of a research output so that a decision or action is never taken.

Other tangible measures to assess clinical output

Basic scientists and full-time researchers devote almost 100% of their work time to research and its scientific publication output. On the other hand, a neurosurgeon needs to balance his time between outpatient clinics, operating rooms, bedside clinics, ward rounds, seminars, journal clubs and research.2 Time spent on basic/clinical research by clinicians varies from 10% (in resource challenged nations) to nearly 80% (in developed countries).There are hardly any tangible measures to assess the clinical output, that is, the volume of patients treated, complexity of surgeries performed, time spent in discussions with patients/relatives, etc. Certain measures have been proposed like the v-index which take the proportion of time spent in research also into consideration. Such a comparison of the v-index suggests that acclaimed academic surgeons could also have “scientometric measures”comparable to Nobel laureates, provided a correction factor is added for time spent in clinical work.[5]

A surgical intervention today may save one life while the lessons learned from research may save many tomorrow. Hence, clinicians in India need to be given some time off from clinical work to focus on asking and solving basic questions in clinical sciences. But equipoise is essential else hospitals in the future would be replete with “well-published”stalwarts devoid of compassion, empathy, clinical skill and surgical expertise.

Thus, Madhugiri's seminal work is an exhortation to Indian neuroscience practitioners to develop a “culture of research”amidst the cacophony of overbearing clinical responsibilities. Nevertheless, citation dependent scientometry and assigning credentials to clinical institutions based on this parameter alone should be tempered with a touch of common sense and caution.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Madhugiri VS. Publication performance and research output of Neurology and Neurosurgery training institutes in India: A 5-year analysis. Neurol India 2015;63:338-46.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Kak V. Neurosciences education: From 'Gurukul' to e-learning. Neurol India 2015;63:298-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Kumar M. The import of the impact factor: Fallacies of citation dependent scientometry. Ann R Coll Surg Engl 2010;92 Suppl: 26-30.  Back to cited text no. 3
Glänzel W, Thijs B. Does co-authorship inflate the share of self-citations? Scientometrics 2004;61:395-404, 41.  Back to cited text no. 4
Vaidya JS. V-index: A fairer index to quantify an individual's research output capacity. Reforming research in the NHS. Br Med J 2005;331:1339-c-1340-c.  Back to cited text no. 5
López-Cózar ED. Impact of the impact factor in Spain. Br Med J 2007;334:561-4.  Back to cited text no. 6
Boldt J, Suttner S, Brosch C, Lehmann A, Röhm K, Mengistu A. Cardiopulmonary bypass priming using a high dose of a balanced hydroxyethyl starch versus an albumin-based priming strategy. Anesth Analg 2010;109:1752-62.  Back to cited text no. 7
Reuben SS, Connelly NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg 2000;91:1221-5.  Back to cited text no. 8


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