Episode Transcript
[00:00:03] Speaker A: Welcome to the Ortho Joe Podcast, a joint production of the Journal of Bone and Joint Surgery and Ortho Evidence.
Join hosts Mohit Bhandari and Mark Swankowski as they discuss current topics and publications in the world of orthopedics and beyond.
[00:00:19] Speaker B: Welcome. Morning, Mo.
[00:00:20] Speaker C: Good morning. Good morning, Mark.
[00:00:23] Speaker B: I'm ready.
[00:00:24] Speaker C: Oh, you know what? I am without. I've had my. I couldn't wait. 9:30 for me is a late to start my coffee.
I've been a little more proactive this morning. I had a couple of cups and I'm. I'm done.
[00:00:37] Speaker B: Well, I, I just always enjoy the opportunity to show my loyalty to my. My Boston based colleagues who who are dyed in the wool DD loyalists. One time when I was in your position, I made the mistake of giving Starbucks gift cards and was nearly placed at the stake and set on fire by my dear colleagues at the Journal. So now I've got a. Duncan. I don't know whether we've discussed this or not, but less than a mile away from my house is the Dunkin Donuts here. Everywhere in Minnesota. Yeah.
[00:01:19] Speaker C: Wow. There you go.
[00:01:22] Speaker B: So, always great to see you and we have a very, very special guest with us today, our esteemed colleague and former editor in chief of JB JS Dr. James Heckman.
And Dr. Heckman served in this role from 2000 to 2009. And I was fortunate enough to be on his editorial board and we saw some wonderful changes in the. The Journal during Jim's tenure. And Jim, of course many people may not know this was an English major at an elite university in New Jersey and that uniquely gifted him as an editor who used a red pencil to correct English from. From unscholarly authors such as myself to make a extremely uniformly written journal.
And so the, the Princeton grad saved. Saved the Journal for at least a decade from luddites like like myself and Jim. Welcome to Ortho Joe, let me just start with a question.
When you took this position late 1999 or early 2000, you had a pretty strong gig going there in San Antonio and department head, a thriving department, doing really well.
What got into you to decide to pull up stakes and move to Boston to take on this position?
[00:03:04] Speaker D: Well, it's nice to be with you guys.
And I had been chair of the department. I'd been there 23 years and I had been. I, Charlie Brockwood recruited me to that position. And so he was my boss for 11 years and then I was his boss for 12 years.
And I figured if I couldn't do it right in 12 years. Then it was time for somebody else to take it over and do the chairmanship. In a small surgical discipline certainly is time limited because you run out of cards after a while and about the only thing you have left is to quit so that somebody else can come in and take your job and negotiate a new deal for the department.
And Charlie did that before and when he was the chair, originally it was a division and he used all of his cards to convert the division to a department.
But then after he became a department chair, he couldn't get anything more at all.
And so then it became my turn. And so then I knew that after 10 years of I had used up my chips and it was time to move on and do something else and turn that over to somebody else. And so I was very lucky, very fortunate that at that moment in time they were seeking a new editor of jbjs. And so it was a time to make a change. And it was something that I had always done and always been involved with the Journal in one way or another. And I thought this would be maybe a good opportunity. And I saw an opportunity to make some changes at JBJ that I thought might be good for the readership.
[00:04:48] Speaker B: Jim, you were the, the last editor to be both CEO and editor in chief. And there were a ton of pressures on the CEO side of things in, in those days. And may maybe you could just talk about the two jobs and how you're able to handle both of them as an orthopedic surgeon.
[00:05:10] Speaker D: Well, I think, yeah, there were two very different jobs and it became a full time opportunity. I spent one day a week doing clinical work at the Mass General, but for the most part I was there at the Journal every day working either running the business, and I had some good in house support.
Mady Tissenbaum was the general manager and she had been there forever and knew the ins and outs of the Journal better than anybody else. And so she was a great help and support to me in that transition. In fact, she'll tell you that she trained me in how to run the Journal.
But it was, I was given a lot of freedom by the board to make changes when I went there in 2000.
And actually my first day of work was Y2K.
I had no, I no idea whether when I got there that morning, the computers were going to be on or not.
And turned out it was a false alarm. And so we moved forward from there pretty pretty well. But the Journal had become kind of dry and kind of stodgy and in fact, it was called by many the Gray Journal because it had. Some of the people listening may remember, it had a gray cover with black print on the.
And that was it. And there was.
[00:06:36] Speaker C: There were.
[00:06:37] Speaker D: Very distinctly different from what Mo has done.
There's been a lot of transformation over the last 20 years. But, in fact, my predecessor, Harry Cowell, who ran that. The journal for 17 years before I got there, told me at one point along the way, near the end of his term, that they had made a major change in the COVID of the Journal.
And I got my next issue of the Journal in the mail, and I looked for that change. And I could not see any change in the COVID of the Gray Journal. And so I asked Harry the next time I saw him, Harry, for the life of me, I don't see any change.
And he said, well, we've gone to an electronic version. So this was 1997, 98, something like that. And he said, and we put a little logo, which was as big as the tip of my little finger on the spine of the Journal with a little E to indicate that there was a possibility to do this electronically. That was the change. And those were the kinds of changes that had been made prior to that time. So I had the opportunity to kind of re. Envision the whole thing. And Madi and I went to work on redesigning the COVID and adding a little color and adding the. The articles to the COVID of the Journal and then doing a lot of other things like that. So the board gave me the freedom to do that.
And we were, I think, successful. Most people like the changes that we saw we created. And then the other big thing that we did at that time, the other big part of the business of the Journal was that Richard Gilberman, who was then on our board, but also was president of the Academy, pushed very hard to secure a membership subscription to the Journal as a membership benefit for JBJS. And that assured us a subscription base of 18,000 subscribers.
And it was. That was a huge advantage for us. And we successfully negotiated that and then continued that throughout my term, which put the Journal on a really solid financial footing for a long time.
So it was.
It was new to me. My experience as a department chair previously was very helpful, and I. I learned how to deal with business issues of all sorts and. And wearing that hat. And so there was that. And then when I got frustrated with the business side of things, I could always go and do some editing and then make sure we got some good articles to publish every month. So it was. It was an very nice balance that I enjoy very much. I happen to have, I guess, enough of the right kind of skills to be able to pull it off for that 10 years. So it was a good time.
[00:09:33] Speaker C: You know, I remember, I remember, Jim, I would have been senior resident at the time. I remember the first issues coming out under your leadership. And I remember looking at it as, you know, literally, it's a dawn of a new age for the journal. It was like, as a resident, we were all, we were, we all noticed it. It was a big shift. I can't imag though that moving the direction that you did, as much as you state that you had the support, which is amazing, that the board supported these bold changes. But can you reflect back on some of the challenges you had in also moving the journal in the direction that you did, or was it as easy that everyone, just the community came along? Did you ever have any issues where you really had to reflect back on and think, okay, you know, was it the right thing to do? I think we're always faced with that, and I'm sure people are generally curious about how you made those things happen.
[00:10:31] Speaker D: Well, yeah, there were challenges. There were weaknesses that I saw in the, in the process that we were using. One of the. One of the major things I did administratively was convert from an imprint to an electronic version of the journal. So when I got there, there were like 50 manuscripts sitting on my desk waiting to be processed by hand and by mail. And we went through the whole process of making that manuscript processing system electronic. And so that was a big challenge, but that was really necessary at that time. It was what every other journal was doing. So I had good guidance about how to do that.
So that was a technical challenge, but nobody put up much resistance to it. I was badgered by some people to move the journal forward intellectually.
One of those people was your co host today who said, you know, we really need more evidence based medicine reported in the journal, and we need that as the basis for what we're doing in this journal. And so I got a very strong and robust education in evidence based medicine shortly after, after my arrival at the journal. And then we then took that on as a, as a challenge. And that was met with some resistance, particularly by the reviewers and some of the editors.
I only fired a couple of people in my 10 years there, and they were both kind of old, fusty old editors who didn't see the light with regard to publishing high quality evidence based material. And so that, that was a challenge to get over, get past that and get some brighter lights in arena to look at these manuscripts. I think, finally, the one challenge that I had, I still have today is having a clear understanding of methodology and statistics, and I have no background in that at all. And I, over the years, have grown to understand some of it, but it's really one of my substantial weaknesses.
And I realized at the time, about 2002, 2003, that rest of my team had about the same level of understanding and methodology and statistics that I did.
And so we decided at that point that we needed some experts, and we went out and hired a group of brilliant biostatisticians to add another level of review to every accepted manuscript.
So any manuscript that came through after 2003 was reviewed by a methodology and statistics expert. And some of those were rejected as simply on the basis of that. Many of the other manuscripts were made much better by adding that further step. And that was one of the, I think, one of the biggest contributions I made to the. To the review process in general.
[00:13:47] Speaker B: Yeah, Jim, I actually remember some of those interviews that you held with a fairly broad group of biostatisticians and epidemiologists and methods people.
I remember sitting in the room and listening to them present their background and experience and what they could bring to the journal.
And some of them actually confused me.
But you, you found a way to identify Jeff Katz as, as being a major leader. I just wonder how. How did you process that decision when all of the people that were presenting to us appeared to have, you know, equal kind of background, interest, skills, et cetera, Somehow you were able to identify this. This was the person.
So how, how's that go?
[00:14:38] Speaker D: He's a clinician, so I, I resonated with him better than some of the other people who, who sounded very bright and very talented, but whom I didn't understand, frankly, in those interviews. And, but, but Jeff was very down to earth and very clinically oriented. He's a rheumatologist.
When I, If I have a problem with somebody in orthopedics or musculoskeletal problem right now, I can call in Boston, I can call Jeff, and he'll see that person the next day.
And Jeff always maintained his clinical base and his clinical foundation. And so I think that, that, that's what resonate. Resonated well with me. And then he had a wonderful team with Elna and so forth. And so we had a. He had a wonderful team to rely on and was just more. Much more down to earth and practical as well as well informed. And so he, his, his decision and his decisions, his review, very practical and helpful then. So it turned out to be a right decision.
[00:15:45] Speaker B: Yeah, absolutely. Yeah. Jeff has just been great for several decades.
[00:15:54] Speaker C: Yeah, I mean I had the chance and the pleasure of interacting with him several times as well. And I think the thing that, that struck me, and I think you've articulated it perfectly, Jim, is that, you know, he had a way of taking a complex idea or has a way of taking a complex idea and being able to translate it to the audience that needs to hear that complex idea in a way that they can understand it. And sometimes we get lost functionally in translation when it comes to statistics and methodology. And that I guess gets me to the sort of a bridging question to you.
You know, the Journal of Born Joint Surgery and I suspect during your tenure and Mark, during your tenure you've had an abundance of, of reviewers who are interested in reviewing. How did you determine who the right reviewers were and higher level, what's a high quality review now because it is so complicated. Right. I mean we do have statistics and methodology, then we've got the clinical issues and then we have this decision around, you know, what the journal will ultimately want to publish. How did you work with that large pool of reviewers? And I guess this is for you, Jim, but also for you, Mark too. Just curiosity about managing the reviewer pool.
[00:17:05] Speaker D: Well, it's always.
You want to give as many new people a chance to get involved in the process as you can. So I think there has to be, it has to be open ended to begin with. So there's an open door where a bright young person who is interested and can, can try out and see how they do and if they're talented then they'll do more.
I have to.
I got started in this business because I initially started reviewing for a throwaway journal which would remain nameless, but which after about a year and a half notified, called me. The manager called me one day and said are you going to go to the Academy meeting this year? This was the late 70s.
I said yeah, I'm planning on going so. Well, good, because we're going to give you an award as our best reviewer.
And I said, wow, that's great. I really appreciate that. And so I went and received this accolade and a certificate and plaque and all this stuff. And I then I asked the very naive question, why did I get this award? Why was I your best reviewer? They said because you turned it around faster than anybody else.
And I used these, these manuscripts would come in and hit My inbox in the morning mail and I would have a cheeseburger at my desk between cases and I'd pull that thing off and I look at it and I'd scribble a few notes on it and my secretary would type it up and return it that afternoon.
And so no quality control whatsoever. But I was quick.
So I thought there's probably more to this than just being fast. Although being timely is extremely important.
So that, that's, that was certainly one factor. But I.
You give people a chance. A guy like Kano Okiki, who was a resident when I was in Boston, was a resident at Harvard and he took a lot of interest in the Journal club activity, which I staff for 10 years every once a month and kind of was always there and very energetic and enthusiastic. And he got to do some reviews as a resident, did well and done well and has continued now right up the. Up the track. So there are people who are generally provide constructive criticism probably is the best term. There are people who love to tear apart things and be negative and critical and nasty. And those people never survive very well in my review system. But people who provided good, solid, constructive, timely criticism that would be useful to the readers or to the authors and then would provide a better manuscript for the readers. So those are the ones that I tended to lean on over the years. And that created a pool which was reliable and consistent and I think provided a pretty high quality journal.
[00:20:23] Speaker B: Yeah, Mo, I would have the same criteria as Jim because I work for Jim. So Jim always has very clear standards and communicates them in a very succinct and clear fashion. So. But one thing I would point out is that the journal remains in the very unique position of having more people that want to review than we need. And that is unique in the world of orthopedics and in medicine in general.
Most journals struggle to get people to do good quality reviews. That's never been our problem.
So the emphasis on giving younger people who are in an academic mindset and academic track a chance to shine with those features of timeliness and construction and well thought out reviews, it's just, it's just a real.
The thing we need to emphasize and we're really privileged to have that at the journal.
But Jim, what. What would you say of your decade that you're the most proud of with things that you initiated and fostered at the journal?
[00:21:34] Speaker D: I think things. A couple things we've talked about already, I think moving it to a more evidence based approach as far as. As that's possible, which is not all that far yet in orthopedics was a major step and one that I'm very proud of.
And I think that said that with the rigorous review process which I think with the, with the biostatistical extra review makes it unique among orthopedic journals, as far as I know. I don't know that there's any other journal that's.
To today that's doing that on a routine and consistent basis. So I think the extremely high quality of manuscripts that were produced consistently over the years enabled us to advance the field.
And there were several articles that we did publish over the years that I think changed the practice of orthopedics in a positive way.
And I think we avoided.
Avoided harm as far as I know and kept a lot of trash out of the orthopedic literature. Although it didn't get stay out of the literature.
Most of that stuff gets published somewhere. But at least we didn't publish some of the poorer quality studies.
So that rigorous review process is the thing that probably stands out. And that's, I mean excellence through peer review seemed to be the theme that we pursued for the time I was there. That's probably the phrase that resonates best with me still to this day.
[00:23:21] Speaker B: Well, you were the person that put that on the COVID if I'm not mistaken.
[00:23:25] Speaker D: That's right. That's right. I did.
Yeah. And that's, that was, that was our modus operandi for the, the time I was there. So that, that certainly stands out as the thing I was most proud of, I'm sure.
[00:23:40] Speaker B: Yeah.
[00:23:42] Speaker C: Well, maybe, maybe I'll. I'll ask a final question mark if I could. As you look to where we've come and where we're going, Jim, you must have lots of thoughts, probably more than we have time to share today because we're, we could always spend another whole session on that with you and maybe we should. But when you look at sort of just the, the, the world state with AI coming in with a pressure for all of us to, to provide shorter snippets and attention spans being decreased, where do you think publishing is headed?
Well, and I don't know and I'm asking because I generally don't know. Like I, I suspect you might have some thoughts on that.
[00:24:24] Speaker D: I'm not sure it I.
The forms that it's taking like this, like podcasts and so forth are useful ways of communicating information.
I think that, I guess the, the biggest fear that I have is that it's unfiltered and that this Review. The review process or peer review process is so essential to providing quality information.
And that's, that's what worries me the most. If there are going to be outlets and opportunities for people to access information that have not undergone review like this, and, and then they're going to, they're going to be wooed or sold a bill of goods that, for somebody who's just trying to make a quick buck or something like that, and that really, that really worries me a lot.
So I think it's incumbent upon the JBJs and the other high level orthopedic journalists to hold to a standard of excellence that will still assure the reader that what they are reading is something that they can rely upon to affect their practice in one way or another, either to advance their skills, how they deliver care to patients. But I don't envy you. I don't envy you at all now. And soon after I left, during Mark's tenure, there were radical changes in the process, the mechanics of information delivery. And those are. That's still changing. And I'm not sure I have good answers. I'm kind of glad I was editor when I was editor.
[00:26:09] Speaker C: Yeah, it's a different time. But yes, I think we all share your concerns and maybe there's optimism at the end of all this as well.
[00:26:17] Speaker D: Here's a guy who had a lot of concerns about some of that information transfer too. And that's my cup of joe to you and Dr. Fauci's quizzical concern about the way things were being handled a few years ago. I have a lot of the same concerns he expressed, I think.
[00:26:38] Speaker B: Yeah, fair enough.
[00:26:42] Speaker C: Well, I would like to personally just thank you for taking a bit of time with us and sharing those insights. I think it's really important that our readers, many, many, many who are taking on JBGs for the first time sometimes, you know, as they're coming into residency, they understand the history and the importance of the leadership that shaped that history. So thank you so much, Dr. Heckman, for taking a bit of time with us.
[00:27:02] Speaker D: Well, thanks. I enjoy being with you guys. Good luck.
[00:27:06] Speaker B: Thank you. Thanks, Jim.
[00:27:08] Speaker D: Yeah, bye.
[00:27:10] Speaker C: Bye, Sam.
