An orthopedist asked me if I could explain why a couple of papers of his did not generate any feedback. He wasn’t even certain that anyone had read them. He enclosed PDFs for me.

Not being an orthopedist, I cannot comment on their validity.

But I think I can explain why the papers have not created much interest.

Are you familiar with the term “impact factor”? If not here is a link explaining what it is:

A journal’s impact factor is an indication of how widely cited its articles are. One can also assume that it is a good indication of how popular the journal is and by inference, how many people read its papers. The impact factor has been criticized, but it is one of the few measures of a journal’s influence.

The two papers in question were published in Orthopaedics & Traumatology: Surgery & Research. A list of the top 40 orthopedic journals ranked by impact factor in 2013 showed that it ranked 39th with an impact factor of 1.168. [link] That means the average number of citations for any paper published in OTSR was about 1, and 38 orthopedic journals were more widely cited than OTSR.

Some search engines (eg, Google Scholar) give the number of times that a paper has been cited and by whom. But a recent article claims that that 90% of published papers are never cited, and 50% are never read by anyone but the authors and the journals’ peer reviewers. That assertion can’t be verified, but it is probably close to the truth.

I was unable to obtain any figures regarding the number of subscribers to OTSR, but I suspect it is not large. This may also account for the lack of responses to the papers. My own experience is similar. It was very rare to receive any comments about any of the over 90 peer-reviewed papers, editorials, or reviews that I wrote.

You may find this interesting. A blog post of mine “Appendicitis: Diagnosis, CT Scans and Reality” which I wrote 4½ years ago has received over 30,000 page views and more than 100 comments. I am certain both numbers are far more than all of my published research papers combined. In fact, my 600 blog posts have recorded over 1 million page views.

What does this all mean?

Journals will have to adapt and become more like blogs. In the future, medical information may be disseminated by blogs and comments rather than journal articles and letters to the editor.

Someday, scientists’ CVs may be valued for the number of page views they receive rather than the number of peer-reviewed papers they have published.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at and tweets as @SkepticScalpel.