The Skeptical Scalpel Presents The Kergin Lecture

Frederick Gordon Kergin Frederick Gordon Kergin was born at Port Simpson in British Columbia in 1907. He began his studies at the University of Toronto at age sixteen and graduated from the Biology and Medical Sciences program in 1927. In 1931, Kergin became a Rhodes Scholar and spent the next two years at Oxford University earning a master’s degree in physiology and anatomy, graduating with first-class honours. In 1934, he began the four-year Gallie Course in surgery at TGH and obtained the fellowship of the Royal College of Surgeons of England in 1935 and that of the Royal College of Physicians and Surgeons of Canada in 1939. In 1937, he joined the surgical staff of Toronto General Hospital and later took the role as the Chair of the Department of Surgery of the University of Toronto and Surgeon-in-Chief of the Toronto General Hospital from 1957 to 1966. He was a pioneer of thoracic surgery in Canada and served as President of the American Association for Thoracic Surgery. In 1966 he was appointed Associate Dean in the Faculty of Medicine and was responsible for developing a new undergraduate curriculum and planning the conversion of Sunnybrook Hospital to a teaching institution with full-time faculty. Dr. Kergin chaired the editorial board of the Canadian Journal of Surgery for many years and served as a trustee of the R.S. McLaughlin Foundation. His major contribution to the University was in education, particularly in structuring the residency programs such that an integrated program amongst all fully affiliated hospitals was established. He died in 1974. Professor Kergin was a man with eclectic interests that included teaching, research and university administration, as well as many outside of medicine. ( http://livinghistory.med.utoronto.ca/people/frederick-gordon-kergin) (http://surgery.utoronto.ca/events/kergin-lecturers.htm)

Kergin Lecture Dinner- from left to right: David Urbach, James Rutka, John Semple, Skeptical Scalpel (anonymity protected), Tony Finelli, Martin Gargan, & Tom Forbes

The Skeptical Scalpel is a deliberately anonymous retired Chairman of Surgery and Residency Director who practiced as a surgical hospitalist and acute care surgeon prior to embarking on his current writing career. He says that tweeting is “like writing headlines”. His followers, including our recent guest lecturer Justin Dimick, describe his blogs as filters that provide interesting insight and knowledge without burdening the reader with the excessive amount of material published in the conventional surgical literature. Unofficially, he may be the most read surgeon-blogger on the internet. His blog averages over 1500 page views per day, and he has over 12,400 followers on Twitter.

“Skep”, as I will call him, told us that, when he did critical care as part of his surgical practice, “there were 25 journals in critical care alone!”. He is enthused about the effectiveness of social media for rapid information, but warned us about the problem of disinformation that can occur through the intervention of hackers. He illustrated the dynamic responsiveness of the media with a graph of the plunge in the Dow Jones industrial average, when a hacker circulated a false story that a bomb had exploded at the White House, injuring President Obama. When this was broadcast as a fraudulent associated press account, the Dow dramatically plunged, but rapidly recovered when the correction was posted.

Skep has 400 followers in Toronto alone – 57% of his followers are in the United States and 8% are in Canada, the rest are scattered throughout the world.

“Academic journals are the most profitable obsolete technology in history. Why do they stay alive? Elsevier, with a 36% profit margin had an income of £878,323. The reason it is so profitable is that we give the content free of charge, reviewers work free of charge, associate editors [like Skep himself] work for no salary. Only Editors-in-Chief receive salaries for most journals. Hindawi is an open access journal with an even larger annual income. Layton Rikkers’article in the Annals of Surgery in 2014 in volume 260(4):567-73 with Drummond Rennie critiqued peer-review as an inconsistent and slow process. “If it were a drug, the FDA would take it off the market”. The British Medical Journal has introduced rapid response as a post publication form of peer review that is more timely than the tedious letter to the editor technique. This is quite effective. The New England Journal took five months to correct an error. Bloggers, by contrast, can make corrections in days. University College London is putting all faculty publications online and quantifying the downloads, tweets, retweets and tails to estimate their impact.

“There are predatory publications that will publish anything, and accept fake articles by authors such as ‘IP Daily and Hug and Kiss’. They have bogus editorial boards, and hijack journal names.

The UofT’s Jocalyn Clark has written an article called How to avoid predatory journals? (http://blogs.bmj.com/bmj/2015/01/19/jocalyn-clark-how-to-avoid-predatory-journals-a-five-point-plan/) In fact, many articles are unread by anyone except the authors and peer-reviewers.” Skep’s article on the value of CT scanning for appendicitis got 30,000 blog reads, whereas he estimates that his entire published output in books and journals probably reached 100 or so readers.” He states that he turned out a lot of bad publications during his academic phase, only because the residency review committee wanted his department to publish. Pauline Chen of the New York Times is an active surgical blogger. Kevin MD, an anonymous medical blogger, accepts pretty much everything that is sent to him, if he judges it to be worth broadcasting.”

The Wall Street Journal asked “Should doctors and patients be Facebook friends?” Skep feels that Facebook is useless and dangerous, as the dental students at Dalhousie University learned to their lasting distress. The College of Dentistry has threatened that they may never get licensed because of their misogynistic statements on the web. In contrast, there are good blogging collaboratives on the web, particularly those devoted to hernias and bariatrics. Using a slide of a surgical textbook used as a doorstop, Skep asks “Why do we ask surgeons on exams what is in the books? We should ask them what they think.”

We now look at the net for movie reviews instead of magazines. Residents and others ask Skep for medical advice, though he is anonymous. He feels that the academic space is being steadily replaced from the outside by social media, analogous to the advent of laparoscopic cholecystectomy, introduced by Eddy Joe Reddick and Douglas Ole Olson outside the academic community.

In the question period, Skep was asked why he persists in anonymity. He answered that he started blogging when he was practicing and was concerned that patients would be confused when they would google him by name. His anonymous blog is now a brand, so he continues it for fun.

M.M.