Something New Under the Sun: Farewell from the Founding Editor

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Critical Care Explorations www.ccejournal.org 1
DOI: 10.1097/CCE.0000000000001180
Copyright © 2024 The Authors.
Published by Wolters Kluwer Health,
Inc. on behalf of the Society of
Critical Care Medicine.
Timothy G. Buchman, PhD, MD,
MCCM
FOREWORD
Something New Under the Sun:
Farewell from the Founding Editor
When I want to understand what is happening today or try to decide
what will happen tomorrow, I look back.— Omar Khayyam
As I conclude my tenure as the Founding Editor of Critical Care
Explorations, I write to share my perspective on the journal and the
broader eld of medical journalism.
A LOOK BACK ON THE JOURNAL
e concept of open access for a major medical publication was not new. In
1997, the Journal of Clinical Investigation (JCI) not only created a homepage
on the emerging “World Wide Web” but also made its entire content freely ac-
cessible. Ajit Varki, the Editor of JCI, wrote: “e pressing issue of the time is
how to properly charge users for this electronic access. e nonprot nature of
JCI allows consideration of a truly novel solution—not charging anyone at all!
Whether this will be nancially sustainable remains to be seen” (1).
Over the next two decades, many medical and professional societies adopted
dierent strategies. Some created open-access journals funded primarily by
page charges. Others, including the Society of Critical Care Medicine (SCCM),
oered hybrid journals that allowed authors to opt for open access beyond the
journal’s subscribers by paying additional fees. Still, others, such as the Public
Library of Science, emerged as entirely open-access publication groups based
on an article processing charge model.
In 2018, SCCM’s Governing Council called for the rapid development and
launch of the society’s rst fully open-access journal. e stimulus was Plan S,
a radical open-access initiative from Europe that was perceived as an existen-
tial threat to subscription-based journals. Plan S, as initially conceived, would
have prohibited European investigators funded by 11 major agencies from pub-
lishing in subscription or hybrid journals (2). SCCM greenlit the new journal
in preparation for that potential shi. Development, prototyping, and initial
production were completed in just four months. Critical Care Explorations
began publishing under the theme “Exploring the Endless Frontier” in January
2019, and it was unveiled to SCCM’s members the next month during the an-
nual Clinical Congress in San Diego (3) (Fig. 1).
All of this was accomplished in record time through close collaboration be-
tween the SCCM Chicago oce professionals and our publisher, Wolters Kluwer
(WK). While there have been changes in personnel over the years, most of the
individuals recognized here were present at the journal’s inception. Sophie Tosta
and her dedicated team—Sarah Less, Madison Drake, and Brooke Kittle—manage
the day-to-day operations. Katie Brobst directs Publications and Global Health
for the Society. Lynn Retford, SCCM’s Executive Director, partnered with me in
the journal’s conception and inception, and Jeremy Nielsen, Associate Director,
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Buchman
2 www.ccejournal.org December 2024 • Volume 6 • Number 12
added strategic direction under the Society’s leadership
of EVP/CEO David Martin. Publishers Druanne Martin
and Ryan Shaw, along with the WK production team led
by Christopher Baeuerlein, oversee the entire process—
from copyediting to rapid posting and the generation
of complete issues on our website, https://ccejournal.
org. We—authors, editors, reviewers, and readers—owe
them our gratitude.
Here are some measures of our extraordinary success:
More than 3,000 initial submissions have been received,
and over 1,100 have been published in the past 68 months.
e journal is now fully indexed in MEDLINE, PubMed
Central, Web of Science (ESCI), and Scopus. According to
Scopus’s CiteScore in 2024, the journal ranked in the top
quartile of critical care journals (4). is success is largely
due to the hard work of our editorial board—including
all our Associate and Special Editors—and our reviewers.
eir peer review creates the journal’s essential value, a
value that is now being reshaped by a new force: articial
and augmented intelligence.
A LOOK BACK ON PEER REVIEW: ITS
DEVELOPMENT AND VALUE
In his brief history of peer review in 18th-century sci-
entic journalism, David Kronick noted that “peer re-
view…is an essential and integral part of the process of
consensus-building and is inherent and necessary to the
growth of scientic knowledge” (5). e modern history
of peer review is complex, but Drummond Rennie’s 2003
summary captures its essence (6). He posed the ques-
tion: “Editorial peer review, however, is arduous, expen-
sive, oen slow, and subject to all sorts of bias, so why is
there almost universal acceptance of its necessity?”
Rennie oers three reasons: First, editors who
are ultimately responsible for what is published are
Figure 1. Launch of Critical Care Explorations at the 2019 Clinical Congress in San Diego, California.

Foreword
Critical Care Explorations www.ccejournal.org 3
reassured by the expert eyes reviewing the work.
Science is built on theory, and theory is oen proven
wrong. Having experts endorse the work before pub-
lication oers comfort. Second, reviewers appreciate
being part of the process. ey see new ideas before
they are available to the general public and weigh in
on whether the ideas are worth the risk and expense of
publication. ird, readers—without whom no journal
can exist—are reassured that the work they are reading
is “true” in the sense that it can be reproduced under
similar conditions. e skepticism inherent in peer re-
view exposes unsupported claims and forces authors to
acknowledge competing theories and data.
Implicit in these histories is the notion that science
is a human endeavor. Peer review brings essential value
to medical journalism and ensures that what is pub-
lished is generally reliable. While experiments, data,
and analyses are not perfect, peer review exposes the
most visible limitations, correcting what can be cor-
rected and acknowledging what cannot.
THE RISE OF ARTIFICIAL
INTELLIGENCE
e rst application of articial intelligence (AI) in
medical practice, the MYCIN program, aimed to select
optimal antibiotic therapy for sepsis patients by mod-
eling the so logic used by clinicians and acknowledg-
ing uncertainty within 600 rules (7). is early AI was
fully transparent, with explicitly dened rules, and
depended on clinicians’ condence in the inputs.
Earlier, Pitts and McCulloch had begun formally
modeling the human brain—or more specically, the
neuron (8). Networks of articial neurons were trained
to recognize patterns that were dicult to encode with
simple logic.
Combining these ideas—using AI to recognize di-
sease patterns and healthcare utilization without ex-
plicit knowledge of the rules—became an irresistible
concept. ree decades ago, the rst two articles apply-
ing neural networks to critical care appeared in Critical
Care Medicine. One aimed to predict liberation from
mechanical ventilation, and the other sought to predict
ICU length of stay (9, 10). ese eorts survived peer
review because the data and methods used to train the
networks were available for reviewers upon request.
AI in healthcare grew slowly, with access to data as
the limiting factor. Roger Mark and his colleagues at
Beth Israel Deaconess Medical Center recognized that
decision-support systems depended on large-scale
ICU patient data. eir MIMIC (Multi-parameter
Intelligent Monitoring for Intensive Care) database,
now in its fourth version, has generated thousands of
studies on AI’s potential to recognize clinical patterns
and forecast patient outcomes (11).
As access to data and AI modeling tools improved,
the number of critical care AI investigations increased.
However, many submissions to professional journals
were little more than theoretical constructs, oen lack-
ing temporal stability, generalizability, or clinical rele-
vance. When authors were informed that implementing
and testing their models in their own environments was
expected, submissions declined sharply. If authors had
little condence or interest in deploying their creations
in their own hospitals, why should others?
PRESENT DAY
AI has evolved far beyond model creation. With the
rise of generative AI in large language models, AI is
now used to write text, analyze data, identify relevant
references, and even respond to peer-review critiques.
Authors are eectively outsourcing their responsibili-
ties to machines whose behaviors they neither assess
nor control. e SCCM journal family has established
clear guidelines on the fair use of AI by authors and
reviewers (12).
Should editors also embrace AI to automate their
tasks? Howard Bauchner and Frederick P. Rivara re-
cently argued that AI will inevitably become part of
the editorial process and should be embraced to screen
submissions for quality and originality (13). ey
concluded, “Rather than avoiding AI, editors should
embrace it, ensuring its performance is rigorously
evaluated to reassure authors of fairness.”
As AI increasingly handles these tasks, peer review
risks becoming a process of AI critiquing AI. is
poses a fundamental issue: technology is not science.
If humans are removed from critical processes such as
experimentation, analysis, and conclusion, we take on
new risks. AI can hallucinate, distort, and homogenize
its worldview. While social media may tolerate mis-
representations, scientic journals cannot aord such
lapses.
e intersection of AI and healthcare is inevitable,
and the combined inuence of these industries is

Buchman
4 www.ccejournal.org December 2024 • Volume 6 • Number 12
shaping our professional lives. e essential value of
a professional journal lies in meaningful peer review,
and we editors must maintain this integrity, ensuring
that what we publish will stand the test of time.
CODA
ree thousand years ago, the author of Ecclesiastes
wrote, “ere is nothing new under the sun”
(Ecclesiastes 1:9). Yet, articial intelligence is indeed
new—a human creation that is evolving at a pace that
challenges our understanding. While we cannot es-
cape AI, the question remains whether we can control
it wisely.
Ecclesiastes 3:1 reminds us that “there is a time for
everything, and a season for every activity under the
heavens.” To this wisdom, I add that there is a time to
become an editor and a time to step down. It has been
my privilege to serve as this journal’s founding editor,
and it is my greater privilege to pass this responsibility
to Dr. Tamas Szakmany. May he and his teams of edi-
tors and reviewers guide us all toward new knowledge.
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4. Scopus Cite Score: 2023. Available at: https://www.scopus.
com/sourceid/21101092741. Accessed September 25,
2024
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