Perspective - Global Neurosurgery
Commentary on:
A Bibliographic Analysis of the Most Cited
Articles in Global Neurosurgery by M. Niquen-
Jimenez et al. World Neurosurg 2020
https://doi.org/10.1016/j.wneu.2020.08.084
Publish or Perish? Publish and Perish? Global Neurosurgery in the COVID-19 Pandemic
Era
Russell J. Andrews
T he phrase “publish or perish” is nearly as old as organized
neurosurgery: It first appeared in the journal Sociology
and Social Research in 1927.1 More recently (since 2007):
“Publish or Perish is a software program that retrieves and
analyzes academic citations . Publish or Perish is designed to
empower individual academics to present their case for
research impact to its best advantage.”2
In a recent Perspective, the case was made for the dramatic in-
crease over the past few years in the use of the term “Global
Neurosurgery” being the result of “Big Data” and “AI” (artificial
intelligence)—terms that are 21st century in application, if not
entirely so in origin.3 In this Perspective, the case is made that the
term “Global Neurosurgery” is in danger of impeding actual
progress toward the primary purpose of the Global Neurosurgery
movement: “delivering timely, safe, and affordable neurosurgical
care to all who need it.”4
A PubMed search using the term “(neurosurgery[Title/Abstract])
AND (bibliographic[Title/Abstract])” on July 13, 2020 revealed 13
results (all published between 2000 and 2020). The majority were
bibliographic searches on topics ranging from cerebrospinal fluid
leak to traumatic brain injury to helmet legislation to spine dis-
ease. These searches typically reported either the top-cited arti-
cles or all articles when the inclusion criteria resulted in only a
handful of articles (fewer than 10).
The COVID-19 pandemic has dramatically reduced in-person
collaboration in all spheres, including neurosurgery worldwide.
This has increased the use of the Internet and virtual collabora-
tion (e.g., virtual conferences and webinars). The pandemic
Key words Abbreviations and Acronyms
- Global neurosurgery HIC: High-income countries
- Global surgery LMIC: Low- and middle-income
- Neurosurgery countries
WORLD NEUROSURGERY 145: 45-47, JANUARY 2021
precludes in-person Global Neurosurgery activities such as ex-
changes (twinning or dyad programs) and neurosurgical mis-
sions. Given the increased time available from the reduction of
both neurotrauma cases and elective procedures, it is not sur-
prising that “socially distanced” methods such as bibliographic
analyses provide material for publications. An important question
is the purpose of such publications and their benefit for Global
Neurosurgery’s “primary purpose of delivering timely, safe, and
affordable neurosurgical care to all who need it.”4
In “A Bibliographic Analysis of the Most Cited Articles in Global
Neurosurgery,” Niquen-Jimenez et al5 present a wealth of
information regarding publications relating to “Global
Neurosurgery.” Of the 17 articles meeting their criteria, they
found 1) only 15% of the authors were from or affiliated with a
low- or middle-income country (LMIC); 2) only 2 of the articles
were collaborations between institutions from high-income
countries (HICs) and LMICs. The authors correctly note they
may have missed important articles 1) by excluding articles that
did not have more than 5 citations; 2) by using only the Web of
Science database; and 3) by their search term strategy. Indeed, in
the earlier Perspective it was argued that the term “Global
Neurosurgery” has become a recent “buzzword”—and that
important articles have been published for decades addressing
the “primary purpose of delivering timely, safe, and affordable
neurosurgical care to all who need it.”3,4
PUBLISH AND PERISH
As Niquen-Jimenez et al5 indicated, an article that does not
include the phrase “Global Neurosurgery” may be overlooked.
NASA Ames Research Center, Nanotechnology & Smart Systems, Los Gatos, California, USA
To whom correspondence should be addressed: Russell J. Andrews, M.D.
[E-mail: rja@russelljandrews.org]
Citation: World Neurosurg. (2021) 145:45-47.
https://doi.org/10.1016/j.wneu.2020.09.018
www.journals.elsevier.com/world-neurosurgery 45
PERSPECTIVE - GLOBAL NEUROSURGERY
Additionally, the use of number of citations and journal impact
factor as criteria for an article’s value or importance has been
questioned recently.6,7 There may be more impact on
improving neurosurgical care in LMICs by publishing in a journal
that is more likely to be read by health care administrators in
LMICs than WORLD NEUROSURGERY or Journal of Neurosurgery
(e.g., a World Health Organization publication or Health Policy
and Planning).8
If the term “Global Neurosurgery” achieves the status of a cult or
a tradition (as may be the case already), another serious concern
is that publications including the term “Global Neurosurgery” will
be interpreted as having achieved the “primary purpose of
delivering timely, safe, and affordable neurosurgical care to all
who need it,” when in fact such publications may merely be
defining the problem in more detail, rather than proposing or
documenting actual solutions. The energy that might be devoted
to creating and implementing solutions to the need for more
global neurosurgery resources is instead spent on efforts that
benefit the curriculum vitae of the author(s) of those publications
more than it benefits those in underserved regions of the world.
In short: the authors “publish,” while those who lack neurosur-
gical care worldwide “perish.”
To their credit, Niquen-Jimenez et al5 address the need for action
and documentation in their discussion. The last article they
reference (by Haglund and Fuller) also addresses this need for
action, as well as documentation.9
GLOBAL NEUROSURGERY 2020 TO 2030—LET US PUBLISH BUT
NOT PERISH!
How can publications in the era of the COVID-19 pandemic
benefit both the authors and those who need (but do not yet
have) “timely, safe, and affordable neurosurgical care”? In other
words, how can we substitute physical global neurosurgery
“boots on the ground” with “boots” that are digital and “ground”
that is a screen (computer or smartphone)?
Some suggestions follow:
- Develop online tools for evaluating the webinars and virtual
conferences that are assuming a primary role in communica-
tion and education among neurosurgeons worldwide.
- Develop creative and innovative online methods to enhance
information exchange and collaboration among neurosurgeons
worldwide.
- Develop creative and innovative methods to incorporate new
technologies to enhance neurosurgical care, particularly in the
COVID-19 pandemic era (e.g., a recent report documenting the
use of smart glasses to allow real-time remote “rounding” on
intensive care unit patients).10
- Develop online tools for evaluating programs for task-sharing/
shifting in neurosurgery (as an example of 1 technique for
enhancing neurosurgical resources in LMICs). Other examples
include expanded prevention programs (e.g., trauma avoid-
ance, helmet use) and programs to reduce prehospital trans-
port and triage times.
46 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2020.09.018
No doubt our younger colleagues in particular can add to a list of
topics amenable to innovative (but “socially distanced”) solutions
during what is likely to be an extended period of pandemic.
In a recent book, Nigel Crisp11 provides an encyclopedia of
programs and projects to improve health. Lord Crisp, who was
CEO of the National Health Service in the United Kingdom (UK)
from 2000 to 2006, is an Independent Member of the UK
House of Lords, and is currently co-chair of both the U.K. All-
Party Parliamentary Group on Global Health and the interna-
tional organization Nursing Now, has devoted his efforts since
2006 to finding cost-effective solutions to health care problems
from colleagues in LMICs, primarily sub-Saharan Africa but also
India and elsewhere worldwide. In Health Is Made at Home;
Hospitals Are for Repairs (a title based on an African saying),
Crisp documents programs—mostly grassroots and mostly in the
United Kingdom—to improve health for the entire U.K. popula-
tion.11 In addition to the traditional problems of communicable
and noncommunicable diseases, programs are described that
benefit population health proactively through improvements in
mental health, family support, education, workplace risks and
stresses, urban design, environmental sustainability, etc. There
is much for neurosurgeons to learn from the innovative,
multidisciplinary health care programs that are being developed
in both LMICs and HICs.
If we are to take the “global” in Global Neurosurgery seriously, it
is essential to widen our attention to include issues far beyond
the neurosurgical operating room, whether in Toronto or Tim-
buktu. As WORLD NEUROSURGERY publishes more articles on
effective and sustainable programs to improve neurosurgical care
worldwide (many such articles originating in LMICs), we need to
move beyond the neurosurgical “silo” and collaborate with col-
leagues in other medical and surgical specialties, hospital ad-
ministrators and ministries of health, and international
organizations (e.g., World Health Organization).12,13 One is
reminded of another African saying: “If you want to go fast,
travel alone; if you want to go far, travel together.”
In 2020 and probably well into 2021, as a result of the COVID-19
pandemic, we will need to think creatively about how to use the
Internet and virtual interactions to advance global neurosurgery.
Efforts that collate and dissect previous publications employing
the term “Global Neurosurgery”—by themselves—will not make
progress toward the goal of “delivering timely, safe, and afford-
able neurosurgical care to all who need it.”4 Hopefully the time
will soon return when we can again address “Global
Neurosurgery” with “boots on the ground”; until then, we
should use our neurosurgical innovation to address “Global
Neurosurgery” in a truly productive manner. Each person
worldwide who needs “timely, safe, affordable neurosurgical
care” is depending on us to do just that.
Niquen-Jimenez et al5 have done an admirable job culling the
literature on the need for improved neurosurgical care
worldwide. As they note at the end, it is time to cast a wide
net across both LMICs and HICs for interventions that will
address that need.
Let us all as innovative neurosurgeons address the Perish, not
just the Publish!

REFERENCES
1. Sociology and Social Research. Oakland, CA: Univer-
sity of Southern California Press. Vol 12. 1927:325.
2. Harzing AW. Publish or Perish. Available at:
https://harzing.com/resources/publish-or-perish.
Accessed July 13, 2020.
3. Andrews RJ. What’s in a name? “Global neuro-
surgery” in the 21st century. World Neurosurg.
Available at: https://doi.org/10.1016/j.wneu.2020.
07.233. Accessed August 28, 2020.
4. Rosseau G, Johnson WD, Park KB, et al. Global
neurosurgery: continued momentum at the 72nd
World Health Assembly. J Neurosurg. https://doi.
org/10.3171/2019.11.JNS191823. Accessed August
28, 2020.
5. Niquen-Jimenez M, Wishart D, Garcia RM, et al.
A bibliographic analysis of the most cited articles
in global neurosurgery [e-pub ahead of print].
World Neurosurg. https://doi.org/10.1016/j.wneu.
2020.08.084, accessed August 20, 2020.
WORLD NEUROSURGERY 145: 45-47, JANUARY 2021
PERSPECTIVE - GLOBAL NEUROSURGERY
6. Callaway E. Publishing elite turns against impact
factor: senior staff at societies and leading jour-
nals want to end inappropriate use of the mea-
sure. Nature. 2016;535:210-211.
7. Leng G, Leng RI. The Matter of Facts: Skepticism,
Persuasion, and Evidence in Science. Cambridge, MA:
MIT Press; 2020:360.
8. Gilson L, Raphaely N. The terrain of health policy
analysis in low and middle income countries: a
review of published literature 1995-2007. Health
Policy and Planning. 2008;23:294-307.
9. Haglund MM, Fuller AT. Global neurosurgery:
innovators, strategies, and the way forward.
J Neurosurg. 2019;131:993-999.
10. Munusamy T, Karuppiah R, Bahuri NFA, et al.
Telemedicine via smart glasses in critical care of
the neurosurgical patient—a COVID-19 pandemic
preparedness and response in neurosurgery. World
Neurosurg. 2020 (accepted).
11. Crisp N. Health Is Made at Home; Hospitals Are for
Repairs. Essex, England: SALUS Global Knowledge
Exchange Publishers; 2020.
www.journals.elsevier.com/world-neurosurgery
12. Khan T, Quintana L, Aguilera S, et al. Global
health, global surgery and mass casualties. I.
Rationale for integrated mass casualty centres.
BMJ Global Health. 2019;4:e001943.
13. Aguilera S, Quintana L, Khan T, et al. Global
health, global surgery and mass casualties: II.
Mass casualty centre resources, equipment and
implementation. BMJ Global Health. 2020;5:
e001945.
Conflict of interest statement: The authors declare that the
article content was composed in the absence of any
commercial or financial relationships that could be construed
as a potential conflict of interest.
Citation: World Neurosurg. (2021) 145:45-47.
https://doi.org/10.1016/j.wneu.2020.09.018
Journal homepage: www.journals.elsevier.com/world-
neurosurgery
Available online: www.sciencedirect.com
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