Circulation on the Run: Special Conversation with Former and Current Editors-in-Chief of Circulation

This week’s episode is special: we have the former and current
Editors-in-Chief of Circulation on Circulation on the Run. Join
Dr Amit Khera, Digital Strategies Editor of Circulation, as he
speaks with Dr James T. Willerson, Editor-in-Chief from 1993 to
2004; Dr Joseph Loscalzo, Editor-in-Chief from 2004 to 2016; and
Dr Joseph A. Hill, the current Editor-in-Chief. They will discuss
the history of Circulation and how it continues to evolve.


TRANSCRIPT


Dr Amit Khera: Hi, this is Amit Khera. I'm digital strategies
editor for Circulation from UT Southwestern Medical Center in
Dallas. Today we have a very special Circulation on the Run. We
have three Editors-in-Chief from Circulation. First, we have Dr
James Willerson, who was the Editor-in-Chief from 1993 to 2004.
He's a President Emeritus at the Texas Heart Institute. We also
have Dr Joseph Loscalzo, who was Editor-in-Chief from 2004 to
2016, the Chairman of Department of Medicine from Brigham and
Women's Hospital. And finally, Dr Joseph Hill, the current
Editor-in-Chief, the Chief of Cardiology at UT Southwestern
Medical Center. Welcome, gentlemen.


Dr Joseph Hill: Thank you.


Dr James Willerson: Thank you.


Dr Joseph Loscalzo: Thank you.


Dr Amit Khera: Dr Willerson, I must say, looking over the tenure
prior to Dr Loscalzo, you had one of the longest tenures ever as
Editor-in-Chief of Circulation, and certainly a lot happened in
the practice of cardiology during that period. It was a really
formative period in cardiology. As you think back, what were some
of the most important topics that you covered during that time as
Editor-in-Chief, thinking about the evolution of cardiovascular
care and science at that time?


Dr James Willerson: You have to remember, there have been many
editors at Circulation. We all build on the shoulders of others,
certainly I did. I really wanted Circulation to be the premier
cardiovascular journal in the world. I wanted it to be much like
the New England Journal of Medicine, but the New England Journal
of Medicine Circulation of Cardiology. I wanted to publish it
every week. We got permission to do that. That wasn't easy, but
we were fortunate. I've been accused of wanting to publish it
every day. There's actually some truth to that. I didn't make
that. I didn't try very hard. I wanted to be able to present the
information, important information, to everybody who cared about
cardiovascular medicine: physicians, scientists, students,
nurses, those who cared for people, and I wanted to do it
frequently. I wanted to publish it quickly. So, we had some
success with that. There are many other things that are
well-known to the other editors, all of whom have built before me
and after me, and I'm very proud of them.


Dr Amit Khera: Well, thanks for that. And certainly, as you
pointed out, this has been an evolution where you took the
gauntlet, if you will, from the people before you, and then built
on that and had many advances. I guess after you, Dr Loscalzo,
you I think did have the longest tenure if I saw of any of the
editors and similarly, a lot of evolutions in cardiovascular care
and a lot in science, particularly during your time. Tell us a
little bit about any particular papers or topics that you focused
on, or that really were revolutionary in the cardiovascular space
during your tenure.


Dr Joseph Loscalzo: I'll pick up where Jim left off and just make
the case that as you're suggesting, I mean, there's sort of been
a natural transition of the kind of science that Circulation has
been publishing over the tenure of the three editors here today.
Before Dr Willerson, it was largely physiology and excellent
clinical science. Jim really expanded the scope of what
Circulation published to begin to put in press in its pages,
fairly basic and translational science as well. I picked up from
what he'd laid the groundwork for to expand the scope of that
science. And as you know, expand it to the point that we had to
develop daughter journals that would pick up the mantle in each
of these increasingly subspecialized areas.


So, it's hard to think about those papers that I found have the
greatest impact because every field had several of them in my
several years as editor. As you know, the subspecialty journals
that we established, which remain active to the current time, are
also broad in their scope from outcomes based research to
genomics and proteomics insistence, cardiovascular medicine, to
everything in between, imaging, intervention, heart failure, and
electrophysiology to arrhythmias. Each of these was led, and
continues to be led, by outstanding leaders in their subspecialty
fields.


I think the beauty of Circulation in contrast to even fine
journals like the New England Journal of Medicine, is that
Circulation has been able to put on its pages those studies that
really do span quite a spectrum. We don't shy away from very
basic studies. That actually began with Jim, I must say, because
that wasn't the case previously. And of course, we move right
through to epidemiology and outcomes based research. And the
impacts have been broad in each of those fields, as witnessed by
the excitement and uptake of the journal, measured however you
wish, by impact factor, or citations, or the frequency with which
it's referred to in the lay press. So, I think that tradition
certainly continues under the current editor with papers of
extraordinary impact.


Dr Amit Khera: Thanks for that. I think your point about the
evolution of science over time from Dr Willerson and certainly
during your tenure and beyond to the breadth of Circulation
currently. You also touched on the subspecialty journals. That
happened in your watch and that was quite a marked change in
cardiovascular medicine to have that explosion of new journals,
if you will. What do you think the impact of those subspecialty
journals has been for the cardiovascular field?


Dr Joseph Loscalzo: We struggled with the idea about whether or
not we should pursue that kind of fragmentation. What really
pushed us was the fact that the acceptance rate remains quite
low, in those days, probably eight or so percent range at its
nadir. So, we were rejecting a lot of really excellent papers
which wound up in competitor journal pages, that we would like to
have accepted and been given the scrutiny of the careful reviews
and editorials that accompany papers accepted by Circulation. We
felt the best way to do that under the circumstances was to
create these daughter journals. They succeeded, in many respects,
beyond our wildest imagination. The numbers of papers that were
published in the family increased, I think in the first two or
three years, by at least 2-to 3000.


So, that really speaks to the fact that we kept the best papers
in the family. We gave them the right kind of audience. Some of
these would have been too technical or too highly specialized to
have been published in Circulation proper, but certainly of the
highest quality and of significant relevance to the
subspecialist. So, we think that it was a successful experiment.
Now it's sort of become tradition. I think that the question that
will always come up, of course, is can we fragment things more? I
would say one of the best reasons to make the case that this was
a successful experiment is that if imitation's the sincerest form
of flattery, the New England Journal is now going to start three
subspecialty journals. In fact, in my role now as an editor of
the New England Journal, editor-at-large, they asked my input in
how to design those daughter journals and what to expect from
them.


Dr Amit Khera: Well, I think that's a great point. It certainly
has been a resounding success and as you pointed out, imitation
is the best form of flattery. I'm going to pivot now to Joe Hill.
Dr Hill, you have certainly been the beneficiary of all the great
work that these two editors have done in the past. You've
inherited a very successful journal and also have crafted your
own vision for where you want Circulation to go in your mark.
Tell us a little bit about some of the new initiatives you've
tried to implement, leveraging on these past successes.


Dr Joseph Hill: Thank you, Amit, it's an honor and a privilege to
be in this conversation, frankly. I mean, Dr Willerson made this
a weekly journal. That was back in the day when FedExes were
flying around. Everything was paper. That kind of volume with
that technology is impressive. And Dr Loscalzo, who has been a
friend and mentor for many, many years, spearheaded the
subspecialty journals, as we just heard, and took the journal to
yet new heights. Each of you has been a pioneer and we've been
fortunate to put together a team that I think has moved in
exciting directions. We've leveraged technology now, such that we
have our video conference meetings. We meet in a video conference
with editors from 17 different countries. We have a third of our
editors in Dallas, where I live, a third in the US outside of
Dallas, and another third in 16 other countries.


It turns out we alternate the time of that meeting each week
because there's no single hour of the day that works around the
globe, so we move it around to capture Asia or to capture
California in alternating weeks. That has been a thrill and,
honestly, I believe a robust success. We have leaders on the
ground in all these different countries. We have a highly diverse
team across the different subspecialty domains of cardiology,
across different geographic regions, across race and sex and
gender lines. It is an amazing team. And Amit, who leads our
robust digital efforts, including this podcast and our efforts on
social media, again, the opportunity now in the 21st century to
take these initiatives forward has been a real privilege.


Dr Amit Khera: It's ironic that Circulation was doing Zoom before
everybody else was in the modern era. I'm going to pivot back to
Dr Willerson. As Dr Hill just mentioned during your tenure how
the volume of papers was handled, FedEx and sort of the nature of
the journal publishing process. And now in the modern era, we
have so much different information. We have a huge volume of
journals. We have online, we have Twitter, we have podcasts. We
have people that are consuming information in so many different
ways. Tell us from your perspective, what's the role of the
scientific journal currently and how has it changed at all in the
last few decades?


Dr James Willerson: It's always going to continue to evolve. It's
about as good as it can be right now with Dr Loscalzo and Dr
Hill's leadership, and I'm really proud of them. There'll be
more. We can't even imagine what it will be in two or three
years. Of course, it'll be better and better, faster, almost
momentary. Thank you, Dr Hill.


Dr Amit Khera: Thank you for that. I think we all look forward to
seeing how this evolves more rapid information, rapid turnaround.
I'm certain that will change. Dr Hill, you had a comment on that?


Dr Joseph Hill: We live in an era now where peer review is under
attack in many ways and pre-print journals, blogs and so forth.
And one of the things that I've really seen, and we've all seen,
is how the peer review process, and we're all authors, right, we
live on the other end of that stick, but it really is important.
It makes a big difference. And people who are anxious to
accelerate that process, I totally get it. We work very hard to
do that. At the same time we, following the traditions here, have
an intentionally redundant review process where every paper is
evaluated by multiple editors and multiple peer reviewers. On a
number of occasions, we've avoided a pothole, or we've improved a
paper many, many times. And that is something that has really
been impressed on me that I think people who aren't on this side
of the editorial fence might not appreciate as much.


Dr Amit Khera: I think that's an important point about sort of
the rigor about the way that articles come out in Circulation.
And Dr Loscalzo, maybe as an extension of the last question, what
do you see as some of the challenges going forward or
opportunities for Circulation? You think about where it's been,
but what are some of the things that you look forward to for
Circulation in the future and what are some of the things you're
concerned about?


Dr Joseph Loscalzo: Well, I too am concerned about this issue of
peer review being under attack, and I'm particularly concerned
about it for papers that have direct clinical impact. A good
example of that concern, of course, are papers published, or at
least publicly released, on non-peer reviewed websites like the
archive sites because of their importance in the COVID epidemic,
potentially. We all know of cases of drugs, at least in test
tubes, with cultured cells and viruses appear to be effective
that have adverse clinical consequences.


So that, and more than in any other sphere of science, ensuring
that proper peer review from as many perspectives as possible is
always a part of the process is absolutely critical for clinical
medicine. And to me, the threat that this need for acceleration
and rapid peer review poses and the sort of socialization of the
transmission of scientific information that we're all interested
in doing really has to have the brakes put on it a bit for the
clinical science that the journal represents for this very
important reason. Not to say we want to slow things down, we want
to make sure that the best possible reviews are performed before
we release it to the public.


I know that, as Joe was pointing out, one of the most exciting
parts of the role of when I led the journal was the weekly
meeting. We had a face-to-face meeting because all of our
associate editors, save one, was actually physically proximate
and they could travel to our conference room. But it's a
wonderful exercise to have people of very different perspectives,
from basic scientists, to clinical electrophysiologists, to
outcomes researchers, make comments on papers that were
completely outside their sphere.


The argument, of course, is if one can write and transmit a
thought with the clear intent in a way that's rigorous and
logical, that any reasonably bright person with reasonable
scientific background should be able to understand it. And often
these folks with very different scientific backgrounds have
perspectives that very clearly improved the paper when they were
acted upon. That's a process that doesn't exist in many other
journals, I have to say. And I would encourage Joe, which I know,
well, he's doing this because he enjoys it and he recognizes its
importance, and Joe's successors continue to do that as well
because that will ensure the value of the journal through all of
the challenges that it is going to have to face in the next
decade or two.


Dr Amit Khera: I think that was a great point. We're certainly
seeing candy bowl examples of the importance of this rigorous
process of the editors looking through it carefully and, as you
both mentioned, peer review. Joe Hill, I'm going to let you maybe
have the last word. I know how hard the three of you have
historically worked on your craft for the journal, how much
effort you've put in, but I also know it's quite a rewarding job.
What would you see as the best part of being Editor-in-Chief of
Circulation?


Dr Joseph Hill: Oh my, I'm learning something every day. I've
been on about a steep a learning curve as when I was an intern at
Dr Loscalzo's hospital long ago. Under Dr Willerson's term, I
imagine many, many studies came in on acute coronary syndromes
and thrombolytic therapy, primary PCI, antiarrhythmic drugs. We
haven't seen an antiarrhythmic drug paper except for a recent
review we did, but for quite a long time. It's artificial
intelligence, it's big data, it's the UK Biobank, it's Omix, it's
incredibly sophisticated genetics and genomics and basic science
with genetic manipulations, IPS cells.


It's a very different world now than it was 10 years ago, 20
years ago and it certainly will be again, 10 and 20 years down
the road. We are now approaching, I will say, 600 COVID related
papers, and they're still coming in at a record pace. The world
has changed. As I said before, this is the 70th anniversary of
this storied journal. And it is truly my honor to be able to
stand on the shoulders of Doctors Loscalzo and Willerson.


Dr Amit Khera: Thank you. I think that's a great way to end this
podcast and congratulations on the 70th anniversary. It truly has
been a privilege to chat with the three of you today. I want to
thank you not only for what you've done for Circulation, but for
the field of cardiovascular medicine. This is Amit Khera, digital
strategies editor for Circulation. Next week we're back to our
usual podcast with Carolyn Lam and Greg Hundley. Take care.


Dr Greg Hundley: This program is copyright the American Heart
Association, 2020.