In August, I posted this: “A paper of mine was published. Did anyone read it?”

A recent comment on it raised an interesting point. Dr. Christian Sinclair at Pallimed said the site had received almost 2 million views since 2005.

He then made the following calculation:

Two million views with an average of 1:30 minutes on a page = 3 million minutes = 50,000 hours = 2,083 days = 5.7 years of 24/7/365 informal learning on hospice and palliative care topics.

He said that this type of communication counts for nothing regarding academic advancement and added that writing another paper and having it published in a journal no one reads or a chapter in an expensive book no one will buy is considered worthwhile.

This reminded me of something I have talked about in recent presentations. The first laparoscopic cholecystectomy done in the United States took place in 1988. The procedure rapidly became popular due to its obvious benefits over traditional open surgery — smaller scars, shorter hospitalizations, quicker returns to normal activity.

Many academic surgeons considered the procedure radical and heretical. Opinion pieces appeared with titles like, “Laparoscopic cholecystectomy: Passing fancy or legitimate treatment option?” and “Laparoscopic cholecystectomy: A new milestone or a dangerous innovation?”

Nearly all of the early adopters were community hospital surgeons who also became instructors, ran courses, and proctored others learning the procedure.

Academic surgeons were slow to take up the procedure because even back in those days they steadfastly demanded to see the results of a randomized prospective trial. The problem was that an adequately powered trial never occurred. Patients did so well after laparoscopy surgery that it became difficult to recruit anyone who would agree to be randomized.

Will most academic surgeons, who have not embraced social media, miss the boat again?

Last year, some Australians, blogging at the Intensive Care Network, found that the number needed to treat stated in a New England Journal paper on targeted vs. universal decolonization to prevent ICU infection was wrong. They blogged about it and contacted the lead author who acknowledged the error within 11 days. It took the journal 5 months to make the correction online.

Post-publication peer review is already happening on PubMed and PubPeer, a new site that allows anyone to comment on any paper.

Three years ago, I wrote “Statistical vs. Clinical Significance: They Are Not the Same,” which reviewed a paper on sleep apnea. The use of compression stockings at night significantly lowered the number of apnea episodes but not enough to enable them to stop using CPAP.

That post has received over 13,400 page views, certainly far exceeding the number of people who have read my 97 peer-reviewed papers, case reports, review articles, book chapters, editorials, and letters to journal editors.

How many scientific papers published in journals have been viewed by that many people?

Since I started 4 years ago, the 565 posts on my blog have amassed 1.1 million page views, but if I still held a teaching appointment at a medical school, I would get no academic credit for that level of exposure.

Is it time to reconsider how academic promotions are determined?

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.