Dr. JACC & Mr. Rxiv

There’s a strange case upon the land — an individual with editorial philosophies in fundamental conflict, one side of his persona embracing “elite” content, top-notch publishers, and stringent standards, while another flouts professional publishers, peer review, and accountability.

It is the case of Harlan Krumholz, who by day is the Editor-in-Chief of the Journal of the American College of Cardiology (JACC) and by night is the Treasurer for openRxiv.org and co-leader of medRxiv.

JACC has an acceptance rate of 7%, typical for a high-prestige journal with a strong position in a specialist community. Its latest stated editorial direction claims it “seeks to publish the highest quality peer-reviewed articles highlighting all aspects of cardiovascular disease.”

openRxiv and its initiatives eschew and denigrate peer review before posting papers for public availability. medRxiv is a preprint server based on cyberlibertarian conceptions of “free speech,” meaning any intervention filtering out someone’s scientific claims is tantamount to censorship. Krumholz defends this way of thinking.

openRxiv is a non-profit initiative owned now by CZI LLC, a private, for-profit company known for selling off initiatives once they reach fruition. openRxiv recently named its new CEO, with Krumholz praising the selection and the anti-peer review sentiments preprints represent:

This is an auspicious time for preprints and an exciting moment to transform medical publishing, and Dr. Tracy Teal is an exceptional choice to lead openRxiv. She is creative, collaborative, and deeply committed to open-source ecosystems, and she will propel the organization to new heights in serving scientists and the public.

While Krumholz uses the euphemism of “transform,” what he is really advocating is upending medical journals and evidence-based systems in general, substituting an “open” (laissez-faire) approach CZI LLC can exploit for some vision of an AI-infused science fiction fantasy.

So, who is Krumholz? A highly selective editor rejecting thousands of papers per year? Or a cyberlibertarian “anything goes” disruptor-by-preprint?

Is Krumholz Dr. JACC or Mr. Rxiv?

The possibility matrix isn’t reassuring.

If he is one by day and the other by night, he is a walking Janus to both employers.

• If he is truly Mr. Rxiv — a wild libertine of papers, unrestrained by quality, relevance, or novelty concerns — then those presuming he can be trusted as Dr. JACC may be sorely disappointed.
• If he is truly Dr. JACC — a tough, selective editor able to pick a handful of relevant, novel, high-quality (or as he calls them, “elite”) works for an important medical specialty without fear or favor — then those who think he is Mr. Rxiv and believe he shares their vision of a cyberlibertarian future of magical information platforms are being played.
• If he wishes to claim he can slip between the roles without difficulty, it is worth remembering what happens in the classic story — at some point, Dr. Jekyll can no longer control his chaotic counterpart and transforms into him permanently.

Given Krumholz’s recent publication conflicts of interest pushing him into the MAHA camp via a probably illegitimate study and then into using attacks as defenses which echo MAGA acolytes, Mr. Rxiv may be coming closer to dominating.

The slippery slope beckons further via a more concrete conflict of interest between the roles — the JACC journals participate in the direct transfer program from medRxiv, meaning that Krumholz can play both sides of the fence, possibly getting a leg up on other cardiology journals with sneak peeks at preprint submissions while potentially biasing his views of these papers in the process:

This arrangement has been in place for more than a year, and it strikes me as unhealthy and unacceptable.

Krumholz needs to choose one or the other. In my informed opinion, he cannot ethically do both.

Perhaps it is time for Krumholz — or someone in authority who is unafflicted by this strange derangement — to choose between being Dr. JACC or Mr. Rxiv . . .

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