The face in the mirror. (Editor's Note).

Bureaucrats obsessed with rules and arcane policies are like vampires. They never see their own image in the mirror. Although a vampire might gaze at an empty mirror, however, red-tape bureaucrats find the reflection of someone who is not really there. They might see a face with a smile or a frown, but they don't see a reflection of their own mindlessness. Being mere mortals, they could not possibly face the fearful creatures they become.

Those of us in health care know a great deal about bureaucracy, but our patients and clients know even more. As a copious user of the health care system, I have had many interactions with red-tape bureaucrats, and at this point I would rather take my chances with vampires--at least vampires can be repelled by garlic and felled by wooden stakes! Some bureaucrats seem immune to any action--and appear to be infinitely replaceable by clones who are incapable of deviation from some master script.

Having established my disdain, which grows daily, for people who are fixated on the application of rules without regard to fairness or common sense, I am free to express a mounting fear. I fear that, as Walt Kelly's Pogo once said, "We have met the enemy and they is us." This possibility has special dread for all of us self-indulgent boomers who assumed that virtue was our birthright and, therefore, that we didn't have to earn it.

Now that everyone reading this knows that I am haunted by the possibility of being a bureaucrat--of having "sold out"--I had better look into the mirror quickly and see what I see. For better or worse, let's look together, and consider whether this Journal and its policies have earned me the label of "red-tape bureaucrat" and whether this is the time for the Journal to turn over a new leaf.

Our Editorial Board annually discusses our policies, and we review the arguments for and against them. We have some differences of opinion, but almost all Journal policies have the overwhelming support of the Editorial Board. Perhaps we have, like some bureaucrats, become too accustomed to the application of our policies, and, if that is the case, we need to hear what others think. Before I continue, I want to list just two of the changes that the Journal has made as a result of feedback from you:

* Initially, the Journal rejected structured abstracts, until letters to the editor convinced us to do otherwise.

* The idea for Updates was inspired by a letter to the editor about the limitations one of the Journal's article categories--the Perspective.

In this month's Note, I will speak specifically of our policy requiring invitations for certain types of articles.

Before calling for your opinions, the Journal needs to go on record as to why our policies exist. That's because there is another property that some bureaucrats share with vampires: They can't stand the glare of sunlight.

If you look through our Information to Authors (found on pages 273-275), you find that 2 types of articles, Perspectives and Literature Reviews, are accepted for review only when invited by the Editor. Systematic reviews, however, are considered a form of research, as is any type of review or analysis article in which a research method is used, and, therefore, no invitation is needed for these papers.

During the 12 years that I have been editing the Journal, we have returned many papers to authors because of our policy requiring invitations. Some of these authors initially are concerned that the policy is arbitrary and elitist, stifles new ideas, or eliminates the ability of some people to make contributions to the Journal.

Why do we have this policy? First, I'd like to explain that the overwhelming majority of papers in the Perspective and Literature Review categories are submitted to the Journal after the authors recommend that I invite them to write a paper. We have no secret panel that selects authors! Anyone can suggest themselves or someone else. When authors request an invitation, I ask for their curriculum vitae, and then, if any of the authors have a record of primary publication in the topic area of the proposed paper, I invite them to submit the manuscript. I look for previous contributions that were made through research articles or case reports. I believe that before people summate and analyze knowledge, they should contribute to that pool of knowledge through peer-reviewed publication.

If the proposed authors do not have the credentials, I urge them to collaborate with a more experienced and published colleague. This collaboration should result in a better paper in addition to catalyzing a working relationship that could benefit all of those involved.

One of my concerns: If people publish before they have experience and before they have made contributions to the primary literature, we will recapitulate what has happened on the continuing education circuit. That is, self-anointed experts will preach their gospel without first contributing to our clinical literature. Researchers should be doing research, and clinicians certainly can be writing case reports. New ideas can be expressed and tested in these kinds of papers before authors choose to discuss issues in more global terms.

Reviewing poorly written Perspective and Literature Review articles is an extraordinary burden, one that I choose not to inflict on our volunteer peer reviewers. I also want to keep the invitation process based on some meaningful criteria, such as the publication record, to minimize the potential for bias.

Is our policy requiring invitations the product of bureaucratic thinking? At this point, I hear the voice of the little boy who, according to apocryphal legend, saw his baseball hero Shoeless Joe Jackson leave the courthouse amid charges of fixing the 1919 World Series and beseeched, "Say it ain't so, Joe!" But in our case, if it is so--if we have succumbed to bureaucracy--we want you to say it! I'm especially interested in hearing from our manuscript reviewers.

Instead of taking refuge in rules, I ask you to let me know if this policy--or any of our policies, for that matter--seem unwise from your perspective. We have open forums both at APTA Combined Sections Meetings and APTA Annual Conferences, and we are always available by e-mail. For contact information, just refer to our masthead, or visit our Web site, www.ptjournal.org.

Jules M Rothstein, PT, PhD, FAPTA
Editor in Chief
[e-mail]