New medical and science journals pop up in our mailbox on a biweekly basis. Offers to join as Editor, solicitation for articles based on past publications, invitations for subject reviews come as unsolicited emails. Medical publication houses, old and new, are expanding, adding more and more subspecialties to their established list of publications. Nature, Science and Lancet have all expanded under the original brand name. Their business model promises authors fast reviews and streamlined acceptance processes. This proliferation of journals virtually guarantees publication somewhere and makes acceptance less competitive. Most journals use a similar business model; most require that authors pay for manuscripts, then charge inordinate amounts of money to non-subscribers for a single article.
Given this proliferation, it is no surprise that libraries can only afford and subscribe to a core set of journals to stay within budget. [1],[2]
Taylor & Francis wants us to shell out USD 104 for an article even if we don’t know whether it is helpful for our research. Your ‘investment’, based on abstract information only, may be a total flop. No wonder, Sci-Hub has become the go-to source for many researchers who don’t have access to a university library or a large NIH grant.
Consider the Article Publishing Charges (APC) for a major academic journal. At Elsevier, APCs are tiered; for the Lancet family of articles the price tag is a hefty USD 7280. Not exactly a bargain.
There is now some push-back to this business model from various stakeholders. The respected Journal of Human Evolution made waves recently [3] when its entire editorial board resigned. Editors felt trapped and complained about working conditions, especially the impact and intrusion of AI into their managing and review duties. There are more cases and more editors leaving academic publishing companies every year.
Undoubtedly, there is increased tension between the time-honored peer-review process with its emphasis on review standards and careful vetting of manuscripts, and the more business- and profit-centered approach of editing houses that pursue a cost-cutting and revenue-driven strategy. The role assigned to AI has become a major point of contention.
It should be a wake-up call for researchers to be selective where they send their next article
We don’t want to lament too much by going over journal pricing for subscriptions and manuscript publication; suffice it to say that ‘We the Readers’ should demand quality work in return. For more info on journal pricing and consequences, here are a few references [4],[5],[6]
A recent article by Wang et al. reflects the wonderful world we live in [7]. This is an article on omadacycline PK and about a better/faster way to measure plasma levels. That’s all fine and good, but why did the authors think that – having this great new assay – there is a clinical need for therapeutic drug monitoring (TDM ) for this drug? They did not provide details about how this assay stands to contribute to patient management, but state that ‘TDM is a must’. Based on what? What is the PK profile in various disease conditions and are there relevant differences that TDM can adjust for? Is there a concern about low PK levels In ICU patients, or some so far unrecognized toxicity that needs to be avoided with TDM? None of that is addressed in the article.
In their analysis of 127 blood samples from 54 patients with ‘severe pneumonia’, the omadacycline plasma concentrations were lower than in normal volunteers. However, peak levels in these patients averaged 1181 ng/mL, well above the breakpoint of 0.5 µg/mL. There would be a better rationale for doing TDM for tigecycline and eravacycline, both drugs with high protein binding and low free drug levels.
Nonetheless, the authors state that “therapeutic drug monitoring (TDM) of omadacycline in critically ill patients is essential” They provide six (!) references in support of TDM for antibiotics in general but none mention tetracyclines, all are related to β-lactams. A case of guilty by association or a hefty dose of extrapolation, it seems.
Now the fun part. The article mixes up ‘omeprazole’ with ‘omadacycline’, as in this sentence “trough concentration distribution of omeprazole in patients is 243.15 ± 124.74 ng/mL,”. Here is the corresponding graph:
Lo and behold – some sentence parts are duplicated (“These results These results”), maybe for emphasis? In the absence of editorial cross-checking, this indicates to us that the AI bot is not infallible.
This article did not have peer review, it seems. They did not even use a spell checker. Relevant PK literature is not quoted. Claims are made without supporting evidence. The author’s suggestion to introduce TDM for omadacycline is not laid out at all. TDM is well established for aminoglycosides and vancomycin, less so for polymyxins. We are unaware of anyone seriously suggesting that TDM is required for the tetracycline class of drugs.
The authors propose that PK testing be done because it can be done. Not a good argument in our estimation.
In summary, we wonder about the review process in place at Nature Portfolio Review.
Had the article been just about a new analytical method, we would have ignored it, assuming that it was mainly written to beef up someone’s CV to support someone’s academic advancement. Given the unsubstantiated claims about future use and the call for TDM, we feel that editors and peer reviewers should have stepped in here and redacted the manuscript.
We live in the ‘Brave New World’ of AI. Of course, there is a place for AI in journal work, but we don’t want to see thoughtful editorial review replaced by machine algorithms entirely. A prestigious journal like Nature has a reputation to defend; not everything should be entrusted to the AI autopilot.
There are a few theoretical reasons why one might consider TDM for certain tetracyclines. For example, tigecycline is often administered at twice its labeled dose in severe infections, like those caused by acinetobacter. We don’t have clinical data to suggest that ‘more is better’ given the drug’s paradoxical PK profile. While higher doses will not increase free drug AUC, it stands to increase toxicity. As many CRAB patients are critically ill, treated in the ICU for pneumonia, TDM may have a very limited role in special circumstances.
But this is not what the Wang article is about…
ATTACHMENT
REFERENCES
[1] Journals Cost How Much? Accessed 8/7/2025 https://www.library.ucsf.edu/about/subscriptions/journals-costs/
[2] Rose-Wiles L. Journal of Electronic Librarianship, 23, 2011: 219
[3] Price M. Journal editors’ mass resignation marks ‘sad day for paleoanthropology’. doi: 10.1126/science.zsk9d10
[4] The Hidden Costs of Pricey Journals: How Academic Paywalls Hinder Scientific Progress. 2024 https://suchscience.net/the-hidden-costs-of-pricey-journals/
[5] An Y. The Cost of Knowledge: Academic Journal Pricing and Research Dissemination, 2024. https://ssrn.com/abstract=4691124 or http://dx.doi.org/10.2139/ssrn.4691124
[6] Sanderson K Journal editors are resigning en masse: what do these group exits achieve? Nature 628: 244 (2024)
[7] Wang. LC-MS/MS quantification of omadacycline in human plasma for therapeutic drug monitoring: method development and clinical application. Nature Portfolio Scientific Reports 15: 27728, 2025
