Are Nurses in British Columbia Licensed to Practice Magic?

Seasons greetings to all.

An Interesting Case

This year I decided to pursue a complaint against a practitioner with the College of Registered Nurses of British Columbia (CRNBC) for a nurse who was using their Registered Nurse (RN) title to market their own private Therapeutic Touch (TT) business. To those outside of the nursing profession this might seem a little confusing, but in other countries where I have worked as a nurse it is an established professional principle that you do not use your professional qualifications/status to promote your own for-profit activities outside of your role as an RN. The reasons for this are fairly self-evident. For example adding RN to your name gives you some professional credibility and it would be disingenuous to use it for personal gain, such as by selling something (be it real estate, car parts, vitamins or even personal life-style counselling). The CRNBC has its own standards governing use of title and even produced  guidance for practitioners with a case example to explain this. See: Can she Use her Title? where they note that having “RN” after your name may be seen as “…important in gaining the public trust and selling more product.”

Indeed, it was this very article that incited me to make the complaint as a test case, as I came across a TT practitioners website where the title of RN was explicitly used next to the practitioners name. I used the exact format and language in the guidance for the complaint and cited the relevant “Use of Professional Titles” standard and College Bylaws (sections 4 & 8)  in the complaint, and simply asked that the CRNBC to ask her not to use the RN title on the website. I had been in contact with this individual on other occasions and suggested that the use of RN was inappropriate to endorse this business activity and had a completely negative response, so a simple complaint to the CRNBC on appropriate use of title seemed an appropriate next step.

At this stage it is probably worth a quick recap on what the professional regulators function is. Basically, the regulation of nurses includes licensing, the creation of professional standards, enforcement of those standards, disciplinary measures and nursing education approval. Overall, the key principles that underpin the statutory professional regulation of nursing may be considered as: (a) maintaining the safety and quality of the care that patients receive from health professionals; (b) sustaining, improving and ensuring the professional standards of health professionals and identifying and addressing poor practice or bad behaviour; (c) providing systems and legislation that sustain the confidence of both the public and the healthcare professions through demonstrable impartiality; and (d) ensuring that the integrity of health professionals is sufficiently flexible to effectively meet the different health needs of the public and healthcare approaches can adapt to future changes and demands (Hewitt 2007; ICN 2014; Walsh 2012; WHO 2002). To ensure that regulatory standards are effective, the regulatory process itself also needs to be seen as impartial and independent from the government, the professionals themselves, employers, educators and all the other interest groups involved in healthcare (Hewitt 2007). I.e. the CRNBC should represent the interests of the public at large rather than the profession or government (this is an important point , which we will come back to). So, one would think that in terms of public protection this complaint would represent a fairly straightforward case of inappropriate use of title to support a commercial enterprise.

Another consideration here is that in this case the title was being used to help market a completely unscientific, non-evidence based and “unverifiable” practice (as indicated by the CRNBC’s own Bylaws, 2012; Section 8.04). We have discussed the merits of TT on this blog before, and it is of course, pure magic in the terms it is portrayed (remote healing using undetectable energies) with no-scientific evidence to support efficacy. A 1999 review of the physics of complementary therapies states that the existence of a “bio-field” or “bio-energetic field” directly contradicts principles of physics, chemistry, and biology (Stenger, 1999). A recent Cochrane systematic review found “no robust evidence that TT promotes healing of acute wounds (O’Mathúna et al, 2012). The American Cancer Society stated in 1999, “Available scientific evidence does not support any claims that TT can cure cancer or other diseases” (AMA, 2012).  Lastly we have the youngest person ever to get a paper published in the Journal of the American Medical Association ( the nine year old Emily Rosa) presenting a study that debunked the claims of TT practitioners in a simple study where twenty-one practitioners of therapeutic touch failed to detect her aura (Rosa et al, 2009). TT is then, complete mystical woo-woo, and fails to meet any test of scientific credibility in that 1) the underpinning theory is tautological nonsense, and b) practitioners can demonstrate no efficacy better than placebo. No respected university will touch TT practical training with a barge pole. Nevertheless we should note it is a profitable enterprise  (the overheads are minimal) and many nurses still champion it. The professional regulator would seem to have some responsibility to ensure practitioners are using evidence-based practices, so TT (based on current evidence) clearly falls outside that scope.

The Outcome

Anyhow, in the end the CRNBC disposition on this case earlier this year sided with the practitioner, and that they were perfectly entitled to use their RN credentials to market their TT business as they found that:

a) the regulations are not intended to apply to RNs providing education services. The CRNBC regarded this registrant as providing an educational service, as the website identified was aimed at a TT consultation service.In other words they viewed an educational service as not being a product (even though it was a commercial, for-profit enterprise)!

b)  Alternative and complementary therapies are considered within the realm of holistic nursing.

Given the CRNBC’s position on CAM in general, I was not unduly surprised with this outcome, but am concerned this represents a particularly troubling precedent as point a) represents a very narrow view of what a commercial product is, and also implies you can sell health education on anything (whether good or bad) and simply tag your RN credential to your marketing materials. Point b) is even more worrying as it represents an “anything goes” approach to the regulation of RN practice (as long as you don’t physically hurt anyone; it’s all good). This completely ignores the regulators responsibility to make sure practitioners don’t financially or emotionally exploit the public, and tarnish the reputation and credibility of the nursing profession.

Let’s examine a comparable example. If I want to promote my business as a tarot or astrology based health practitioner, and make good money selling my advice and education to the public who believe in this. Then I can tag on my RN credential to give it an air of professional respectability, better market my magical consultation services and improve my profits. Its all good!

In what universe does this approach protect the public rather than the profession? the finding does nothing to protect the public from exploitation, and gives carte blanche for RNs to practice magic. To illustrate this, I have just acquired a practising Witchdoctor (WD) certification from the Canadian Association of Witch Doctors (it was a tough program, and examination I can tell you)! So, with my new magical powers, apparently using my title in the following advertisement is well within my scope as an RN:

Loco Advert

Click here to see the full size Locomatic Energy Inc Advert

This advert covers the same ground as the website I made my original complaint against (well, apart from the cat and windsurfing). The use of the RN title to support this sort of activity is clearly nonsense, and to be frank, supporting it is a travesty of regulatory practice and represents an example of where our professional regulatory body is failing miserably. Regulators traditionally err on the side of caution, remain impartial, and represent the public interest, not those of the professionals they regulate. In this case I would argue they clearly failed to meet their regulatory obligations in this respect.

Other nursing and health professional regulators I have observed seem to do a much better job in this area. The College and Association of Registered Nurses of Alberta (CARNA) Standards on CAM, 2011 notes:

“Registered nurses cannot use the title ‘RN’ or ‘NP’ in association with the endorsement or promotion of products or services. Endorsement of a product or service occurs when a nurse uses their credentials to lend credibility to a commercial product or service (CNO, 2009). The endorsement of a product or service without providing information about other options could mislead the public and may be considered a conflict of interest.”

Likewise the College of Nursing of Ontario, Professional Misconduct Regulations, 2014 states:

“It is not acceptable for a nurse to use her/his registration status to promote personal interests such as commercial products or services. Endorsement occurs when the nurse inappropriately uses her/his credentials to lend credibility to a commercial product, product line or service. The endorsement of a product line or service without providing information about other options has the potential to mislead the public and compromise trust.”

Both clearly indicate services (such as educational consultation) are to be treated the same as products in this respect. In the UK, The Nursing and Midwifery Council Code of Conduct 2014, is similarly clear, requiring practitioners to:

  • not abuse your privileged position for your own ends.
  • ensure that your professional judgement is not influenced by any commercial considerations.
  • uphold the reputation of your profession at all times.
  • ensure that the use of complementary or alternative therapies is safe and in the best interests of those in your care.

The College of Surgeons and Physicians of BC are also much clearer on how we should consider CAM in respect to public healthcare:

“Practitioners must not misrepresent the safety or efficacy of any therapy or procedure.”

“Complementary and alternative therapies differ from conventional medicines because they are generally unproven. When an alternative treatment undergoes rigorous testing, for example in a controlled and randomized trial, then the results dictate whether the alternative treatment becomes conventional treatment, whether the unorthodox becomes accepted, and whether the unproven becomes proven. Assertions, speculations, and testimonials do not substitute for scientific evidence.”

I did pursue this CRNBC disposition on this case with the BC Health professional Review Board (HPRB), but have dropped it, as there is really nothing they can do in such a case as the HPRB are focused on interpretation of process and the law and are very unlikely to intervene in what they see as “professional jurisdiction” unless there is clearly evident harm arising. Interestingly, it appears guidance published in CRNBC newsletters and advice has no real legal grounding anyhow, so can be completely different from interpretation of the actual standards by the disciplinary board. I worry that this doesn’t seem to reflect a coordinated organization. So, my next action is another formal approach to the CRNBC (I have raised this issue with them before) requesting they review their regulations and toughen them up in this respect.

Although TT is generally harmless, we should be reminded these are serious concerns here and these are not the trivial issues they are often taken as. Firstly, financially exploiting vulnerable people is a serious issue. Secondly, where the public are advised to consider alternatives to conventional evidence-based treatments, life-threatening results occur, as exemplified by the recent cases of the parents of two children with acute leukaemia seeking CAM remedies, and with people being advised to take homeopathic vaccines rather than actual vaccines. If we continue with this  approach to regulation and CAM practices, and allow them to be marketed with implied professional support, sooner or later deaths or injury will result from people In BC choosing CAM over medical alternatives on the advice of a nurse using their professional title to support their CAM practice. Effective regulation can help prevent this.

So, are nurses in BC licensed to practice magic? What do you think…

Bernie

References

American Cancer Society (2012) Therapeutic Touch.  Retrieved 20 October 2014.

Hewitt, P. 2007. Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century. London: H.M. Stationary Office

International Council of Nurses (2014). Regulatory Board Governance Toolkit. Retrieved July 29, 2014. http://www.nurse.or.jp/nursing/international/icn/report/pdf/2014m/04-04.pdf.

O’Mathúna, D. N. P.; Ashford, R. L. (2012). O’Mathúna, Dónal P, ed. “Cochrane Database of Systematic Reviews”. Cochrane database of systematic reviews (Online) 6: CD002766

Rosa, Linda; Rosa, E; Sarner, L; Barrett, S (1998). “A Close Look at Therapeutic Touch”. JAMA 279 (13): 1005–10

Stenger, Victor (1999). “The Physics of ‘Alternative Medicine’ Bioenergetic Fields”. The Scientific Review of Alternative Medicine.

Walsh, P. 2012. “Health Professional Regulation.” AvMA Medical and Legal Journal 18(3): 3–4.

World Health Organization (WHO). 2002. Nursing and Midwifery: a Guide to Professional Regulation. Cairo: WHO Publications Eastern Mediterranean Regional Office.

Other Relevant Sources

1. The CRNBC has a self-identified mandate to “protect the public through the regulation of registered nurses and nurse practitioners: https://www.crnbc.ca/crnbc/Pages/Default.aspx

2. Registrants are required to use their title(s) in ways that comply with the: CRNBC Standards of Practice. See: https://www.crnbc.ca/Standards/Lists/StandardResources/343AppropriateUseofTitlesPracStd.pdf

3. CRNBC October 2013 case study “Can she use her RN title?” which was subsequently amended – current version is at: https://crnbc.ca/Standards/resourcescasestudies/beinganurse/selfemployment/Pages/marketing.aspx .

Creativity and Science: An overlooked relationship?

Hello again!

After a long break here is another blog. If you are our reader, you may have noticed something of a hiatus in regularity of the blog when it’s my turn. Bernie is obviously not working hard enough and seems to have bags of time. In the UK October/November tends to mark the deadline for all research bids, so I have been terrifically busy – begging.

Anyway, I have a book out this month on Creative Science so thought I might write about just that. Strange really that the two are often seen as being so distinct, for curiosity is a key scientific attitude as is a willingness to change ideas in light of evidence. Therefore, science is, by its very nature, twinned with creative thinking. Furthermore, Murphy (2005) suggests that learning science enhances the development of creative thinking skills, such as fluency, flexibility, originality of ideas and imagination.

It is interesting that Torrance (1965), an eminent creativity researcher, nearly 50 years ago put forward the following definition of creativity ‘As the process of becoming sensitive to problems, deficiencies, gaps in knowledge, missing elements, disharmonies, and so on; identifying the difficulty; searching for solutions, making guesses, or formulating hypotheses about the deficiencies; testing and retesting these hypotheses and possibly modifying and retesting them; and finally communicating the results.’ (p. 663-664) This definition, a scientific definition of creativity, met resistance, with objections that he had no right to use the term ‘creative’ outside such fields as art, music, and writing. He argued that his definition seemed to fit the creativity of both artists and writers as well as it did that of the creative scientist. p. 665 Fortunately, things have moved on from then and the notion that science and creativity may not be mutually exclusive is certainly plausible.

In his highly regarded TED talk (Robinson 2006), Sir Ken Robinson made a robust case for creativity in formal education stating that it should have equal status with literacy. He argued that all children have tremendous talent and have an extraordinary capacity for innovation. However, he declared unequivocally that children are ‘being educated out of creativity.’ To be creative, he asserted, you have to be prepared to be wrong, and that the current model of formal education leaves children frightened of being wrong. Unfortunately, this is particularly pertinent in science where there is often a perceived ‘right’ answer and this notion drives down creativity and divergent thinking. Scotland have rooted creativity firmly in their Curriculum for Excellence and it is seen as fundamental to the definition of what it means to be a ‘successful learner’ in the Scottish education system (Education Scotland 2013).  Unfortunately, the recent National Curriculum for England (2013) does not seem to be embracing creativity as much.

Why creativity is important

Science is exciting and engaging in many of the ways in which it is already explained and taught. Some teachers, or trainee graduates, particularly with science backgrounds will already hold a clear and functional view of what science is and what is important in terms of teaching it. You may have very clear ideas of what constitutes a scientific approach and quite strongly held views on what is really important for children to understand about ‘science methods.’ However, such interpretations can framework and even confine your approach to teaching.  The issue here of course is not everyone, even within the scientific community may share your view. We may be very different in terms of the subject we studied (such as physics, chemistry, biology) and the different skills and approaches that this imparts. Indeed, it is not uncommon for those with science degrees, training to be science specialists on initial teacher training courses, to express concerns about teaching areas of science that they “know nothing about!”

In teaching we can utilise all sorts of creative and imaginative methods and apply these to topics not normally associated with science curricular. Of course the obvious question is why should we bother to change? Well, the answer to this is twofold. Firstly, we want to reassure those who are new to science that they have a whole range of valuable skills that can really promote and encourage children to see science as a creative and relevant subject and secondly, to address a wider issue; that something is going wrong in science education for across many of the ‘high-income countries’ (including the UK) a distinctive downward trend in the numbers studying science has been recognised (Fensham, 2004). Yet, for those of us who work around children, it is plainly obvious that they are natural scientists in that they have an almost universal curiosity about the world around them. Young children are always asking the question “why?” Yet, somewhere along the line they appear to lose this curiosity and fascination.

Of course paradoxically in the last 20 years the advances in science and technology have bordered on the revolutionary, particularly in areas such as biomedicine and electronic communications. The technological tools that we have developed now allow us to explore not only adjacent planets but to view horizons that span from the edge of the known universe to sub-atomic space. Never before in our history have we understood so much about ourselves, or the physical world around us and never before have we had the means of communicating this understanding (as well as intriguing questions concerning that which we still do not understand) to such a wide and literate audience. The advances that we have made and the pace of such developments have been little less than spectacular.

It is also undoubtedly true that the planet is facing a seemingly worsening environmental decline and that there needs to be a profound change in the way we live that is based on sustainability. Science also has a profound role in providing the knowledge and skills that young people will need to face the problems that the future will certainly pose.

Given this, how can it be that young people are being put off science apparently by even as early as 7 – 8 years old? The only possible answer is somewhat worrying. Children do not tend to ‘do’ science at home and only rarely in ‘out of school’ settings. They come across it predominantly at school and therefore something is quite clearly going wrong at this point. Put plainly, children appear to be put off science at school.

How can we halt this decline? One way in which this may be achieved is to remove the artificial barriers that lead to the compartmentalization of science in teaching. We suggest a more holistic approach to science teaching; one that both blurs the distinction between approaches in arts and science and also one that sees science as an integral part of social, emotional and personal development. In a way we would like children not to be able to necessarily distinguish science from any other area of the curriculum. Going even further, sometimes barriers are not just theoretical, but made from bricks and mortar and in the same way we would wish to see artificial divides removed, we’d extend that wish to the classroom walls. Teaching in the environment, for the environment may be a well-worn phrase now, but it is still a valuable sentiment.

We would like to move science away from being a distinct subject to having a more integral role across the wider curriculum. A potential problem with this lies in the way in that science is sometimes perceived. How would you describe science? Logical? Precise? Analytical? Or creative, imaginative and inspiring? Most people would probably draw up a list close to the sentiments at least to the first set of words

 Challenges

Calls for new approaches to teaching science are of course not new, the famous Nuffield Science Teaching Project was developed in the 1960s and the Schools Council Integrated Science Project in the early 1970s.

We have over 50 years of pedagogic and curriculum development as a backdrop to the decline in numbers studying science. Given the amount of time, money and enthusiasm put into these projects to re-contextualize science and to change the approach to science teaching one wonders about the real impact of any suggested change in teaching approaches. Perhaps the difference here is that we only want to utilize the skills and develop the confidence of teachers in primary settings not to see science as something daunting and separate from everything else that goes on. In fact to see ways of teaching science that don’t necessarily depend on designing and carrying out experiments, that maybe are creative and artistic in the way that data are presented, that can lead to discussions about ‘bigger’ ideas and concepts, not being afraid to engage in potentially controversial areas. In reality of course, all the characteristics of good science!

What we are not suggesting here is a ‘new science’ but rather different ways of teaching and seeing the old one. Whenever there is an attempt to change the way we approach teaching science, we have to be very wary of slipping into what could be called pseudo-science. Pseudo-science is perhaps best described as something that purports to be scientific, looks scientific, even sounds scientific (in terms of the language it uses) but on close inspection it is not. It is a bit like a science ‘tribute band’ – it looks a bit similar from a distance, but doesn’t stand any degree of closer inspection. It normally lacks supporting evidence, employs non-scientific methods and cannot be reliably tested or verified. In this sense it is different from something that has come to be called ‘Bad Science’. Bad Science is just that, poorly designed, erroneous results, it is generally just poor practice. Any endeavor, however noble and well intentioned can be carried out badly, it sometimes happens and can be understood. Pseudo-science cannot.

Roger

 

Open Access Science and the Rise of Predatory Publishing

Following our summer hiatus from the blog Roger and I thought we would kick off this academic year with a piece on the changing nature of peer review and science publishing.

Like most professors we are finding our mailboxes more and more full of academic spam. If it is not companies trying to sell me transgenic rats, monogrammed lab coats in stylish colours or bioassay systems, its now invitations to present papers at conferences in exotic locations or publish with new journals I have never heard of (and usually well outside of my discipline). It’s enough to make me long for the days when I simply won the Nigerian state lottery a couple of times a week.

New technologies have arisen that now allow academics to publish more directly than ever before. Traditionally scientific work has been presented to the world for consideration of its merits and for challenge. The principle being that ideas and claims are independently examined, become refined, and bad ones rejected. This is a central part of the skeptical nature of scientific inquiry and remains a firm part of academic training, with PhD. candidates being required to defend their theses in robust discussion with their peers.

The peer review process for scientific papers prior to publication is an embodiment of this principle. The value is that the process is self-critical, and the conventional wisdom is consistently challenged. Modern science is pragmatic in that it presents ideas for peer review and openly invites opportunity for anyone to challenge the dominant theory if they can come up with alternative results or better explanations supported by evidence. Nevertheless, we know this culture is not value free as we have discussed previously, and there are costs associated with the dissemination of scientific information are traditionally passed on to the end-user. Hence, the large publishers tend to be driven more by circulation and sales goals rather than more altruistic motivations, especially with books. For example, you can have an innovative well written book but still get it rejected by major publishers as it goes against the flow and is considered unlikely to sell in any volume. Despite their expertise and peer-review systems publisher’s often still get this spectacularly wrong (J.K. Rowling being a case in point in the world of fiction)! If we look at the number of retractions in scientific journals too, we also see some evidence of flaws in this traditional system.

So, with the advent of desktop publishing and mass circulation using the web, alternative models for dissemination have now arisen in all forms of academic publishing. Open access (OA) is one such innovation, and supports unrestricted online access to peer-reviewed scholarly research. A declaration on the principles behind OA were made at a 2003 Berllin Conference.  Although primarily intended for scholarly journal articles,it now also encompasses a growing number of theses, and book chapters too.This is hardly new though, and John Brockman noted there was a culture, of scientists communicating directly with the public about their work in media back in 1995 (Brockman, 1995). Nevertheless, the ideas behind OA publication reflect a desire to provide faster and more open access to scientific work.

Basically OA comes in two flavours, gratis open access, which is completely open and free online access, and libre open access, which is free online access plus some additional usage rights. These additional usage rights are often granted through the use of various licensing agreements such as Creative Commons. Authors have two options with OA publication. They can either  self-archive their papers in an open access repository, also known as “green” OA, or publish in an established OA journal, known as “gold” OA. Central repositories such as PubMed Central are examples of green OA, whilst gold OA usually use a fee-for-service model that tends to range from $1000 to $3000 per paper (depending on the open journal). This is justified on the basis of the editorial support and peer-review services involved in the publishing process.

Struggling academics looking to raise the profile of their work are often encouraged to use OA services to increase their citation rates (I have been advised of his on several occasions in my career), and some granting agencies require OA publication in any proposals submitted. So, overall there is growing pressure for academics to use these new publishing models, and gold OA seems to offer a robust peer-review process on a par with established traditional journals.

However, what is becoming more concerning is that the fee-for-service model has become a boom industry and entrepreneurs have recognized good money can be made here. This has led to the rise of the predatory publishing tactics which we are now seeing. The term was conceived by University of Colorado Denver librarian and researcher Jeffrey Beall upon noticing the large number of emails inviting him to submit articles or join the editorial board of previously unknown journals. Here is a classic example from my mailbox last week:

Pharmacology and Alternative Medicine Therapeutics

Dear Dr. Garrett,

Scholoxy Publication‘s journals are International Journal of Education and Research welcomes and acknowledges high quality theoretical and empirical original research papers, case studies, review papers, literature reviews, and technical note from researchers, academicians, professional, practitioners and students from all over the world.

We coordinately invite you to submit your papers to Pharmacology and Alternative Medicine Therapeutics an Open Access (Gold OA), peer reviewed, international online publishing journal which aims to publish premier papers on all the related areas of advanced research carried in its field.

The Journal has strong Editorial Board with eminent persons in the field and carries stringent peer review process.

It all sounds very genuine and scholarly, apart from the fact I don’t know anyone in the pharmacology department who has heard of them (in a positive way), and I am not even a pharmacology or alternative medicine professor! This unsolicited invite is actually from a pay-per-publication service whose peer-review process is completely unverified, and I am certainly a little suspicious as to how “stringent” the peer review process is when each publication is accompanied by a cheque.

More subtly these new publishers are also engaging academics to join their editorial boards, or become reviewers on their prestigious journals. Another tactic reflecting these practices is the use of what seem like personal invitations to present at conferences (in reality they are mail-merged bulk mailings to spam lists). To highlight these issues, I see the Canadian Association of Witch Doctors recently submitted and got a spoof paper approved at one such peer-reviewed  OMICS conference. Again, for academics beginning their careers (or even established academics) these may seem like great opportunities to develop their profiles or get their work to a broader audience.

So how can we discern the predatory publishers from genuine scholarly OA providers? Luckily, there are some resources that can help.Jeffrey Beal provides an extensive list of dubious OA outfits on Scholarly Open Access. Worth a look as it’s amazing how many there are!

There are also several sites that provide journal rankings, so academics can check out the status of their chosen journal. E.g., in my discipline (nursing) there are the following examples:

Many disciplines also have lists of established journals in their field, such as INANE’s list of nursing journals. However, even these lists are not foolproof in terms of establishing the academic credibility of journals. For example  Nursing Science Quarterly (incredibly still published by Sage – note my earlier comments on publishers motives) makes several of these lists and although not a predatory publication, is hardly a paragon of scientific excellence, self-citation or rigerous peer-review practices. I think Roger would see this one fit his “isn’t that like asking your mum to review your papers?” category.

Overall, the rise of predatory publishing and how it will impact the broader scientific community and influence the public understanding of science is something of a concern. It seems the best advice for scientists everywhere is buyer beware. There is nothing wrong with traditional journals, and we should remember there are a good many reputable OA journals. However, the usual practice is you send them a paper: not you receive an invite from them. Sometimes good journal editors do solicit work from established researchers and theorists in the field. But, if an offer comes your way to join an editorial board, present at a conference or publish in a venerable new journal and it seems too good to be true, it probably is.

Onwards and upwards

Bernie

References

Beall J. (2012) ON Predatory Publishers http://chronicle.com/blogs/brainstorm/on-predatory-publishers-a-qa-with-jeffrey-beall/47667 

Brockman, J. (1995). The third culture. New York: Simon & Schuster