“Publish or perish” describes the intense pressure placed on academics and researchers to publish scientific papers regularly to establish and maintain their careers. Publications are frequently used as indicators of academic productivity and can influence recruitment, promotion, tenure, research funding, professional recognition, and institutional reputation. Scientific publishing is essential for communicating knowledge and advancing medicine and public health. However, when publication quantity becomes the dominant measure of academic success, it can create incentives that distort the research process. Moving from a culture of “publish or perish” towards one of “research well and communicate responsibly” requires a broader understanding of what constitutes valuable scientific contribution.
The pressure to publish can have some positive effects. Academic researchers are encouraged to remain productive, communicate their findings, contribute to scientific debate, and share new knowledge with the wider research community. Publications also provide a mechanism through which research can be evaluated, challenged, and built upon by other scientists. Peer-reviewed journals play an important role in this process by providing a platform for scientific communication and quality assessment. However, problems arise when the number of publications becomes more important than the quality, reliability, or relevance of the research itself.
One consequence of excessive publication pressure is the fragmentation of research into several smaller publications, commonly described as “salami slicing.” Instead of presenting a research project as one coherent contribution, researchers may divide findings into multiple papers to increase their publication record. While publishing separate papers can sometimes be scientifically justified, excessive fragmentation can make the literature more difficult to interpret and may prioritise publication metrics over meaningful scientific communication. Researchers may also feel encouraged to favour projects that can generate rapid publications rather than pursue complex questions requiring long-term investigation.
Publication pressure can also contribute to publication bias, particularly the preferential publication of positive, novel, or statistically significant findings. Negative, inconclusive, or contradictory results may be less likely to attract editorial interest or be submitted by researchers. This creates an incomplete scientific literature in which successful findings may appear more common or more consistent than they actually are. When evidence is selectively visible, researchers, clinicians, policymakers, and patients may make decisions based on an incomplete understanding of the available evidence.
The consequences can be particularly serious in health research. Medical research directly informs clinical guidelines, public health policies, diagnostic strategies, medicines, surgical procedures, and healthcare technologies. If research findings are unreliable, selectively reported, or difficult to reproduce, the consequences may extend beyond academia to patient care. Reproducibility is therefore a fundamental principle of trustworthy health research. Researchers should be encouraged to conduct rigorous studies, report methods transparently, share appropriate data and materials, and communicate limitations honestly. Scientific progress depends not only on discovering new findings but also on confirming, challenging, and refining existing knowledge.
The pressure to publish can also discourage researchers from pursuing long-term, interdisciplinary, and high-risk research. Some of the most important health challenges, such as antimicrobial resistance, climate-related health threats, emerging infectious diseases, health inequalities, and chronic disease, cannot be adequately addressed through short-term or single-discipline projects. They require collaboration between clinicians, epidemiologists, laboratory scientists, social scientists, engineers, environmental researchers, policymakers, and communities. Such research may take many years to produce meaningful outcomes and may not immediately generate a large number of publications. Academic evaluation systems should therefore recognise contributions that involve collaboration, capacity building, data resources, community engagement, policy development, and other forms of impact.
The publishing system itself also requires consideration. Scientific journals and publishers play an important role in peer review, dissemination, archiving, and quality control. However, the economic model of academic publishing can create tensions between commercial interests and the principle of broad access to scientific knowledge. Subscription costs may restrict access to research for institutions and individuals without sufficient financial resources, while article-processing charges associated with some open-access models can create barriers for researchers who cannot afford publication fees. These inequalities are particularly relevant to global health, where researchers in low-resource settings may face both limited access to published literature and difficulties in publishing their own research.
Predatory journals present another challenge. These publications may prioritise financial gain over rigorous peer review and editorial standards, exploiting researchers who feel pressured to publish. The growth of such journals illustrates how a system based heavily on publication quantity can create opportunities for low-quality scientific communication. Researchers, institutions, and funding agencies therefore have a responsibility to promote research integrity and support credible channels of dissemination.
Changing the “publish or perish” culture requires reform at the institutional and funding levels. Universities, research organisations, and funding agencies should adopt broader and more responsible criteria for evaluating researchers. Instead of relying primarily on the number of publications, citation counts, journal impact factors, or rankings, assessments should consider the quality, originality, methodological rigour, reproducibility, transparency, and societal relevance of research. The contribution of an individual researcher to collaborative projects should also be recognised rather than assuming that academic value can be measured solely through first or senior authorship.
Research assessment should also recognise contributions beyond traditional academic publications. These may include datasets, software, clinical guidelines, systematic reviews, policy contributions, educational resources, patents, community engagement, research infrastructure, and improvements in clinical practice. In health research, the ultimate value of a study should partly be assessed according to whether it contributes to better health outcomes, more effective prevention, improved healthcare delivery, or greater health equity.
Responsible communication is equally important. Researchers have a responsibility to communicate findings accurately, transparently, and in ways that can be understood beyond academic audiences. Scientific uncertainty should not be hidden or exaggerated, particularly when research findings are communicated to policymakers, healthcare professionals, journalists, or the public. Overstating preliminary findings can contribute to misinformation, unrealistic expectations, or inappropriate healthcare decisions. Responsible communication means clearly distinguishing established evidence from preliminary results, explaining limitations, avoiding sensationalism, and placing findings within the wider body of evidence.
The rise of digital communication and social media has made responsible scientific communication even more important. Research findings can now reach millions of people rapidly, but information can also be taken out of context or amplified without appropriate scientific interpretation. Researchers therefore need to develop skills not only in scientific writing but also in communicating evidence responsibly to patients, communities, policymakers, and the wider public. Effective communication should build trust rather than simply increase visibility.
In conclusion, the purpose of research is not to produce as many papers as possible. The purpose is to generate reliable knowledge that contributes to understanding, improves decision-making, and, particularly in health research, ultimately benefits patients and populations. Scientific publishing remains essential to this process, but publication should be viewed as a means of communicating knowledge rather than an end in itself.
Moving from “publish or perish” to “research well and communicate responsibly” requires a cultural shift in academia. Researchers should be rewarded for asking important questions, conducting rigorous and transparent studies, collaborating across disciplines, reporting all relevant findings, and communicating evidence honestly. Universities, journals, funders, and policymakers must create incentives that value quality over quantity and meaningful impact over simple productivity metrics. Such a transformation would strengthen research integrity, improve the reliability of scientific evidence, and ensure that academic research better serves society.
For health research in particular, this change is essential. Every published study can potentially influence clinical practice, public health policy, and patient outcomes. The scientific community therefore has a responsibility to ensure that research is not only published, but conducted well, reported honestly, interpreted carefully, and communicated responsibly. The future of academic research should not be measured by how much researchers publish, but by how much trustworthy knowledge they contribute and how effectively that knowledge improves health and society.
References
Sartelli M, Mossialos E, Coccolini F, Jammer I, Labricciosa FM, Barie P, Biffl WL, Memish ZA, Maeurer M, Kobinger GP, Ippolito G, Zumla A, Catena F; Global Consortium for Solidarity to Overcome Challenges, Restore Trustand Advance Science for a Sustainable Future. Global health at crossroads: uniting together to overcome challenges, restore trust and advance priorities for a sustainable future. World J Emerg Surg. 2025 Nov 10;20(1):84.
Receveur A, Bonfanti J, D’Agata S, Helmstetter AJ, Moore NA, Oliveira BF, Petit-Cailleux C, Rievrs Borges E, Schultz M, Sexton AN, Veytia D. David versus Goliath: Early career researchers in an unethical publishing system. Ecol Lett. 2024 Mar;27(3):e14395.
Author
Massimo Sartelli
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