Reflections on feces and its synonyms

As medical parasitologists we tend not to be too squeamish when discussing human feces. They represent one of the “five F’s” of parasitology – feces, fingers, flies, food, fomites – and indeed, most of the world’s poor living below the World Bank poverty level lives with intestinal worms and consequently parasitic helminth eggs in their feces.

Lester & Charlie Present

Image Credit: Lester & Charlie Present

Still, we were caught a bit off guard when one of the staff at PLOS Neglected Tropical Diseases telephoned to give us a heads up that we were about to publish “An In-Depth Analysis of a Piece of Shit: Distribution of Schistosoma mansoni and Hookworm Eggs in Human Stool” by Krauth et al.  The voice on the other line said the article had gone through extensive peer review as well as reviews by both Associate and Deputy Editors, and it was to go live in a couple of days.  They called because we should know that as the Editors-in-Chief we still had the prerogative to change the title.

It was an interesting dilemma!  After all, the article had gone through multiple layers of review, and frankly, PLOS Neglected Tropical Diseases is first and foremost a community-journal for the community of scientists and public health experts committed to the NTDs.  So our first thought was the community had spoken, and who were we to interfere!

But to reassure ourselves we thought to look for precedence.  Somehow we felt better knowing our journal would not be the first to use the S word.  A PubMed search using the word shit revealed about 30+ publications in the biomedical literature.  The majority were written by scientists with the family name of Shit.  None of these provided much guidance.  There was a paper in the J Hist Med Allied Sci, entitled: The history of shit: an essay review, but basically we were on our own on this one.  We wound up emailing and telephoning a few trusted colleagues to obtain some constructive feedback.  It was interesting to note that there was a pretty even split.  Older colleagues were mostly dismayed, while younger colleagues thought it was just great.

In the end we went with the community and the younger colleagues, and so far haven’t looked back much.  Since its publication in December of 2012, the Krauth et al article has gotten over 176,000 views and 12,000 shares in Social Media , the latter of which is the current highest for any paper published in a PLOS journal. Interestingly, the article made the Internet and Twitter rounds without any specific promotion from PLOS Twitter or Facebook accounts. There were also several articles written about it in The Scientist (“Deep Doo-doo”), Times Higher Education (“This worthwhile piece on shit”), and numerous blogs. The majority of the internet coverage was quite favorable and supportive; nearly all noted that the contents of the paper had very real importance for health practitioners around the world. Its significance has been noted outside the blog community as well, as it’s been recommended by F100Prime and given the endorsement by a leading Faculty Members as a methodological advance. It has also been referenced in the Wikipedia pages for Helminthiasis and Soil-transmitted helminthiasis, and at the writing of this post, Kauth et al. has 9 citations in the literature. You can bet it’s not all because of the title. The scientific merit of the work stands on its own, and it being widely distributed is just more of a good thing.

The family of PLOS journals have an important role in biomedical publishing as leaders who are willing to push the envelope, provided it does not single out any one particular group.  After all, we helped to pioneer the concept of Open Access at a time when this was considered highly controversial.  In the end, we think the paper by Krauth et al is an important one and provides a significant contribution to the NTD literature. We’re proud to have it in our journal!

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