The twenty-first Century changed our way of communication and also our way of reading and publishing science. Since Gutenberg our method of learning was associated with reading printed material and the Btraditional^way of being a scholar was associated with attending lectures made by teachers BEx cathedra^where knowledge was almost dogmatic and unquestionable. Universities were in charge of sharing the science. The practice of surgery was taught in the Boperating theatre^where technical manoeuvres were demonstrated by well-dressed attendings that eventually washed their hands after the case. A majority of surgical cases were amputations. [1] Museums and libraries are depositories of the efforts made over centuries to provide healing and hope, keeping medical evidence and sharing our knowledge with the upcoming generations. Medical Journals appeared in the eighteenth century and became rapidly peer-reviewed, this major step opening the way to criticism, doubt, questions and progress.With the Internet and electronic communication our traditions were challenged and new tools were developed. Patient databases became more reliable and easier to understand, medical statistics and meta-analysis became possible. A plethora of medical Journals appeared and competition between publications raised based on the visibility, readership and citations. This drive is associated with inherent growth in new publications that have short life span and have an aggressive behaviour [2] New values were based on the ability of a new publication to impact, change or improve current practice. When a paper is published in our days, the data, text, images and full information are available instantly everywhere. In this acceleration of publications, augmen