“…As has been widely described, the journal impact factor is calculated by summing the total citations during a given year to articles published in the previous 2 years and dividing this by the number of ''items'' (a number derived secretively by Thomson Reuters) published in the journal during that same 2-year period. 10,11,13,16,23,24,44 The ability of journal editors and publishers (particularly large and influential ones) to manipulate (and negotiate) the journal impact factor to achieve higher values has been well documented. 16,25,[45][46][47][48][49][50][51][52][53] Unfortunately, journals from small subspecialty fields are at a distinct disadvantage with fewer articles for possible citation, a smaller population of investigators, and little leverage to finagle higher journal impact factor values.…”