„Always note and record the unusual…Publish it.“ (1)
While contemplating the evolution of medical publishing, one might be tempted to think of it under terms of the Recapitulation theory. Namely, as ontogeny recapitulates phylogeny, similarly it might be conjectured that both evolution of medical publishing, at least in its forms, and the stages of scientific production in a clinicians` career follow similar progression of evolutionary stages. In other words, a modern „evidence-based“ clinician, trough his publications, climbs the steep „Level-of-evidence“ pyramid, recapitulating much the growth of the pyramid itself; during his first clinical steps, he writes case reports, strives towards taking part in clinical trials, and, as he grows proficient in his field of interest, finally writes and publishes reviews and meta-analyses. Even though advocates make a strong case when substantiating that solely case reports bring attention to novel entities and are indispensable for medical progress, in the evidence based era of impact factors and citations, case reports are often considered invaluable, due to their low citation rates (14). However, case reports have not only changed and grown more complex in their form, but continue to report on a wide range of topics other than direct clinical experience. Similarly, the role of case reports has outgrown its primary purpose. In its beginnings case reports were intended to identify clinical novelty, following to alert of adverse reactions and highlight innovations, whilst today they play a significant role in medical education and emphasize ethical predicaments (2, 3).
Throughout the history of medicine, numerous case reports have played a major role, subsequently becoming highly cited works that often represent cornerstone publications in respective fields. Hippocrates, father of modern medicine, reported his findings in what would today be considered anecdotal form (11). Sigmund Freud reported of his patients, now considered famous cases which mark the beginning of psychoanalysis, in the form of case reports. Four weeks after performing the first ever human heart transplantation on December 3rd 1967, Christian Barnaard reported of it in a case report published in the South African Medical Journal (5). Case reports once again proved to be crucial publications in 1981, when a series of case reports reporting of unusual infections and neoplasms led to the formation of a task force intended to monitor these outbreaks, which eventually led to a discovery of a new syndrome, namely AIDS (6, 7,8). A recently published case series, which reported of a novel therapeutic option for Shiga-toxin producing Escherichia coli - Hemolytic-uremic syndrome, led to advancement in treatment protocol for refractory cases (9, 10). Although this example clearly shows that case reports still are an invaluable means of communicating medical novelty, from 1970s hither, the proportion of...