What future for medical journals?

Richard SmithEditor, BMJ

http://bmj.com/misc/talks/

What I want to talk about

•Dangers of predicting the future

•What’s wrong with now•Drivers of change•How might general journals

look in the future

Predictions of Lord Kelvin, president of the Royal Society,

1890-95

• Radio has no future• X rays will prove to be a hoax• Heavier than air flying

machines are impossible

What was predicted

• The paperless office• The leisure society• The death of the novel

What wasn’t predicted

• The collapse of communism• The explosion of the internet• September 11

What’s wrong with

now?

Words used by 41 doctors to describe their information

supply• Impossible Impossible

Impossible Impossible Impossible Impossible

• Overwhelming Overwhelming Overwhelming Overwhelming Overwhelming Overwhelming

• Difficult Difficult Difficult Difficult• Daunting Daunting Daunting• Pissed off• Choked• Depressed• Despairing• Worrisome• Saturation

• Vast• Help• Exhausted• Frustrated• Time consuming• Dreadful• Awesome• Struggle• Mindboggling• Unrealistic• Stress• Challenging Challenging

Challenging• Excited• Vital importance

The information paradox

• “Doctors are overwhelmed with information but cannot find information when they need it”

• “Water water everywhere, nor any drop to drink”

What’s wrong with medical journals

• Don’t meet information needs• Too many of them• Too much rubbish• Too hard work• Not relevant• Too boring• Too expensive

What’s wrong with medical journals

• Don’t add value• Slow every thing down• Too biased• Anti-innovatory• Too awful to look at• Too pompous• Too establishment

What’s wrong with medical journals

• Don’t reach the developing world• Can’t cope with fraud• Nobody reads them• Too much duplication• Too concerned with authors rather

than readers

What are the drivers of a new form of publishing?

• Failures of the present system• A vision of something better• Money• Balkanisation of the literature• Slowness

A vision of something better: for researchers

• "It's easy to say what would be the ideal online resource for scholars and scientists: all papers in all fields, systematically interconnected, effortlessly accessible and rationally navigable, from any researcher's desk, worldwide for free.” Stevan Harnad

A vision of a better information tool for

clinicians• Electronic• Fast• Easy to use• Portable• Able to answer highly complex

questions• Connected to a large valid database

A vision of a better information tool for

clinicians

• Prompts doctors in a way that’s helpful not demeaning

• Connected to the patient record• A servant of patients as well as

doctors• Provides psychological support

Future of scientific papers• Will be “published” on the world wide

web--perhaps Pubmed Central or an open archive

• They will be multimedia and include raw data and the software used to manipulate it

• They will be live not dead documents

Journals in the new world• The future is not paper or electronic but

paper and electronic, using the strengths of each medium

• Not “business as usual” but “reinventing ourselves”

• Probably far fewer• Concentrate on meeting the needs of

readers/ a community rather than authors• “The long march from Brain to GQ”

Journals in the new world

• Rather than peer reviewing whatever is sent to them they would select relevant material from Pubmed Central (or whatever) and present it in an attractive way. (What the BMJ has always done).

• All the rest - education, debate, reviews, what’s on, obituaries

• Forum for debate

Journals in the new world• “Be the glue that holds a community

together”• ELPS (electronic long, paper short)• Online open review• Copyright back to authors - each does

what they want, payment to authors for reprints

• Benign publishers - low profit professional societies

ELPS (Electronic long, paper short)

• Paper - easier, shorter, brighter, more fun, more readable

• Electronic • full data, software, video, sound• extra material• links• interactive• updating• immediate posting

Problems with peer review

• Slow• Expensive• A lottery• Ineffective• Biased• Easily abused• Can’t detect fraud• Works for improving studies not selecting which

to publish• Can’t detect fraud

The power of peer review• Forgive me if I return it without formal

review, but I am totally unqualified to comment. You need someone with a postgraduate training in epidemiology, not an unlearned professor of neurology.

• Having said that, the paper is clearly rubbish…

The power of peer review

• Reviewer A “I found this paper an extremely muddled paper with a large number of deficits.”

• Reviewer B “It is written in a clear style and would be understood by any reader.”

Towards online peer review

• Reviewers identity revealed to authors (RCT)

• Reviewers’ comments posted on the web of accepted papers (RCT)

• Reviewers’ comments posted as available

• Training reviewers (RCT started)

Vision of peer review

• “Peer review is changed from being an arbitrary decision made in a closed box to an open scientific discourse.”

Conclusions• We get the future wrong all the time• There are many problems currently with

the information supply to doctors• There are many problems with journals• Original articles will be posted on the

internet

Conclusions• Clinicians will have their information

needs met in other, far more effective ways

• The future for journals is paper and electronic, using the strength of both media

• But we need to reinvent ourselves, becoming more like GQ than Brain