What future for medical
journals?
Richard Smith
Editor, 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?
•
•
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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
•
•
•
•
•
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full data, software, video, sound
extra material
links
interactive
updating
immediate posting
Problems with peer review
•
•
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•
•
•
•
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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