Richard Smith has spent 25 years working for the British Medical Journal and is now the chief executive of the United Health Group’s operations in Europe. At a benefit event on November 21 for the newly launched Open Medicine Journal, an open access peer-reviewed medical journal, Smith sat down with John Hoey, former editor of the Canadian Medical Association Journal, to offer an insider’s view on medical journals.
A qualified medical practitioner in Edinburgh, Smith became editor of the BMJ publishing group in 1991. He decided to investigate the topic of medical error after reading several compelling studies on American healthcare and identifying many similarities with the United Kingdom’s publicly-funded National Health Service. Smith then wrote an editorial, voicing concerns about patients mishandled by the British medical system and calling for action. The swift reply from the president of the Royal College of Physicians in London brusquely rejected the notion: “How dare you suggest people in the NHS are being damaged by medical care?” According to Smith, this issue illustrates one of the most fundamental roles of medical journals—to point out to uncomfortable truths the public would prefer to ignore.
In 1997, BMJ was the first major journal to put its entire catalogue on the Internet. The incentive of attaining a much wider audience outweighed the concern of less revenue from lost subscriptions. This move led to a reader shift.
“It would take three to four weeks for the journal to be received in Australia. Now we would have it all embargoed until midnight London time, which of course was morning in Sydney. They were now the first to engage with the journal. So now we suddenly had a huge number of electronic letters coming in from all around the globe,” said Smith.
The journal had roughly 115,000 copies circling the globe, with 100,000 going to the British Medical Association.
“Absolutely none of their money that they paid in subscriptions came to us. Instead all that money went on big dinners, lobbying, robes, and all that stuff,” said Smith.
The traditional model of publishing had scientists submitting their research for free while journals charged fees for access to the information. This newer model is markedly different: the institution pays for the peer-review process—which can be compromised by personal vendettas and is mostly useless, according to Smith—and the costs of putting it all up on the web. Since research is being funded, Smith said, to add on a comparatively small amount of money for all-access use is only logical. Potentially, this could become a self-sustaining business model in the future.
“You’ve written it, commissioned it, shaped it. There is an argument to be made that it is not unreasonable to charge for that because the better you do it, the more income you’ll get and you can reinvest it,” said Smith.
Since 90 per cent of the articles submitted to journals are ultimately rejected, it seems reasonable to charge a submission fee. This would lessen the economic burden on the research that is published and would be an incentive to submit high quality articles.
So what is the single most important factor for comparing the productivity of different journals and research groups? In the world of publishing, it is the impact factor, the number of times a journal is cited for each article published based on a three-year period.
“People crave the impact factor. We had an example in London of someone who had a 3-star rating in his restaurant and lost one and jumped out of the window. I think that is what is going to happen with impact factors, some editor is going to kill himself or herself if it goes down by 0.02 or something,” said Smith.
But it’s difficult to differentiate a high-quality journal from one whose impact factor is bolstered by a large number of papers. This also discriminates against subjects with a slower publication pattern, such as archaeology, as opposed to quick-moving fields like molecular biology.
With the ongoing technological revolution, perhaps journals as we know them will soon cease to exist.
“I met a young doctor in London last week, and he is in the last stages of producing a sort of Facebook for doctors. To try and think what is going to be the role of the CMAJ or Open Medicine in the age of Facebook is quite challenging. And just maybe this whole community thing will happen through this technology rather than sending out what some perceive to be the holy words of medicine in these journals,” said Smith.
But for the present: can we trust medical journals? The answer seems to be a definite “no.” The take home message from Dr. Smith was clear:
“More transparency will create more trust. But transparency won’t substitute for trust. There will always come a point when you will have to trust. I think you have to be very canny- not take everything at face value. Science is about provisional truths. It’s quite likely that we know that there is evidence pointing in one direction, but quite soon it will be pointing in another. In God we trust. All others bring data.”
