Medical journals are dead. Long live medical journals

From: Peter Singer <>
Date: Thu, 24 Feb 2000 20:24:38 +0000

PAS: I want to thank Prof Harnad for his insightful comments on my
paper, Medical journals are dead. Long live medical journals,
published in the Feb 22, 2000 issue of the Canadian Medical Association
Journal. The original paper is available on the CMAJ's website at My goal was to offer one vision of
the future. I set the piece in the future to give me some leeway to
challenge some traditional assumptions. I have responded to Prof.
Harnad's comments below.

> [pas] Some prestigious journals failed to make innovations in response
> [pas] to PubMed Central. They vigorously defended their ownership of
> [pas] articles by continuing to insist that authors assign copyright to
> [pas] them. Intent on protecting their subscriber-based advertising
> [pas] revenues, they continued to restrict access to their Web sites to
> [pas] paying subscribers. However, realizing that these policies
> [pas] limited the dissemination of their findings, authors no longer
> [pas] sent their best work to these journals. Subscriptions fell,
> [pas] advertisers defected, and some of the leading journals ran into
> [pas] financial trouble.

> [sh] This doesn't quite make sense: If revenues based on advertising rather
> [sh] than subscriptions, why would access be restricted?

PAS: My understanding is that the subscription base of a journal is the key
factor of interest to advertisers in medical journals. Advertisers have not
yet embraced banner ads on websites to the same degree. Access would be
restircted to sustain the subscriber base to the paper journal in an effort
to maintain advertising revenues.

> [sh] And it is unrealistic to imagine that authors will choose their
> [sh] journal by its web policy (or price) rather than its prestige
> [sh] quality and impact factor.

PAS: I understand the allure of brand name of the journal, but I dont think
the scenario is so unrealistic. Researchers want to communicate with each
other. It sometimes takes many months for some high profile medical
journals to review articles, and the articles may then ultimately be
rejected. Submission to more than one journal may be required before an
article is available to peers. Many journals will not accept articles that
have been posted as eprints. So, faced with the choice of a low probability
of publication in a prestigious journal and a long wait (often involving
submission to more than one prestigious journal) vs. immediate "publication"
as an eprint, authors with good work they want to disseminate may choose the
latter path especially if they have already jumped through the hoops of
academic promotion.

> [sh] Much more sensible for authors to stick to their preferred established
> [sh] journals and simply self-archive their papers in the Open Archives.

PAS: Journals ask authors to sign over copyright. I dont know whether
they would systematically agree to web publication of publsiehd articles in
a large proportion of their authors began to request self-archiving.

> [pas] Competitive advantage came from the value added for subscribers
> [pas] through customization and editorial commentary. Subscribers
> [pas] gratefully paid $200 per year for a journal, since the customized
> [pas] email commentaries saved them the time of sifting through
> [pas] information and helped them to apply new findings in their own
> [pas] practice.
> [sh] I doubt it; all this can be had for free, and peer review is the quality
> [sh] controller that guides the usage; commentary is just a supplement.
> [sh] (When it comes to peer commentary, I know whereof I speak!)

PAS: You put a lot of faith in peer review as a quality control mechanism.
Based on my reading of the recent BMJ book, I think it is reasonable to
concludethat the benefits of peer review are not completely proven and the
risks, in terms of suppression of innovation, not adequately examined.

PAS: These services are not available now. I am unaware of a customized
education service in medicine based on individual subscriber characteristics
or desires (the "Dell Computer approach" to medical publishing). As for the
availability of commentary, I am unaware of any source of commentary in
medical publishing akin to real commentary journals in other fields (the
"Economist approach" to medical publishing).

> [pas] Readers were well served by these changes. Research information
> [pas] was now available on the Internet upon completion of a study (on
> [pas] an e-print server), following journal review (on the journal's
> [pas] Web site) and in an historical archive (on PubMed Central).
> [pas] Readers appreciated the customization of content and the
> [pas] informative commentaries provided by journals.
> [sh] It's much simpler than that:
> [sh] Publishers will downsize to becoming only Quality Control/Certification
> [sh] (QC/C) service providers. Open archiving of the QC/C'd papers will take
> [sh] care of access and distribution for free. QC/C will be paid for by the
> [sh] author-institution out of annual S/L/P
> [sh] [Subscription/Site-License/Pay-Per-View) savings, and the literature
> [sh] will be free for all (commentary and all).

PAS: That is another vision of the future. Which one you hold depends in
part on your faith in peer review.

> [pas] University promotion and tenure committees were less enthusiastic
> [pas] about these changes. In the good old days they could rely on the
> [pas] "brand" of the journal in which an article was published to
> [pas] establish its merit. But some of the best "brand name" journals
> [pas] were running aground, and journal impact factors had converged.
> [pas] Therefore, tenure committees had to actually read articles and
> [pas] reflect on their worth. Of course, they were greatly aided in
> [pas] this task by the journals' detailed commentaries.
> [sh] This is unfortunately just speculation (and, I think, wrong). Impact
> [sh] factors will not converge on the free journals; they will stay with the
> [sh] high-quality journals. But self-archiving will force the high quality
> [sh] journals to downsize to QC/C and become free on the reader-end.

PAS: Free and high quality "journals" may not be mutually exclusive. The
Los Alamos physics archive is arguably both. The "journals" i envision are
high quality and not free but have some additional key features ---
commentary and customization. As for the issue of speculation, the reason i
set my article in the future is so i wouold have the leeway to speculate and
challenge some traditional views.

> [pas] By initiating a revolution in medical and scientific
> [pas] publishing, Dr. Varmus equalized access to medical knowledge
> [pas] around the world. Building on PubMed Central, the Word Health
> [pas] Organization launched its "Global Medical School" initiative,
> [pas] in partnership with the Gates Foundation, which developed and
> [pas] donated a "Global Doctor" Internet computer to every physician
> [pas] and medical student in middle- and low-income countries. These
> [pas] initiatives have improved the health of billions and brightened
> [pas] prospects for global justice and peace. Dr. Singer is
> [pas] supported by a Medical Research Council of Canada Scientist
> [pas] Award. The views expressed in this article are the author's and
> [pas] should not be attributed to his employers or supporting
> [pas] institutions.
> [sh] Maybe, or maybe not! See:
> [sh]
> [sh]

PAS: The possible direct linkage between innovations in medical publishing
and global health is arguably a unique feature of the medical arena which
ultimately may be the most important legacy of changes in scholarly
communication in medicine.

Peter A. Singer, MD, MPH, FRCPC
Sun Life Chair in Bioethics and Director,
University of Toronto Joint Centre for Bioethics
Professor of Medicine, University of Toronto
Medical Research Council of Canada Scientist

fax: 416-978-1911
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Received on Mon Jan 24 2000 - 19:17:43 GMT

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