Among the delusions I use to warm myself in the bleak midwinter, channeling Dr Who is not one. But as the 17th editor of The Medical Journal, now concluding its centenary year, I wondered if this was an oversight. As an adopted child wonders about his or her biological parents, I wished to know more about my predecessor and my kin. Who am I and where did I come from? Currently 30,000 medical journals publish 20 million scientific papers a year. Where to start? At the top, I decided. So my wife and I flew first to Chicago to the Journal of the American Medical Association (JAMA). I had not visited Chicago previously, at least not in this life.
JAMA’simpact factor is 30 meaning that every research paper it published in the previous two years is cited on average 30 times in subsequent papers. Ours is around 2 so I approached my encounter with humility, easier when suffering from Day 2 time-zone hangover. JAMA is in great shape, with energetic editorial leadership, with a keen appreciation of online, and realistically confronting the economic pressures known to print media everywhere. JAMA has not always been a happy place. Most journals I visited, especially those auspiced by a medical association, fire editors from time to time. Dr George Lundberg, the editor of JAMA was dismissed because, as the BMJ put it, ‘he published an article indicating that American university students did not think that oral sex was real sex. This coincided with the impeachment trial of President Clinton.’ The peer-reviewed paper reported a 1991 survey of 599 ‘students at a large mid-Western university.’ The executive vice president of the American Medical Association, Dr Ratcliffe Anderson Jr, said Dr Lundberg had ‘inappropriately and inexcusably interjected the American Medical Association into a major political debate that has nothing to do with science or medicine.’ ‘The current public debate regarding whether oral sex constitutes having ‘had sex’ or sexual relations has suffered from a lack of empirical data on how Americans as a population define these terms,’ the authors wrote. Their survey showed 60% of students did not consider oral-genital sex to be real sex: ‘almost everyone agreed that penile-vaginal intercourse would qualify as having ‘had sex.’’ A statement from Dr Anderson explaining the firing of the editor said that Dr Lundberg had threatened the historic tradition and integrity of JAMA. Dr Anderson claimed ‘JAMA has been misused in the midst of the most important Congressional debates of this century.’ Other editors fulminated about an assault on editorial freedom.
Editors can be fired and occasionally fired upon. In Ottawa to visit CMAJ, we stayed in a hotel between the war memorial and the houses of parliament. Michael Zehaf-Bibeau had not hatched his plan. At CMAJ, all papers go online first. Ten years of print left was a common view. A previous editor, John Huey, was fired after years of conflict with the CMA. Moral for today: always stand with your back to the wall especially in Ottawa; a violent city despite its Disneyesque beauty.
Monday: on the Acela from the Big Apple to Boston. I am visiting the NEJM. Boston is multiple universities surrounding coffee houses, Au Bon Pain, cycleways, and academic creature comforts. Dear me, the NEJM even has a Starbucks Coffee Dispenser in the staff room (as tidy and shiny as a neurosurgical operating theatre). Every paper is completely rewritten. Each staff member has an office.They have an impact factor of 50. Jeff Drezen the editor for 17 years, has a Keatingesque delight in clocks: they’re everywhere. One staff member spoke of ‘democratic dictatorship’. But the quality is indisputable. Ah yes, I almost forgot. In 1999 Jerome Kassirer, then editor of the NEJM, did not have his contract renewed (things are generally done surgically at Harvard) because the Massachusetts Medical Society that owns the NEJM wanted to split up its content, repackage it and sell to different audiences. No-fault divorce, just irreconcilable differences that once again led, in the opinion of fellow editors, to assaults on editorial freedom.
London: I visited the BMJ at Tavistock Square on one of those appalling grey, cold, wet days with hopeless traffic. Miserable bands of workers in the BMA were clustered around the entrances smoking. It is a massive, diverse, inspirational enterprise. It has done battle with pharmas in the past year seeking full disclosure of all clinical trial data, even that which shows new products don’t work. It is courageous and progressive. But Lancet seems like more fun and has a dozen or so independent lines – Lancet Oncology being the latest.
A most interesting encounter with Vitek Tracz, a friend of erstwhile BMJ editor Richard Smith, who specializes in open access publication. Richard left me unprotected over lunch while he had a hernia repaired at St Thomas’s. Vitek believes the future of research publication must be liberated from editorial whim and interference. Let an author pay $3000, have their paper on your site, nominate reviewers who analyse and say what they think and let the world decide. Vitek’s approach represents one of the polar extremes to medical publication. He curses NEJM as an inhibitor of scientific progress. Most of what is published is wrong, he says, and misleading, even when grammatically polished and tidied up.
Wednesday: back in Sydney. Much to consider with colleagues as we plot the course for the next couple of years for the MJA. We must do better to get research online. We need to consider what will make the remainder – opinion, reviews, summaries, guidelines, debates – interesting to our readers. And for the editor – me – a warning: watch your step.
