The future of biomedical publishing with a few

extra thoughts

Richard SmithEditor, BMJ

www.bmj.com/misc/talks/

What I’m going to talk about• What’s wrong now with our attempts to provide doctors with the information

they need?• Why might journals die?• Drivers of change for the future of biomedical publishing• What might the future look like?• For research studies• For journals• For peer review• For meeting the information needs of doctors• For pharmaceutical advertising• For research misconduct• HINARI

Current problems

• A picture that captures in one image how doctors feel about information

Current problems

• One man’s view

Current problems• Our current information policy

resembles the worst aspects of our old agricultural policy, which left grain rotting in thousands of storage files while people were starving. We have warehouses of unused information rotting while critical questions are left unanswered and critical problems are left unresolved. Al Gore

Current problems• On my desk I have accumulated journals and books as

information sources, and I assume that I use them. But in some respects they are not as useful as they might be. Many of my textbooks are out of date; I would like to purchase new ones, but they are expensive. My journals are not organised so that I can quickly find answers to questions that arise, and so I don’t have print sources that will answer some questions. On the other hand, there is likely to be a human source who can answer nearly all of the questions that arise, albeit with another set of barriers. An ordinary doctor

Current problems

• Think of all the information that you might read to help you do your job better.

• How much of it do you read?

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1%-10%

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90%

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Current problems

• Do you feel guilty about how much or how little you read?

Do you feel guilty about how much or little you read?

Yes

No

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

Conclusions of studies of doctors’ information needs during consultations

• Information needs do arise regularly when doctors see patients (about two questions per consultation)

• Questions are most likely to be about treatment, particularly drugs

• Questions are often complex and multidimensional• The need for information is often much more than a

question about medical knowledge. Doctors are looking for guidance, psychological support, affirmation, commiseration, sympathy, judgement, and feedback.

Conclusions of studies of doctors’ information needs during

consultations

• Most of the questions generated in consultations go unanswered

• Doctors are most likely to seek answers to their questions from other doctors

• Most of the questions can be answered - but it is time consuming and expensive to do so

• Doctors seem to be overwhelmed by the information provided for them

The information paradox: Muir Gray

• Doctors are overwhelmed with information yet cannot find the information they need

Information paradox

• “Water, water, everywhere• Nor any drop to drink”• The Rime of the Ancient Mariner

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

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 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

• "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 something better

• If you have an apple and I have an apple and if we exchange these apple then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.

George Bernard Shaw

MoneyWhat does the research community

do?• Do the research, often funded by public money, often costing

millions• Hand over the copyright to the journals• Do the editing, often unpaid• Do the peer review, almost always unpaid• Often do the technical editing, often unpaid• Buy the journals, often at inflated prices, some cost $10 000• Read the journals• Store the journals

MoneyWhat do the publishers do?

• May own the journals, although often they don’t• Manage the process• Lend the money to keep the process going• Design - usually minimal• Typeset, print, and distribute the journal• Market the journal - but often to libraries that have to have

them• Sell reprints - sometimes for $250 000 a time (nothing to

authors or funders of the research); can almost sell themselves• Sell advertising - often none

Money

• Money paid by all academic libraries per article for access to only those libraries that have paid

• $5000• Money paid by authors per article for

whole world to have access• $1500