Balkanisation• If you are a gastroenterologist the research that

might matter to you may be in 30 different journals

• The difficulty of doing systematic reviews• Important research articles are all over the place,

some in Pubmed, many not• Even if you can find the stuff, it costs a fortune to

gather it all together (systematic review on research misconduct -£2000 to get photocopies)

Slowness

• For many journals the time between submission and publication is over a year--unacceptable

Dangers of predicting the

future

• I never make predictions, especially about the future. Sam Goldwyn Mayer

Research will be made available for free on publicly accessible

databases

Journals in the new world

• Not “business as usual” but reinventing ourselves

• Probably far fewer• Concentrate on meeting the needs

of readers/ a community rather than authors

Journals in the new world

• Rather than peer reviewing whatever is sent to them they would select relevant material from Pubmed Central and present it in an attractive way. (What the BMJ has always done).

• All the rest - education, debate, reviews, what’s on. Forum for debate “Be the glue that holds a community together”

Journals in the new world

• Use all the possibilities of the electronic and paper world

• 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 • full data, software, video, sound• extra material• links• interactive• updating• immediate posting

Problems with peer review• 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

Towards online peer review

• Reviewers identity revealed to authors (RCT)

• Reviewers’ comments posted on the web of accepted papers (RCT underway)

• Reviewers’ comments posted as available

• Training reviewers (RCT)

Vision of peer review

• “Peer review is changed from being an arbitrary decision made in a closed box to an open scientific discourse.”

A vision of a better information tool for clinicians 1

• Part of the information system that doctors use as they see patients

• Able to answer highly complex questions

• Connected to a large valid database• Electronic• Fast

A vision of a better information tool for clinicians 2

• Easy to use• Portable• Prompts doctors in a way that’s helpful not

demeaning• Connected to the patient record• Gives evidence related to individual

patients• A servant of patients as well as doctors• Provides psychological support

Future of pharmaceutical advertising

• Currently nationally based• Will become regional (European) and

global• Currently mostly on paper• Problems with internet advertising

– too easy to ignore– can turn it off– low click through rates

Future of pharmaceutical advertising

• Will surely be “where the eyeballs are”

• May need to be more intrusive (pop up ads)

• Needs to be more imaginative• Would you prefer to pay for an ad

free journal or get a journal with ads for free?

Research misconduct

• There’s a lot of it about• Prevalence depends on definition• A fifth of papers are published more than

once• Most authors have conflicts of interest but

most don’t declare them• Fabrification, falsification, and plagiarism are

less common, but the Committee on Publication Ethics has dealt with 200 cases in five years

Research misconduct

• It occurs because “Why wouldn’t it?”• We need codes of good practice and

training for prevention• We need systems for investigation,

judgement, punishment, research, and leadership--most countries don’t have them

Overcoming the digital divide

HINARI

• Three years old• 45 publishers• 113 countries, hundreds of institutions• 1500 journals free or at low cost• As good--if not better--access than in

London, New York, or Paris• Just rolled out to agriculture

HINARI--challenges• Improved access• Training• Local publishing• Reaching the front line• Information flow within the developing

world and to the rich world• Avoiding the information paradox• Creating cultures of reading and debating

Conclusions

• We do a bad job of meeting the information needs of doctors

• Medical journals are full of defects• Various strong drivers mean that

research studies will eventually be published on the web

• The role of journals will be to select what’s relevant and important and present it in a sexy way

Conclusions

• Doctors will work all the time with information aids

• Peer review will become more open• Pharmaceutical advertising will continue• Research misconduct is endemic and

needs a coherent response• The digital divide is closing fast

The future’s coming to crush you

• When the steamroller comes through you’re either part of the roller or part of the road.

Stuart Brand