Editorial: Are Medical Journals Obsolete?

Journals

The Internet has changed the world. Traditional medical journals are obsolete and should transition to modern on-line versions. Internet-based journals potentially solve most of the problems of contemporary print-media journals and enhance the peer-review and feedback-communication processes. In addition on-line journals could dramatically increase readership by providing access to information for everyone throughout the Internet. On-line journals would also allow the interactive exchange of ideas and would operate profitably.

For over a century, print medical journals have been around to disseminate information to physicians. I used to enjoy sitting in the stacks of the medical library and scanning the old books. Imagine my glee when as a junior faculty member, I discovered Dr. Casselberry’s Presidential address from the 23rd Annual Congress of the American Laryngological Association in the 1899 edition of The Annals. I had that book in my hand. I loved the old books — but that was then, and this is now. Today, I don’t even keep my medical journals after I read them; storage space is an issue.

Before burying traditional print journals and laying out my vision of the on-line journal of the future, let me briefly recount the history of the written epistle. For the last two millennia, letters travelled by foot, horse, train, plane, truck, and/or ship. A letter might take days, weeks, or months to arrive. The U.S. Postal Service was created in 1792, but the letter sorter to speed things up wasn’t invented till 1957. Both FedEx and email were started in the 1970s, but it wasn’t till the 1990s when personal computers became relatively affordable that email became popular. Looking at my mail today, I find that I get about fifty real emails (not unsolicited or spam) for every item that gets delivered in an envelope. Email is how we communicate in 2014. So, what’s wrong with traditional print journals?

Traditional Print Journals Are Slow To Get Information Out. After a paper is presented at a national meeting, it takes on average from six months to two years to get it published. This has to do with the peer-review process, the speed at which authors revise papers, the volume of publication-worthy material, i.e.,  journal size (page count per issue), and the printing and distribution processes.

Alternatively, on-line journals could publish abstracts and full-texts of articles presented and reviewed within days. For ease of handling, each on-line journal could specify its manuscript style. The page count of on-line journals is irrelevant as a there is no cost per page. In other words, unlike print-version journals, more pages do not cost more.  In addition, color photographs cost no more than black & white.

Traditional Print Journals are Expensive to Produce and Distribute. If the circulation of a journal was 10,000, and if it was sold at a price of $250, it would generate a gross income of $2.5 million. Adding $1 million in advertising revenue, the gross income would be $3.5 million. If the costs of editing, typesetting, printing, sales, distribution, administration, etc. were $3 million, the net profit would be $500,000.

On the other hand, the estimated maximum cost of managing a first-rate web-based journal would be less than $100,000, and so if there were only 2,000 subscribers at $100 each, the journal would break even. (In fact, I will soon start a new on-line journal with a budget of $15,000. Hint: Integrated Aerodigestive Medicine.)

If, however, the on-line journal were open to the public—all the abstracts could be viewed by anyone free of charge—the journal might then charge non-subscribers $2-3 for a PDF of each complete article (or perhaps in the form of a mini eBook). Thus, a popular, well-indexed article might generate a huge income. (I personally believe that excess journal profits should be channeled to fund research through an independent non-profit organization. In other words, the journal should not seek to maximize profit as if it were a strictly commercial entity.) The idea of opening up medical journals to the public, to the whole world, is exciting and appropriate. And every article might have a “layman’s synopsis” and a translator, so that absolutely anyone might be able to understand the ideas of every paper.

Traditional Print Journals Are Biased Against New Ideas and Employ a Sometimes-Defective Peer-Review Process. In our world today, conflicts of interest and corruption are common and sometimes even occur within the peer-review process. In my experience, the peer review process breaks down often, and there are several situations for this; if the reviewer has: (1) a personal dislike of, or personal conflict with, an author; (2) a personal bias for or against a certain way of doing things; (3) unwillingness to consider new ideas that challenge the reviewer’s basic understanding of the status quo; (4) the reviewer either misreads or does not understand the author’s subject; (5) a belief that only “evidence-based” papers deserve to be published, even though such articles may be just as flawed as other papers; and (6) a reviewer’s desire to prevent an author’s publication, because the reviewer wishes to publish a similar subject “first.”

The problem is that when a paper gets rejected, there is no rebuttal. Furthermore, what purpose is served by allowing anonymous reviews? I have been a journal reviewer for many years and I would be happy to have had my name at the bottom of every review. I would argue that if a reviewer can’t own up to her or his review, then it is likely that s/he may have a hidden bias.

In the on-line journal of the future, the peer reviews should be shown at the bottom of the article as the first comments in a string of comments. By making the reviewers’ comments the beginning, and not the end, of the paper’s critique, the review process becomes both more transparent and more complete. I suspect that this format would also make reviewers more respectful and objective.

Traditional Journals Are Insufficiently Interactive. If you write a letter to a traditional journal in response to an article, it may appear months later. With an on-line journal, comments might be posted much sooner. I believe that comments should be screened by the Editor and approved and/or condensed before posting. (Comments would be limited to subscribers, and no commercial references or links would be permitted.)

Having an ongoing commentary is exactly what journals need to make them more relevant. The proliferation of ideas and how they hold up to scrutiny over time is the most important task of good journalism in all of its forms.

Since on-line journals are not cramped for space and computer-friendly; they could be organized and cross-referenced by issues, years, authors, topics, and subtopics. There also could be established galleries of pathology. Certainly, another advantage of on-line journals would be having direct links to video-segments.

In summary, on-line journals will expand the influence of important medical ideas; they will encourage communication across different medical specialties; and they will allow for more rapid proliferation and exchange of ideas. Printed journals have had their day. Now it is time for us to move on-line.

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