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1840 marked the introduction of the penny post and the first issue of the Provincial Medical and Surgical journal (the BMJ's precursor).(ref 1) Since then the journal has depended crucially on the postal services for its distribution. Any change to this intimate relationship has been unthinkable - until the arrival of the internet.
The internet is a global network of computers that allows communication among its estimated 30 million users.(ref 2) As Enrico Coiera points out in his article on recent advances in medical informatics (ref 3) one of the internet's most important recent innovations has been the creation of the World Wide Web, which allows users to exchange not only text (email does that) but images, sound, and video. Documents are stored as "home pages" at "web sites" and are available for the price of a local telephone call to anyone with a computer, a modem, and a contract for access to the internet. Two years ago there were about 100 web sites; on current projections this will have increased to about 40000 by the end of this year.(ref 4) From this week the BMJ will be one of these sites - the first general medical journal to launch itself into cyberspace. For the journal the consequences may be as far reaching as the introduction of the penny post.
Users will now be able to scan the list of contents, read the editor's choice, pick out from the page headed "This week in BMJ" what interests them most, and download the full structured abstracts of these papers. Some articles will be available in full text (for example, in this week's journal all the articles on electronic developments). As more of the "hard" copy of the journal is produced electronically we hope to increase this proportion.
Past issues of the journal will be available from an electronic archive, as will our advice to authors on the conduct and presentation of research. Details of other journals and books published by the BMJ Publishing Group (with ordering facilities) will also be provided.
Speed of delivery is an advantage that will most appeal to readers outside Britain. Whereas more than 95% of readers in Britain receive their journal by the publication date, other Europeans have to wait three to four days, east coast Americans a week, and Australians nearly a fortnight. Now readers everywhere will have access to the journal from the moment of publication. Making the journal more widely available is another advantage. We are painfully aware that subscriptions to journals are an unaffordable luxury in many countries.(ref 5,6) Funding agencies, such as the World Bank, are targeting the telecommunications systems in these countries for modernisation, so that in the near future their medical libraries are much more likely to have computers connected to the internet than a rack full of current journals.
One of the features of the World Wide Web that provides special advantages to journal readers is that it allows links to be followed - both within documents at one web site and between documents at different sites.(ref 7) For example, in the electronic version of this editorial the mention of Coiera's article on medical informatics in the second paragraph is underlined. To call up the full text of this article, readers of the electronic journal need only click on the highlighted text.
We are restricting most of the BMJ's home page to text because images, sound, and video take a long time to download with currently available software. But there are tantalising possibilities for the future - for example, our recent fortnightly reviews on Parkinson's disease could have included video clips of parkinsonian gait and tremor. The linkage functions of the web mean that access to a paper could provide simultaneous access to any correspondence and editorial comment it provoked. Linkages could provide the full text of references to papers, and the full text of references to references (and so on), so that readers need no longer take authors' interpretations of earlier work on trust. Authors' original data could also be made available through an electronic archive linked to the paper.
Predicting the future of electronic publishing is as risky as any other branch of futurology. For some commentators the world wide web is just another piece of whizz bang technology looking for a use. But for others the web is the greatest advance in information transfer since the invention of the printing press, and after a few moments' reflection it's easy to appreciate why they might think this. Electronic journals manage without paper, print, postage, and most of the current production process - which together account for much of the cost of traditional journals. Some people believe that electronic publishing will fundamentally change the way that science gets done and may even spell the end of scientific publishing in its current form (ref 8)
We hope that the BMJ's presence on the internet might help to change the one - to - many relationship.the journal has with its readers. The electronic medium allows for much greater interaction than the traditional format of the journal, and our home page makes it easy for readers to send their comments back to us. At present we have just dipped our toes in the water; future electronic developments will be closely informed by what our readers tell us they want and need. For those who felt out of their depth on reading the title and subtitle of this editorial and now feel that they are drowning we will be offering a more detailed guide to the internet and the World Wide Web in future issues, which is likely to be followed by a regular column devoted to the topic.
Visitors to this year's annual representative meeting of the BMA in Harrogate in July will be able to see our home page at first hand - and so, from this week, will anyone with access to the internet, from Addis Ababa to Zagreb.
Tony Delamothe Deputy editor BMJ London WC1H 9JR bmj@bmj.com
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