The death of biomedical journals
Ronald E LaPorte, Eric Marler, Shunichi Akazawa, Francois Sauer, Carlos
Gamboa,
Chris Shenton, Caryle Glosser, Anthony Villasenor, Malcolm Maclure
Correspondence to: Dr LaPorte (rlaporte@vms.cis.pitt.edu) .
The musky scent of aging paper in our medical libraries still evokes an
atmosphere of scholarship. But the cloistered peace of the stacks is
increasingly punctured by the faint sounds of the coming revolution: the
clicks, beeps, and whirrs of computers linked to the internet. For whom do they
toll? Are they the death knell of biomedical journals as we know them? Or are
they the pealing spire of the global village summoning health scientists to the
electronic commons to share the harvest of knowledge?
We are at a watershed in biomedical publishing. For some time the costs of
paper journals have been mounting and the budgets of health science libraries
contracting, while the number of have nots in poorer countries clamouring for
access to medical literature has been growing (ref 2) But now the information
technology explosion that revolutionised banking and the airline industry is at
the gateway of the biomedical community.
As the hard copy journal system has started to decay, there has
been an
information technology explosion that, some argue, will completely transform
the exchange of information in the biomedical community. The current process of
biomedical publication expanded in the late 1800s. The approaches towards
delivery of information to the scientists have changed little during the 20th
century: mailed journals, text books, and scientific meetings. Transmitting
information through the journal system can be likened to the use of the
Addressograph in the 1950s for producing mass mailings, or the vinyl records
that we all re member. New technology came in to produce the mailings more
effectively and to "deliver" music to the consumers. Within a short period the
Addressograph and the record player became virtually extinct. We believe that
biomedical journals as we know them will become extinct in the next few years
as the result of the development and evolution of new, high powered electronic
information delivery engines which will revolutionise information exchange
among scientists and between scientists and the lay public.
The publication system
We publish to exchange information and to archive our
work with some degree of permanence so as to leave a paper trail of evidence
for future scientific work. We also publish for currency, to obtain promotion,
to obtain grant support, and to obtain accolades from our peers. A new research
communication system should be able to deal with these needs. It should be an
efficient system that helps us to obtain the information that we need quickly
and cheaply. It should also have as part of this a currency system whereby one
can determine which communications are viewed by the people in the field as the
"best," having the greatest "impact."
We are in the process of developing such
a system through the Global Health Network (ref 2.3) called the global health
information server (GHIS). This has evolved as the result of the information
superhighway (ref 2) and the internet's world wide web,(ref 4) which have
transformed the ergonomics of access to electronic information. Before these
technologies accessing the internet was (and still is for many users)
"irkonomics." They had to remember addresses and search lists and know what to
type and when. Now you just need to read, point, and click. How will the world
of health information look when every original paper, letter of criticism, and
review article, as well as every form, chart, and database in the computerised
world, is accessible with a couple of dozen clicks of a mouse? We envision new
forms of transmission of research communications.
The peer review system
The current peer review system involves prospective peer
review: articles submitted to journals are subsequently sent to reviewers in
the field, and these reviewers give comments and priority scores. The reviews
are sent back to the editorial board for the final decision. If it is positive,
the papers are posted back for changes, sent back to reviewers, and eventually
published. Often there is a 12-16 month gap between submission and publication.
The reviewers and the editors act as gatekeepers, and in some of the leading
journals, such as the BMJ, Lancet, or New England Journal of
Medicine, only
about 10% of the articles are published. As scientists we want to publish in
these journals because we reach a large number of people (the BMJ, for
example,
has a subscription of 110000); the articles in these journals are heavily
cited, thus we have a greater impact on the field; and publishing in these
journals is very prestigious when we look for tenure, grants, and new
positions. After publication, journals are then sent to individual subscribers
and libraries throughout the world. For an individual to subscribe to the
Lancet, New England Journal of Medicine, and the BMJ it costs over
$400, which
is more than the per capita income in many developing countries. The journals
accumulate quickly, occupying large amounts of space; many eventually find
their way to the dustbin, an enormous waste of natural resources.
Global information servers
It is time to develop the architecture for a new
global health information server, as all kinds of benefits could result. To do
this, we can learn from what has been developed in physics, as this field is
the first to have the courage to move beyond the print format and a print
"mentality." It has developed the first generation of electronic research
communications, and can serve as a starting point. In physics Paul Ginsparg in
1991 started the first electronic research communication system with virtually
no budget.(ref 5) It has grown rapidly and now has a user base of more than
40000, with the information retrieval on the system being the primary mode of
information technology. The hep-th (high energy physics theory) is an automated
system on the internet (see http://xxx.lanl.gov/). The system allows the
community of research users to electronically submit and replace research
communications and to search listings for subject and authors. It also allows
ongoing corrections and addendums. When a researcher writes a communication, it
is electronically submitted and archived. Users who subscribe receive a daily
listing of titles and abstracts of new communications and can use various
search engines to identify information of interest and obtain the
communications electronically.
This system is not an electronic journal, but rather an electronic archive of
scientific research communications. There is no peer review in the system. The
system runs smoothly, for virtually no cost. Why can't we do this in health,
and in fact improve on this system? Most people in health care have access to
the internet. The storage of information is not a problem any more - the cost
of memory has gone down very rapidly, such that collecting all the biomedical
literature is indeed feasible.
A global health information server
The work in physics was developed with 1990
technology; if we begin there and move to 1995 technology there are truly
exciting possibilities. A first step would be to archive existing and new
papers electronically. Currently most papers worldwide are created on some form
of word processor. It is not difficult to convert these to standardised coding
of the text. The files can be transferred to the global health network
information server by using the internet. The articles can be fully text
searched with the wide area information system (WAIS), and the article
retrieved. As with physics, daily listings of titles and abstracts would be
distributed through the internet.
The listings would be tailored to the interest of the readership. The search
functions in the electronic document server will revolutionise publications, as
they can be used to search electronically through text to find words and
concepts, something that is not possible with paper based systems. This
addresses one of the most important areas in research: that of information
discovery. There is the concern, however, that the articles might have to be
peer reviewed thus we need to consider new technologies for peer review. This
leads into the second step.
It is simple to develop a peer review system; before an article is put in the
archive, it is reviewed and then added to a moderated list. Opinion about
whether this is needed is divided. Perhaps a better approach would be to make
this a truly democratic system. When a title, abstract, or article is pulled
up, a comment card can also be seen. This rates the article as being in the
top, middle, or bottom third of articles in this subject. Also, comments can be
attached to the abstract or article, or directed exclusively to the authors of
the paper. In this system all the readers of the paper serve as the reviewers
of the paper. Individuals from developed and developing countries alike could
comment or ask for comments from the author or the other readers.
When pulling
up the abstract or the title so as to decide whether to read the paper, the
reader could also pull up the average "priority score" as well as the comments.
The selection could be based on reviewers who are researching that topic or are
otherwise concerned with the content - for example, statisticians. If papers
are poor, then the scientific community will most certainly indicate that they
are poor; this is the nature of science, and this is the nature of the
internet. This is analogous to choosing a film on the basis of film reviews in
the newspaper or on the basis of surveys of filmgoers.
An important component of the current journal system is prestige and
recognition. How should this be incorporated - if at all - into the proposed
system? In the ideal world we as scientists would just communi cate with one
another, and prestige "impact" - would not be relevant. We could design the
system idealistically to develop the most efficient way to communicate. The
paper journal system outlined above has within it measures of quality and
impact. In the proposed electronic system, quality would be determined by the
ratings and comments of the readers, perhaps the most democratic means
possible, as everyone can "vote" with ratings and comments. Impact can be
examined in several ways. The simplest is a count of how many times the article
is retrieved. A second measure would be analogous to a citation. In a hypertext
system it is easy to see how many times a research communication is referenced
and in fact retrieved. The greater the number of times a communi cation is
referenced and retrieved, the greater (presumably) the impact. This system
would be in many ways fairer than that which exists now for judging articles;
for someone coming up for tenure, the perceived quality of the papers, and
impact by researchers in the same field and in other fields, can be measured
directly.
The reader who wants to examine only "good" articles, or articles that are
being read by many people, could easily have a filter on the articles to screen
out, say, articles with a priority score of less than 2 - 3 or those read by
fewer than 400 people a week. In this system the peer review is not left to a
handful of people but involves the whole scientific community.
Coping with information overload
A major problem of the information
superhighway is too much information. In the global health information server
there can be software agents that learn what the reader selects to read. Thus
if a reader typically chooses diabetes articles and medical technology
articles, the agents will learn to select these, sifting out articles of no
interest to that reader.(ref 6)
Redesigning research communications
In general, electronic journals have failed as they have tried merely to take
the print format and make it electronic, rather than creating a new, much more
powerful and attractive format for biomedical research communications. The
nature of the information super highway also allows us to redesign the mode of
information transfer - the journal article itself. We are not dealing with
journal articles any more - we are dealing with research communications among
scientists. Thus the terms "article," "paper," and "publication" should die.
The latest internet technology uses the web/ hypertext language. An article
might have certain terms highlighted in the text: if the Cox proportional
hazard model were highlighted, a click on this would bring up information about
the Cox model. Citations would not be needed: a click on "Jones 1994" would
pull up the complete article. A click on the data in the article would allow
direct access to the stored data. We need not be constrained by text alone; a
click on "Ron LaPorte" could bring up a video with him saying how important the
work is.
We need to start to consider a brand new format for research communications,
as
many of the constraints of paper journals are being lifted. As the terms
"paper" and "article" convey a two dimensional print nature, it is best not to
use these terms, but rather "research communication. " In the new paradigm,
research communications are n dimensional as one can "jump" from one idea to
others, as in the example just given. The nature of the communications also
differs in that there will be a change in philosophy in that a print journal
article is permanent and almost impossible to change. With the new technology,
as comments are received and new analyses done, the authors can make ongoing
changes to the communication. Instead of scientists punctuating the corpus of
literature with their papers, as happens now, they can construct ever changing
stories as they do their research, and through hypertext these stories can be
much more easily seen in the web of the total information in that discipline.
We have grown to accept the technological advances of adding colour to old
black and white film with technology we can change and update our research
communications. Why do research communications have to be "permanent"? Why
shouldn't they change as new information becomes available? We could also
incorporate video and sound as part of research communications. Scientists will
begin to demand information such as this. There could be a parallel archiving
system for health information from the lay press, and lay people and scientists
alike could go from the lay press to the scientific literature at will. Because
these things are now possible, we believe that not only will the journals be
replaced, but their nature and format will evolve away from conceptualisations
of the paper or the article into something much more powerful.
Virtually all things are possible
Moving beyond this, we envision a virtual
communication facility with the establishment of a health "MOO" (multiple-use
dimension object oriented).' MOOs permit scientists the opportunity to "chat"
in real time, share data and information, and present research. In the area of
research communication, a user could "walk" down a virtual corridor and enter
the public health room and browse through the articles there.
These virtual systems are just being developed and hold considerable
opportunity. Users could also strike up conversations with other people in the
room. They can find the information they need as well as identify people with
common interests, such as those who read the same articles. In the room they
could also take classes and obtain a degree in the Global Health Network
University (ref 8) with classmates from around the world. They could
simultaneously show new research communications to their classmates. A global
health MOO thus represents the integration of varied research communication
systems with collegial interaction and training across the world.
An illustration of the power of the primitive electronic systems that already
exist is the response to a letter we recently published in the BMJ
requesting
that people contact us concerning participating in the Global Health Network
University.(ref 6) At about the same time as it was published in the journal it
was sent to several lists on the internet. The publication in the BMJ
brought
six letters and two electronic mail messages. The response from the internet
was over whelming: 147 email letters. Few of us receive more than a handful of
letters responding to our articles, yet a short electronic letter received an
electronic response almost 20 times that of print format.
Conclusions
Compared with the paper journal system as currently constituted,
the global information server most certainly is faster; research findings will
be presented to scientists in days rather than years. It is also less expensive
and potentially more equitable, at least for the type of information transfer
entailed in a short research communication. The new technology will foster much
more of an interchange among scientists through electronic mail.
The internet is spreading rapidly to almost all countries; thus researchers in
developing countries will have access to communication that they do not have
through print. For these reasons and others presented earlier, we believe that
the "printing" technology of the journals will rapidly be obsolete. If journals
are to survive there will have to be a profound transformation to n dimensional
knowledge structures. The people with the journals are skilled and can lead in
part this revolution. However, they need to shake themselves away from the
current mind set.
It is time that scientists begin to take control of their research
communication; the global health communication server allows this to occur. We
are just touching the capabilities of the systems. A discussion concerning the
development of the system will become available on the global health net home
page
We invite you to join the
dialogue. We should consider the development of a trial system for a specific
discipline, such as epidemiology or public health. This is similar to the
development of the server in physics. We need to develop this not only with
people in health but also with groups, such as the NASA Scientific Internet
(NSI) and industry, who are more advanced than we are in telecommunications and
who will allow us to take rapid advantage of the existing as well as future
technologies.
It is time to move beyond the vinyl records of journals articles to the CDs of
research communication on the electronic information superhighway.
Department of Epidemiology University of Pittsburgh
3460 Fifth Avenue
Pittsburgh, PA 15213, USA
Ronald E LaPorte, professor
Tarrytown NY, USA
Eric Marler, independent consultant
Geneva Switzerland
Shunichi Akazawa, information specialist
AT&T (GIS), Group of Enterprise, Design and Development
Boca Raton FL 33434,
USA
Francois Sauer, managing partner
Pan American Health Organisation
Washington, DC, USA
Carlos Gamboa, regional adviser
Sterling Software Washington, DC, USA
Chris Shenton, internet engineer
Pittsburgh, PA
Caryle Glosser, psychologist
NASA Scientific Internet
Washington DC
Anthony Villasenor, manager
Department of Epidemiology
Harvard University
Cambridge, MA, USA
Malcolm Maclure, associate professor