Editorial

New technologies in medicine and medical journals

ABI BERGER, SCIENCE EDITOR. 

BMJ

RICHARD SMITH, EDITOR. 

BMJ

For most of medicine the future is highly uncertain

Edwina Clark, a 42 year old woman with diabetes, no longer needs to test her blood sugar concentrations every day because she now has a glucose sensor implanted under the skin of her thigh. Her toilet at home provides a double check because it can analyse glucose, protein, and bacteria concentrations in her urine. Instead of giving herself daily injections of insulin, she now relies on an implanted insulin reservoir that automatically adjusts her insulin dose. Her blood sugar concentrations are so well controlled that she is unlikely ever to develop any of the vascular and neurological complications that used to be common.

The futuristic technology Edwina is using is almost here. Exciting advances and new technologies are appearing every day. We already have computer systems that make diagnoses, and telemedicine is beginning to challenge the need for hospitals. Patients are visiting the internet for many of their health needs. Future family doctors will provide expert guidance to patients who are better educated about their condition than their doctors. Some doctors have experienced this already--and enjoyed it. And once science enables us to know our own genome, we will be able to anticipate future health problems, change any risk taking behaviour, and have personalised treatments designed for us.

In this unusual issue of the BMJ, which shares its theme with many other journals including JAMA, we are not only looking towards this rosy future, but also trying to figure out which route to take. We examine a number of new technologies and promising scientific advances, but we have set them in the context of a world which is having to make harsh choices about what should be made available and to whom. Whether Edwina gets her implantable devices will depend both on financial resources and inequities in access that are already being faced.

In the shorter term we must question whether the presumed benefits of new technologies, invention, and discovery outweigh the costs. Sometimes more harm than good may occur. For example, Edwina may in future learn that she carries a gene for another disease that remains untreatable. She may also discover that implantable devices are only available to the rich or that they cause some unexpected harm. New information and options spawn new responsibilities.

For most of medicine the future is highly uncertain. Most diseases have multiple causes, and treatment decisions will have to be made through sophisticated risk analysis. So, while new technologies are exciting, better scientific understanding and limited resources are likely to make the decisions that Edwina and her doctors face not less but more difficult.

The future of medical journals is still more uncertain. Medical journals that comprise mostly research articles (most of them) are almost certain to disappear. Instead research studies will be published on a huge electronic database. The primary job of the surviving journals will not be to publish research studies but rather to visit the database, scavenge the studies that are important for clinicians (a small minority), and present them in as sexy and appealing a form as they can manage.

We have made an attempt with this theme issue to create the medical journal of the future. (Don't worry if you hate it: normal service will be resumed next week.) The paper version of the journal will present information in a condensed and attractive form as a trailer for the electronic version, which will be multimedia and rich in links to other information sources. Knowledge will come not in distinct chunks (an issue of a journal) but rather as part of a rich web that will cater simultaneously both for those who want a bite and those who want a full banquet. Thus this week's paper journal consists of many short and, we hope, readable, articles: long versions of each of these appear on our website (see the URL on each page for the specific address), together with more illustrations and several video clips.

Don't be scared of the future. Sit back and enjoy it with this recyclable BMJ.