Does the world need the BMJ?BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7073.1 (Published 04 January 1997) Cite this as: BMJ 1997;314:1
Every institution needs to question its existence
- Richard Smith, Editora
To consider whether the world would be different if your institution disappeared is a sharper exercise than to compose its mission statement. Would the world miss the BMJ? The day that the BMJ is redesigned seems a good time for us to try to answer that question.
Nobody would start a new general medical journal today, and many that exist are beginning to disappear. Information scientists argue that there are too many journals, that much of what they publish is of poor quality, and that important material may be lost in a welter of the unimportant: the “signal to noise” ratio is horribly low.1 Meanwhile, enthusiasts for the Internet curse the slowness and exclusivity of paper journals and predict their imminent demise.2 They want a world where authors go directly to readers unimpeded by editors. The BMJ's environment may not thus seem inviting, but that is nothing new–of the hundreds of journals started at the same time as the BMJ (1840) only a handful survive.
The first thing to get clear is what the BMJ is. For many readers it is that “blue mag” that pops up once a week, but the BMJ is more than that. It is also the Student BMJ, 20 local editions (in countries ranging from Brazil to Poland, many in local languages), a version on the worldwide web, and two different classified advertisement supplements. In the future readers might encounter BMJ material in other forms, and we are currently planning an electronic version that will be interactive and will use all the possibilities of the Internet. We might in the future send you material that we know will be specifically useful to you, or you might electronically access the BMJ to answer questions that arise as you consult with patients. We will respond to what you want. My bet is that many readers will continue to want the traditional journal, just as most people want to watch major sporting events at the same time as everybody else. You want to be part of something and to have the opportunity to stumble across the unexpected. And one of the attributes of good journalism is to fascinate people with subjects they never knew were interesting or relevant to them.
Whether journals in general survive will be determined by whether they “add value”–whether their contribution to the process of informing and educating doctors is sufficient for readers to continue to pay them for it. Some journals, it has to be said, add little value.3 General journals like the BMJ tend to add more. We carry important scientific papers selected from the 5000 we receive each year and a great deal more. Our peer review system is well developed and is more concerned with improving the papers we publish than simply deciding which to publish. Through technical editing and design the material is presented in a way that can be understood by anybody, and we enhance the usefulness of the papers by publishing clusters on the same subject and adding editorials and commentaries. The aim is to deliver distilled material that helps doctors, who are always fighting time. And our audience stretches beyond clinical researchers. Indeed, our readers are probably our greatest asset.
But why does the world need the BMJ rather than any general medical journal? It may be because of its values, its flavour–something that is much more enduring than individual editors. The BMJ is the most general of the general medical journals, and it tries to provide readers with material from as wide a range of disciplines and methodologies as is necessary to practise medicine well. In particular, the BMJ has a long tradition of publishing research from primary care: at one time this may have seemed odd, but now the whole world is discovering the importance of primary care. One area where we have not paid enough attention is basic science, but we are starting today a new series of papers that will try to transmit to ordinary doctors the great excitement of basic science (p 43).
The heart of medicine is still the clinician consulting with the individual patient, and that is the lodestar of the BMJ. We are rooted in clinical medicine, and nothing gives us greater pleasure than to publish a scientifically sound paper with a message that will benefit patients directly. But medicine, like most important activities, is becoming increasingly complex. The modern doctor can benefit from the work of molecular biologists, philosophers, statisticians, physicists, sociologists, economists, and others. A broad range of methodologies–from clinical trials to anthropological observations and beyond–is needed to move medicine forward.4 The BMJ explores that whole terrain and tries to present what it finds in a way that will be understandable and useful to doctors. We also aim to reach out to the many people other than doctors who are vital for improving health. Readability has always been one of our core values, but so is being rigorous. We want to make the journal both more rigorous and more readable, and we believe both can be achieved at once. One without the other is worthless.
Another longstanding value of the BMJ is being international. The future of successful medical journals is undoubtedly global. Yet, one of the BMJ's greatest strengths is that it is the one journal read by most doctors in Britain: based on the 110 000 members of the BMA, the BMJ is the forum where British medicine can decide what it thinks. Isn't this a paradox–being international and being British? We see it as a challenge. Britain at its best has values that the world appreciates: impartiality, fairness, honesty, rigour, clarity, an enthusiasm for debate, irony, and humour. The BMJ aims to bring those values to an international medical audience and to present British doctors with an international view of medicine–because every challenge faced by British medicine is being faced somewhere else as well. In pursuit of still greater international understanding we have appointed an editorial board that includes 28 members from outside Britain (p 52) and international networks of advisers on basic science, education, primary care, and information for health.
The BMJ is committed to education as defined by William Butler Yeats–“not the filling of a pail but the lighting of a fire.” When we ask readers what they want more of (which we do regularly), they always answer, education. The BMJ offers education within a scientific context and encourages questioning rather than acceptance. One of our educational precepts is that information must be presented in many different forms, ranging from the highly successful ABCs (invented by my predecessor, Stephen Lock) through controversies to in depth systematic reviews. We continue to explore new educational methods, and the Internet opens up new possibilities.
Ernest Hart, the great 19th century editor of the BMJ, said that “a subject needing reform has to be kept before the public until the public demands reform.” The BMJ led many important reforms in Victorian Britain, and, like the BMA, continues to campaign on many issues–including inequalities in health and the harmful effects of tobacco. Another closely related job for the BMJ is to put before doctors things that they don't necessarily want to hear. Hugh Clegg, editor from 1947 to 1965, wrote that “a medical editor has to be a keeper of the conscience of a profession, and if he tries to live up to this ideal he will always be getting into trouble.” Increasingly editors are not “hes” and editing is a team activity, but the notion of pricking the profession to examine itself lives on.
Is all this enough? We are confident that readability and rigour, important and sometimes surprising material from all of medicine and beyond, an international scope, and an urge to campaign and amuse will mean that it is–even if the journal is beamed directly into your brain by satellite rather than pushed through your letterbox.