Every institution needs to question its existence

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 …