Four futures for scientific and medical publishing

Strong forces are operating that may change radically the world of scientific and medical publishing. These include:

• The appearance and spread of the world wide web, opening up the possibilities that authors might communicate directly with readers and that many intermediaries may not be needed

• Increasing resentment in the academic community that it is having to pay ever more for information that it effectively produces itself

• The rise of evidence based medicine and systematic reviews in particular, making people understand how medical information is disorganised and “Balkanised” and that finding information is expensive and difficult

• Increased understanding of the “information paradox,” which says that doctors are overwhelmed with information and yet cannot find the information they need when they need it

• Increased evidence that most medical studies are of low quality and of limited relevance to clinicians

• Globalisation of medical publishing, exposing weak local products to strong international competitors

• Appearance of new players—such as HighWire Press, BioMed Central, and PubMed Central—who are trying to capture value that currently belongs to publishers

• Greater pressure on doctors to base their treatments on evidence

• Increasing recognition that information alone will not change practice

• Better understanding that improved health care will come not from exhorting individuals but by improving systems

• The rise of patient power and doctor-patient partnership, meaning that patients expect access to the same information as doctors and that patients' evidence is just as important as doctors' or research based evidence

• Growing acceptance that doctors cannot work effectively without considerable support from information and decision making tools

• The spread of handheld technology, opening up new possibilities of delivering “just in time” information

• Doctors and other health workers have to be regularly revalidated or recertificated

• Those doing applied research are becoming increasingly impatient with systems that reward basic researchers but not them, and …