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The Trouble with Medical Journals by Richard Smith: an alternative view

BMJ 2007; 334 doi: (Published 18 January 2007) Cite this as: BMJ 2007;334:125
  1. Pritpal S Tamber, managing director, Medicine Reports Ltd

    I am amazed that the BMJ has published such a negative review of a book that should be shaking medicine's foundations (BMJ 2007;334:45). Medical publishing has many failings; the fact that this book is not compulsory reading for everyone may well be yet another.

    Although starting positively, reviewer Stuart Derbyshire describes Smith's concerns as not “obviously supportable.” Smith, together with colleagues at JAMA, has probably done more than anyone to search for “evidence” for the true value in the cornerstone of medical publishing: peer review. Much of the research conducted at the BMJ during his tenure showed that there is little or no objective value to the process,1 yet journals and their editors persist with—and advocate—peer review; their only defence is that “there's nothing better,” even though few have tried to find an alternative (to my mind there is a notable exception, the system used by Biology Direct2).

    Derbyshire also talks of the “essentially positive fundamentals of the profession.” Although this may be true, one has to remember that so much can rest on a publication—a job, a promotion, a grant approval, the licensing or the withdrawal of an intervention. It would be naive to believe that all medical publishing is informed by these positive fundamentals. Indeed, more and more articles describe how unscrupulous authors have “played the system” and corrupted the scientific record, bringing potential harm to patients worldwide.3 Many editors have anecdotes about the behaviour of authors, reviewers, and readers whose “moral character” has not been enhanced by their chosen profession.

    To my mind, the book is brimming with important ideas, but Derbyshire describes these as “neither necessary nor helpful.” The one that he dismisses in detail is putting patients on to editorial boards: his rationale is that this would put “the journal into the hands of novices who have no stake in the intellectual integrity of the journal.” He implies that editors are not novices, but this is untrue. They may be experts in their scientific or clinical fields, but few editors have even a basic understanding of editorial or publishing matters, including the pros and cons of peer review. This is usually not through any fault of their own, but the result of an institutional failing within medical publishing. Editors are often appointed without any clear process, there is no formal training, only recently has a code of conduct been devised (but few journals have adopted it),4 and there is no way to measure whether an appointee has done a “good” or “bad” job. I cannot think of any other respected profession that would allow such a flawed recruitment and training process, especially when there is so much at stake.

    Derbyshire then says that the “status of a journal is a matter for the members of the discipline that the journal supports,” but those of us within the publishing industry will know that often the only entity that really matters is the owner, as is evidenced by the constant firing of respected editors.5 6 He also seems to be appalled at the idea of having “consumerist views” at the heart of medical research—yet it would seem to me that being patient focused is key to the business of health care (and let us not be fooled into thinking it is anything other than a business).

    Finally, I am deeply saddened to see the BMJ waste this opportunity to raise such important issues. All publications cover their backs by saying that the opinions expressed are those of the author and not necessarily of the journal, but in essence the BMJ has chosen not to give these issues more of an airing. I'm afraid I see that as an awful failing. In her Editor's Choice, Godlee confidently concludes: “Medicine and communication are changing, and so too is the BMJ.” Change is often good, but before any industry can devise where it wants to go, it must understand where it is. This book should be an important signpost in medical communication's journey, but it's unlikely to be that if one of the world's most influential medical journals cannot see the wood for the trees.


    • Competing interests: PT is secretary of the World Association of Medical Editors (WAME), a council member of the Committee on Publication Ethics (COPE), a friend of Richard Smith, a member of the BMA, and has been employed by the BMJ on two occasions (the first of which was reporting to Richard Smith) and by Biology Direct, the publisher of the “notable alternative” to peer review.

    • This article was posted as a rapid response to Stuart Derbyshire's review on 10 January 2007. The full response, with references, is at

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