What our advisory board can, and can’t, tell us

Since the BMJ set up its editorial advisory board in 1997, a rolling cast of medicine’s finest has been on hand to support and challenge the journal (http://resources.bmj.com/bmj/about-bmj/editorial-advisory-board). Each year when we gather in London for the annual meeting, as we did last week, the personalities, expertise, and advice are subtly different. This year for the first time, the meeting included editors in chief of the BMJ’s 26 sister journals (http://group.bmj.com/products/journals), bringing not only knowledge of their own discipline but an instinct for what journals can and can’t do.

The discussion was as inspiring and wide ranging as ever: the global food crisis; the loss of one to one personal care in general practice; the “procedurisation” of secondary care, with specialists being asked to operate on patients they haven’t seen before; the need to rethink medical ethics, which has become too bound up with the rigours of randomised trials; the need to link clinical medicine with basic science; the BMJ’s key role in getting evidence into practice; and the growing influence of the drug industry on research, clinical practice, and education.

Speaking to us by video link from North Carolina, Suzanne Fletcher told us about the Macy conference she recently chaired, which concluded among other things that commercial support for doctors’ education should stop (http://josiahmacyfoundation.org/documents/Macy_ContEd_1_7_08.pdf). The tide does seem to be turning, in North America at least. The Association of American Medical Colleges has just proposed that US medical schools should prohibit drug company support (doi: 10.1136/bmj.39569.475428.DB).

And what of the future for medical journals? We have lots of plans, especially for developing the BMJ online. But are we the right people to see what lies ahead, given that almost all of us are over 40? Bob Eggington, who launched the BBC’s first news website in 1997, reminded last week’s meeting how, inexplicably, a Cadbury’s advertisement on Youtube simply showing a man in a gorilla suit playing drums to a Phil Collins song restored the confectioner’s fortunes after salmonella had contaminated its chocolate. Perplexed, Cadbury’s chief executive Tod Stitzer said, “I am a 55 year old person who has lived through a different advertising experience . . . In the end, I trusted in the young and talented people who came up with the idea.”

Perhaps this is why government funded IT initiatives are doomed to fail. As Microsoft’s HealthVault and Google Health begin to offer personally controlled health records, Michael Kidd asks if the lumbering development of the NHS’s electronic patient record is too little, too late—a 20th century healthcare solution being overtaken by 21st century technology and social networking (doi: 10.1136/bmj.39567.550301.80).

Medicine can learn from Cadbury’s experience, says Peter Singleton (doi: 10.1136/bmj.39563.591481.80). Companies develop an internal culture by always selecting the same sort of people. In clinical medicine this means “shapers” rather than finishers, people who prefer solving problems in high stress situations to working through care pathways and protocols. “There is a danger in simply selecting what you already have, as it may not be what you need.” The BMJ can learn from this too.