Intended for healthcare professionals

Preprint debate

Preprint debate

Several scientific journals have come down firmly against authors putting drafts of their papers on the Internet before publication. At the BMJ we're not so sure.

In the following article I've set out our current thinking on the topic, but we would like to know what you think. Our ultimate policy will be guided by your responses.

We will add the comments we receive to the end of the piece. Include your name and email address in the body of your text if you want it to appear.

Please tell as many people with a stake in the debate as you can: the better the input we receive, the better the outcome.

Tony Delamothe

Why we should allow authors to post preprints on the Internet

  • Philosophical preamble
  • What are scientific journals for?
  • What might the brave new world of scientific publishing look like?
  • Downsides?
  • Summary
  • Feedback
  • Replies (last updated 20/10/97)

  • Philosophical preamble

    When confronted by any innovation that could change our practice we can respond in several ways. We can, more or less vigorously:
    1. Defend the status quo
    2. Bow to the inevitable
    3. Try to exploit the innovation for all its worth
    Believing that the possibilities of the Internet for scientific publishing are so fascinating and so profound, I have always plumped for the third option.

    What are journals for?

    When trying to work out how we can harness the benefits of the Internet it's worth recalling what scientific journals are for, not what they currently look like. Among other things, they are the means by which authors communicate the findings of original, important, and methodologically rigorous research to other interested parties in a timely fashion .

    Currently, we rely on our peer review process to select papers of sufficient originality, importance, and methodological rigour, and the journal commits itself to publishing them as quickly as possible.

    Because so much intellectual effort has been expended on regularising these processes our easiest response to the challenge of new ways of doing things is to argue for the maintenance of the "rules" that we have so painstakingly devised. But that is to take a very "journal centred" rather than a "customer centred" view, and that way lies oblivion. Electronic developments are rapidly changing the world of our customers (both authors and readers). We might want to stick with the hard copy paradigm, but the market has a habit of determining the eventual outcome.

    What might the brave new world of scientific publishing look like?

    Researchers might begin a study by posting their protocol on a web site for review by their peers, possibly followed by a call for collaborators and for assistance in recruiting research subjects. After the research is completed, early drafts of papers would be posted for comments and criticisms, which could then be taken into account in further drafts. At some point the paper would be transferred to a journal's web site (if the editors thought it had a chance of eventual publication). It might be made available on limited access (to specialist referees and statisticians) or on open access (for anyone to make comments). At some point the raw data from the study would also be posted on the Internet.

    After further revisions the electronic version of the paper would be given the journal's imprimatur and made available simultaneously in hard copy and electronic form. The time elapsing between submission and the journal's offer to publish and between ultimate acceptance and publication could dwindle from the current months to days (or even hours).


    This more open, collaborative model cuts across the notion thata paper's content is a secret shared between the authors and the journal until the moment of publication. There are potential downsides, but none of the obvious ones seem fatal to me:
    1. Before publication, ideas could be stolen by others If (dated) protocols are posted on the Internet, along with early drafts of papers, priority disputes should be easier to resolve. A faster peer review process could reduce the time available for rivals to act on what they have stolen.
    2. The public could be seriously misled by the results of half baked papers. The public is forever prey to scare stories not based on published papers. We need to encourage the press and the public even more strongly to withhold their belief from scientific stories that have not appeared in reputable journals.
    3. Journals might become redundant if authors could widely disseminate their findings without the need for us. Analogous to the preprint is the conference presentation or abstract, which are already picked up by the press. But because journalists have got their fingers burnt so often with authors unjustifiably hyping their findings they seem to give them less credence.
    4. We lose our "public interest" defence for maintaining embargoes (ie doctors should have received the relevant BMJ before patients hear of important new findings) As for points 2 and 3 we need to encourage the belief that the only research findings that matter are those that have received the journal's seal of approval.


    The arrival of the world wide web gives us a good opportunity for us to decide exactly how we add value to the dissemination of scientific information. Perhaps we're not adding enough: adding even more seems like the best way of countering the "threats" posed by preprints. Success is more likely if we work with authors rather than against them.

    Authors already circulate hard copies of drafts of their papers to colleagues for their comments. Using the Internet for this purpose is an obviously more efficient way of doing this. As the intended outcome is better papers we would be cutting off our nose to spite our face by trying to prevent them.

    And lastly, if we adopt electronic peer review, authors will be struck by the inconsistency of our desire to post their unpublished papers on the net when we have been conducting a campaign against their doing the same.

    Tony Delamothe



    Last updated 20 October 1997

    Sept 20, 1996

    Tap, Tap, Tap

    If we listen very closely in the distance there is a tapping. With all major journals developing Internet web pages in the past year, and the BMJ courageously coming out questioning the logic of opposition to prepublication, the noise is becoming louder. What is the tapping? As we come closer to the tapping we see it is nails being pounded into the coffins of biomedical journals. When we wrote our paper on the Death of Biomedical Journals (, we thought the death would be a long, slow, agonizing death. However, the events that have transpired in only a year suggests that the journals death and burial will be rapid.

    As with Dr. Delamothe, we too have written on preprinting ( . This paper is scheduled to appear in December in the BMJ. However, it is very germane to the current preprint discussion. It would be foolish to wait until December, and it is redundant to reword our comments so they are sufficiently different from the paper in December to jeopardize publication. We in fact would very much appreciate comments on the paper so that a revised..... better..... version could be published. It is a much better argument for preprinting than we can write in this short letter.... With this also we challenge the preprint policy of the BMJ and all other journals as if we are forced to take it down the journal and its readers will not see a unique perspective on copyright and prepublication, which is very important for rational scientific decisions. However, if it is permitted to remain up, it is tacit agreement that preprints articles are permissible. It is of interest that the article that we are commenting on today is in fact a pre-print. If it is permissible for the BMJ editors, it should be permissible for the scientists who read the BMJ to put articles on the Internet before they are published..

    We thus refer the readers to our comprehensive legal perspective of preprinting in medical journals in our preprint. Is it better for science that you not be able to see this? We think not. Would it be better for science if we did not have the opportunity to review the BMJ pre-print on "posting pre-prints on the Internet"? We think not.

    We agree whole-heartedly with the policy of Internet pre-printing. However, as scientists we also see that there are arguments against it. Perhaps a scientific experiment should be developed to judge if it is effective instead of having 1000 letters for and against. This has to be designed and developed quickly as the journals and technology are changing very rapidly.

    We thus cast our votes for preprinting on the Internet, as well as the development of a randomized trial to assess the risks/benefits of preprinting. We also applaude the BMJ for moving down the information superhighway much faster than all major medical journals.

    It is time to move into the 21st Century... It is time to move onto the information superhighway.

    Ronald LaPorte


    Deborah Aaron


    Sept 20, 1996

    Having recently become a devotee of the rather modest MJA pre-print page I would heartly recommend the practice. I do not recieve the MJA regularly and do not even review it weekly in the library, however I always check on it on the net and keenly read not only the papers of interest, but the reviewers comments. The presence of these valuable comments, not normally available in pint should help guard against some of the concerns you raise. My bet is that pre-prints will eventally become standard.

    Chris Ryan

    Sept 22, 1996

    The BMJ proposal would be very helpful from my perspective. It should be coupled with a faster and universal search (or auto-notification capability not just for BMJ (which of course should participage) but all biomedical journals. That is, I would like a daily email notification of every new article (in my area) that has been posted in any stage of the publication process. My research deals with life and death delays in availability after work is completed run 9 months or more today preprints are made available within various closed cliques, to the detriment of scientific progress and public health. I see too many journals headed off in esoteric directions that will make online searches a nightmare. Myk preference is for a SuperJournals with links to current journals with their individula flavors and policies, and perhaps some standard fee for downloading full text of articles.


    Sept 22, 1996

    Of course you should encourage "pre-printing". Surley the early dissemination of knowledge is what it's all about! And if you don't take the lead and do it, someone else will, and leave you behind.

    Remember the story about Canada's railway - when air travel bacome popular, they diversified and bought into the industry. If they hadn't they'd have gone under by now.


    Sept 22, 1996

    My thinking is that you have to continue to post. The enormous benefit of a fast retrevial of medicine abstracts and publications must be consider as a prior necessity for our professional improvement.

    From: dott. Alberto Pastorelli

    Dipartimento di Chirurgia Generale B
    Istituto di Patologia Chirurgica II
    Universita' degli Studi di Pavia
    Policlinico S. Matteo - Pavia - ITALY

    e-mail: albe{at}

    Sept 23, 1996

    I am in favour of the posting of preprints and comments and reviews. I think that at the moment the published article is only the tip of the iceberg the full meaning of the article and its place in the structure of knowledge involves at leaast the submitted article, the reviewers' comments, the reply to the reviewers' comments, the editor's emendations and suggestions, and the final revisions. Full transparency would contribute to a fuller understanding of the construction of medical knowledge.


    Sept 23, 1996

    Anyone can ask colleagues on the internet to respond to data or idea which the author has generated. But a final formal publication should be left for a classical journal (in whatever form it chooses to appear - electronic or hard paper copies) So, the whole article cannot (or at least) should not appear on the Internet before formal peer-reviewed publication. Excerpts and tables can appear as detached pieces of information, for advice, response, comments, etc... before the formal publication.

    I still would go for a formal publication before a preprint appears on an electronic or Internet format.

    Should the Journal choose to appear on an Internet format, that is another matter. Seeing how things are developing it seems that the Journal will soon have an electronic form of (formal) publication.

    From: H. Eliahou MD
    Tel-Aviv University School of Medicine

    Edith Wolfson Hospital,
    Holon 58100,

    e-mail:eliahou{at} and

    Sept 24, 1996

    I mostly agree with your position. However, it is difficult to believe journalists or the public will not inadequately use any material they find in the net, or that they will be able to thoughtfuly decide what is worth publishing or believing.

    Ways to restrict access to pre-prints to those who can work on then or judge them before final publication are surely necesary.


    Sept 24, 1996

    I agree with posting preprints on the internet, mainly because important and useful information will get out more quickly. I do not think that the public will get significantly more halfbaked information than they already do. As A GP I am already used to getting sensational new medical "facts" from patients who have gleaned them from TV, talk-back radio and popular magazines.

    As for journals, well, the whole publishing process is up for total change anyway, so get with it - remember King Canute.

    Good Luck from Oz!!

    Sept 24, 1996

    I am fully in favour of electronic versions of QUALITY journals. There is an outbreak of low-quality electronic only journals. WE MUST AVOID THIS! I suggest you go all the way with the electronic peer review process, with the safeguards you suggest. List me as a scientific reviewer if you wish, I am already a reviewer for Stroke and Cerebrovascular Diseases and Movement Disorders - regularly. My areas of interest are Stroke and Parkinsosns and Drug Treatments.

    Donald Grosset,
    Consultant Neurologist

    Southern General Hospital,

    Tel: 0141 201 2478
    email: dgross{at}

    Sept 25, 1996

    As a researcher I have divided my responses to preprinting into two

    1. In my specialist area of gynaec infections I would be quite glad to post material for opinion, comments and advice

    2. In my more topical work on stress and morale in General Practice I would not be prepared to post much about it as it would be picked up by the weeklies etc.

    I am also involved in collaborative work with social scientists on what we in Ireland euphemistically call "crisis pregnancies" and I would need the agreement of colleagues who don't read the medical press all that much.

    It raises issues about the ingelfinger rule - perhaps you have gone soft on that at the BMJ?

    I would like to see how it works and perhaps those of us in research may well get more out of it that those of you in publishing.

    Best wishes
    Tom O'Dowd

    Trinity College,


    Sept 26, 1996

    I love the MJA pre publication reviews, it has taught me much about medical writing and improves the article, Martin v/w has been very courageous

    Sept 26, 1996

    I agree with your approach and comments. As you, I look forward to development of this new and exciting process.

    Best regards, keep up the good work.


    Sept 26, 1996

    I agree with the main ideas included in the post.
    Maybe, the process of peer review might be enhanced in order to adapt it to the new reality of Internet, but this is one reason moving into reflection, and not a cause for preventing electronic publication.


    Sept 27, 1996

    My only real concern is with the distribution of the content of an article before the process of peer review takes place. Where the conclusions of research will change public health policy, medical practice or patients' lifestyles, there is a real need to have the full peer review process take place before this information is distributed.

    There are many basic science articles that may be major advances in their fields but which will be ignored by the general public or the news media. In these cases, the rapid dissemination of this information may trigger other research by researchers who have the ability to judge an article properly - essentially reviewing the article themselves.

    It is not easy to distinguish between these. How do you judge the impact of an article before it is fully reviewed? I don't have any advice on this, but I think this is what separates medical journals from other professional journals. There is more uncritical reading of medical literature than any other type of professional literature.

    David R. Gagnon, MD MPH


    Sept 27, 1996

    A couple of points against the uncritical rush to embrace electronic prepublication:

    1) There must be no doubt as to which "version" of a paper is the "final" version, for future citation and discussion.

    2) If prepublication is too easy or unregulated, it may lead to a free-for-all, with authors rushing to publicise data when the analysis is incomplete or which later requires multiple amendments (and which allows them to deflect criticisms of the work by claiming that subsequent analyses/drafts have ironed out problems or will do so).

    3) Improvements in the speed and openness of the conventional review and publication process would address many ofthe arguments in favour of prepublication on the Net.


    Sept 27, 1996

    I think that the possibility to read (at least some selected?) and comment on articles in the preprint form on the Internet is enormously important for the development of a new open mind in scientific world. In the discussion that will follow up to the final presentation, many points of view and remarks from people unable otherwise to be heard or seen can be taken.

    In the future we hope that this also will have an impact, espec. on publication of controlled trials, the majority of which still are launched on the initiative of the interest of Drug Companies.

    Hans Liedholm, MD PhD
    Clinical Pharmacologist

    Mollevangsvagen 37
    S-222 40 Lund

    e-mail at home: m-35889{at}
    e-mail at work Hans.Liedholm{at}

    Sept 27, 1996

    For many researchers, it is practically impossible to scan, let alone read, all publications that appear within their fields of interest. We should be grateful to all those reviewers, who skim the milk and prevent papers from being published that are either not original, irrelevant or based on bad research.

    Furthermore, I expect pre-prints to be less readable from the consumer point of view, since they have not been thoroughly examined and corrected on their textual contents.

    In conclusion, let's not get drowned in an ocean of suboptimal papers.

    Johannes C van der Wouden

    email: vanderwouden{at}

    Instituut Huisartsgeneeskunde
    Department of General Practice
    Erasmus University Rotterdam
    Room Fe319
    P0 Box 1738
    3000 DR
    The Netherlands

    tel + 31 10 408 7611 / 7621
    fax + 31 10 436 07 17

    Sept 29, 1996

    The main problem with pre-prints verses sending articles for private peer review, is that it may be difficult to control the quality of the responses.

    How easy would it be for someone to review the article and intentionally misguide....etc.

    Call me paranoid.


    Sept 29, 1996

    Electronic peer review would be a good idea as long as the referees could be verified

    The main problem would be access for those without an internet connection Comments may mainly be from overseas

    Roll on the BRAVE NEW WORLD!

    Dr C I Flowers
    Consultant Radiologist

    Sept 29, 1996

    I was very pleased to see that a highly respected journal such as The BMJ is taking the lead in the field of electronic medical information. It is my belief that Internet will do for the dissemination of knowledge, what the printing press began doing 500 years ago.

    The need for peer reviewers (filters) , although important as a factor in quality control, the final acceptance of the written word takes place in the mind of the readers and their experience with the subject in question.

    The interaction on line will eventually transform medical meetings into socialising events rather than the only direct way discuss matters among colleagues. I congratulate you for this valuable support to medical information.

    Luis G. Brenes, M.D., F.A.C.P.

    University of Costa Rica School of Medicine

    e-mail: Luis_Brenes{at}

    Sept 30, 1996

    Please, don't put draft papers on the internet. Being a clinician, but also being involved in research I heavily rely on the peer review of the different journals. Knowing what it is to review papers for a journal, I cannot put the same effort in every paper I come to read. Knowing that an 'expert' had already a critical look at this paper makes it more worthwhile reading this paper. Since we all read so many papers, we cannot have the same critical look at every paper, especially when we don't feel like a real expert on this subject......We need also to rely on the peers.

    So please, don't make us read more papers!!

    A R J Girbes, MD, PhD


    Oct 4, 1996

    The idea of posting preprints on the internet by one of the more respected journals in the medical community is really very satisfying because it allays the doubts in many people's minds about journals'real commitments to spreading of knowledge rather than 'their'journal-oriented interests first.

    I generally agree with your opinion to allow some form of preprint posting on the internet along with the opportunities to comment on the original hypothesis, data, methodology etc. It will definitely allow more input from people around globe than is possible in the published journal. When medical journals have been able to prevent lay press from publishing scare stories: that is not a real danger. This whole process might eventually make the peer review process more transparent, fair, reliable and satisfying to authors more in the case of papers which are not accepted for publication.


    Oct 8, 1996

    The problem with circulating copies of manuscripts before peer review is that they will be picked up by the media, and will be accepted as authentic by patients and the public.

    It would be better to have a closed system using the Internet with password protection to allow for the normal peer review process.

    Once papers are accepted for publication, it would be a major use of technology to make them available on the Internet. Full text could be subscription with registration and password protection.

    Best wishes

    Stephen Z Fadem, MD FACP
    Nephron Information Center

    Oct 8, 1996

    I am of two minds on this issue. I believe in the Internet. A free and open Internet is, in my opinion, our only hope for world peace. If everybody has access to the NET, then how can dictators for force their citizens to follow them? With this is mind, I am in agreement that pre-publishing drafts is a good idea.

    On the other hand, I am against it. I believe in the sanctity of the peer review process. I also firmly believe that too much junk is now being published and we should be more rigorous in what we, as peer reviewers, approve. By encouraging pre-publication in the NET, even more bad science will find its way into the public domain. That is good enough reason to discourage this behaviour.

    As a result, I guess I'm one vote for and one vote against.


    Oct 10, 1996

    I am strongly in favor of encouraging authors to publish preprints on the web. The issue of quality measures will resolve itself. I expect an industry will develop, perhaps employing untenured and detenured academics. These academics wil, for a fee, evaluate and certify a web published document. Some certifications will be more valued than others, and their owners may charge appropriately.

    I would also like to see authors post the full text of their published material on personal web sites, and to extend their published material through the web with additional tables, data analysis and references.

    John Faughnan

    Oct 12, 1996

    I review papers in an international journal. Some of these papers are clearly in error. Without detailed knowledge the errors could not be corrected: for contentious papers (or those which are topical) this will be dangerous: scientific research must undergo peer review before they receive widespread publicity.

    Unfortunately, if its on a computer screen it must be true.... (or so many believe)

    P G Lawler


    Oct 13, 1996

    Please do. I am really excited by the MJA home page, and enjoy watching the review process, contributing occasionally

    Oct 15, 1996

    I have found the ability to participate in commenting on pre-print papers which are to appear in the Medical Journal of Austrlia a fascinating and exciting process and agree with my colleague Chris Ryan that reading the comments and reviews by others adds greatly to the value of the paper.

    I support the concept of pre-prints on the Web.

    Oliver Frank MBBS, FRACGP


    Oct 17, 1996

    I welcome the BMJ taking the initiative in electronic publishing and already use your web site regularly. I would like to see pre-prints of articles after some initial screening - that is what the Web was designed for them after all. However I share the concern that much data on the web is of questionable quality. A prestigious journal like the BMJ provides much needed validation. It is essential that you unequivocally label pre-review material probably with a "health warning" to journalists that it cannot be used as an official source. With the emphasis on evidence based medicine people may act quickly and decisively on new data. Therefore I suggest that you consider digital signatures for fully reviewed articles to give complete reassurance of origin.

    Hamish S F Fraser MRCP MSc


    Oct 18, 1996

    I agree with all of your arguments for pre-print publishing. One relevent factor not mentioned perhaps is the fact that the internet promises freedom of access, but actually delivers this to a priveledged few!

    My response is therefore to say, yes, what you are suggesting is a valid and workable future, but your target audience isn't geared up for it yet- indeed my guess is that the more junior the reader the more positive the response at this time - however, since the technology is now mature enough, my suggestion would be for the BMJ to begin a staged move in the right direction and see if it is possible to reduce the review time electronically- effectively via a closed system at this stage.

    A big dilemma as yet unsolved with the internet is that there is yet to be produced the equivalent of a signature - at the moment mail can appear to come from where it hasn't, and this must limit the wholeharted adoption of the paperless journal - sadly.

    Carl Littlejohns
    Consultant Psychiatrist


    Oct 18, 1996

    I favor journals placing accepted manuscripts on the Internet for widespead dissemination of scientific information as rapidly as possible. However, I am strongly opposed to authors placing unaccepted manuscripts on the Internet. Although a small proportion of readers will be competent to rigorously evaluate the scientific merit of submissions, the vast majority of potential readers will not have the ability to distinguish between valuable information and garbage. A manuscript carrying the imprimature of a respected journal assures readers that it has undergone peer review and is considered worthwhile. I have no doubt that dangerous misinformation will intentially or unintentially be disseminated without such protections.

    Robert S. Klein, M.D.
    Professor of Medicine and Epidemiology and Social Medicine

    Albert Einstein College of Medicine


    Oct 20, 1996

    Dear Sirs-
    I too am in favor of a more open discussion of medical issues, including future and current medical research on the Internet.

    Regarding possible misuse by the media, my patients are already developing a healthy wariness for journalistic reports of medical issues.

    Such reports do serve the useful purpose of bringing out the evolving nature of medical practice, and highlighting the uncertainties that exist.

    At the same time, they bring to the patient's attention that we physicians (following the efforts of our colleagues in academe) are studying these issues that concern our patients, and

    I think many of my patients are heartened to realize this.

    Douwe Rienstra, MD


    Oct 20, 1996

    I am strongly in favour of posting Pre-prints on the Internet.
    The arguments which let me favour this are:
    (1) Speed of distribution
    (2) Much wider general availability round the globe than the printed format can offer.
    (3) which in turn may stimulate replies and suggestions from workers in the field, which otherwise may not have had access to the material. (4) and the subsequent possibility to incorporate comments and suggestions before final publication.

    Contributions should be very clearly marked as Pre-prints, so that it is VERY clear that they have not gone through an official peer review process yet.

    Search Engines and "Agents" need to be further developed, so that relevant information is found by the right people on the net.
    Very specific search capabilities and e.g. e-mail postings of relevant web-sites are desirable.

    Ulrich Desmarowitz, FRCS MD
    Research Fellow to Mr. G. Hamilton

    University Dept. of Surgery
    Royal Free Hospital & School of Medicine
    Pond Street
    London NW3 2QG

    Internet: 100022.1600{at}

    Oct 22, 1996

    Already in my field (image processing) the WWW has become more important than traditional means of publication, which are now far too slow to be of use in a fast-moving field. The Web is also much more democratic, since if I disagree or want to question the author then I simply email them and ask.

    DDr. Chris Kirtley

    Institut fuer Sportwissenschaften
    University of Vienna
    A 1150 Vienna


    Oct 22, 1996

    You are to be congratulated for pushing a new frontier. But..I am not convinced about the system you envision. As a reader, I rely (too heavily in most cases)on an article being peer reviewed, because I rarely have the time to read an article with the rigor I do when asked to review. Peer review does me a great service. Frankly, in this highly competitve world, I don't trust a system without checks and balances. In the end, if an author wishes to share prepublished data with colleagues, the Internet is a perfect tool, discounting security etc. I applaud the development of electronic publishing, but I want peer reviewed information.


    From: John Delehanty


    Oct 22, 1996

    Interesting thoughts. My first reaction was that putting pre-prints on the net was a bad idea. Now I'm not so sure. Having just completed an article on the varying degrees of reliability and novelty between books, journals and material available on the Internet for my professional journal (a non-refereed organ for members of the Norwegian Association of Midwives), I feel it is essential to make clear the distinction between drafts and finally approved versions. What does it mean to have the BMJ seal of approval? It is important to me that readers recognise the difference between refereed journal articles and John Homepage's personal diatribes. I will be following this discussion with interest.

    Rachel Myr,



    Oct 24, 1996

    Although I am delighted to see the increased use of the Internet for education and debate on many aspects of medicine, I do not think that publication of draft papers is advisable. One of the principal problems with the Internet is that there is so much information available which is misleading, or simply wrong, because of lack of peer review. Whatever your intentions, the publication of draft papers will simply add to this.

    Michael A. Palmer FRCS Urol

    Oct 25, 1996

    It is vital that people have access to scientific publishing, so that they might make informed decisions based upon that information.
    We can no more trust our collective futures to scientists, than we can to politicians - both of whose "secrets" are sinister to the rest of us, and with good reason.
    The BMJ is to be congratulated for their stand, and joined by others, who believe ignorance more toxic than intelligence.


    Oct 25, 1996

    Given the already questionable quality of many papers submitted, an unrestricted license to disseminate whatever the noblesse of electronic media (or paper) will tolerate, defeats the spirit and purpose of serious science. Peer review prior to publication - with all its imperfections - still surpasses the capacity of the individual in ensuring the value of potential contributions to our arsenal of medical knowledge.

    Oct 26, 1996

    INTERNET will represent the same as the press did to lead to the Renaissance. Our journals and libraries canot reach as many people as INTERNET o newly developed NETS will do in the future. Imagine the day in which MEDNET or GALENNET will be developed. BMJ will be totally in the NET and will sell a CDROM every three months with all the published material or current subscriptions will enable us to access the journal in the NET. Those who will adopt and understand earlier the possibilities of INTERNET will survive. I am glad that you are prepared to listen. That's not very common. Congratulations.

    Jeronimo Farre MD


    Oct 28, 1996

    Ultimately the goal of scientific research is to broaden the knowledge base of both scientists and the public alike.

    I agree that pre-publications not subject to peer review not be published with the imprimatur of any publication. This type of distribution could only lead to improper use of the information and would ultimately damage both the scientist and the publication.

    However, once the study is subject to peer review there is purpose served by delaying distributions of the results based on the mechanics of publication. At this point in time the best purpose would be to disseminate the results by all possible means. In this way those with an interest in the subject would not be left to speculate on outcomes.


    Oct 30, 1996

    I feel authors should not be allowed to post pre-prints of their papers on the internet. Most authors will agree that the current peer-review process usually (but not always) guarantees the publication of papers which can be defended on sound scientific principles. Allowing authors to post their pre-prints on the internet will result in the "publication" of potentially misleading results.

    All the "downsides" stated above are very true and I believe some are potentially fatal! For example number 2 (misleading the public) - what would happen if someone publishes data on the internet, concluding that he has found a definitive cure for cancer, stating that the paper has been submitted to the BMJ for publication? Some members of the public and press might ignore it but some will not especially if the data appear to be convincing to a lay public. The scientific world will then spend considerable time, energy and journal space (internet space as well!) disputing such data.

    Oct 30, 1996

    I agree strongly that more papers should appear on the Internet. There is plenty of rubbish already on the Net and it can do no harm to air some papers from publication.

    I have published several papers (not in the BMJ), and can comment on one or two occasions the reviewers have gone way over the top delaying publication of perfectly valid papers.

    Cut out the delay by getting peer review on the Net.


    Nov 15, 1996

    Internet is changing the traditional paradigmas of human communication.

    A draft of a scientific paper on internet is exposed to at least thousand people peer review committee.

    I fully agree with the publication of drafts on th WWW, before the final journal publication.

    Daniel Sigulem M.D., Ph. D.


    Nov 15, 1996

    I think putting preprints on the web is reasonable and in fact perhaps inevitable. The authors could note where a manuscript is in the review process, and readers could be appropriately cautious.

    Doug Owens


    Dec 9, 1996

    I think the advantages outweigh the disadvantages with a few caveats:

    a) Authors should be free to display their own work on their own web site provided they, and in their employers ( university or hospital ) retain accountability for what they say in public.
    Many organisations have rules regarding web materials so displayed, with the ultimate sanction for misinformation being dismissal and/or subjugation to the laws of the land.

    b) All preprinted articles should have a discussion forum attached to them such as this. The process of peer review then truly becomes one of review by ones peers. Journalists etc should have free access to the discussion. No comments about the paper should be accepted without the email address ( suitably validated ) of the commentor.

    c) When accepted for formal publication the JOURNAL should have the option of selecting comments made by others which it may wish to include with the paper.

    d) Once published the paper should be removed from the authors site and placed on a site linked with the journal.

    Regarding the peer review of materials via the net this can work very well. I have been a part of the AusWeb conference for the last two years ( and ..../ausweb96 ) where papers were reviewed and submitted within an 8 week timeframe. Adoption of this rapid turnaround model has many advantages.

    Dr T.E. Allan Palmer BMedSci, BM, BS, FRCAnaes, FANZCA
    Lecturer - Anaesthesiology & Intensive Care

    The University of Queensland,


    Dec 9, 1996

    The scientific/medical publishing model which evolved over the past century was, in the view of many, outmoded before the development of the Internet (let alone the Web). Unintentionally, as the fields of science and medicine expanded, it encouraged the development of an elitist, "insider-based" mechanism for control over the dissemination of new scientific and medical information, which often delayed rather than encouraged the dissemination of important advances.

    The Internet and the Web now offer new opportunities for us to reassess the underlying principles and methods for the dissemination of scientific and medical information. These opportunities will be taken by a whole range of competitors to traditional publishers and the next generation of scientific and medical researchers. As a consequence, the traditional medical publisher would be wise to evolve his or her thinking about many of the traditional processes, including the publication of preprints and the structure of the peer review process on line. (And some continuing form of peer review process does remain an essential component of medical and scientific publishing, even on line. However, it may not have to happen before publication.)

    It is the view of this contributor that the Web and the Internet will do to traditional scientific and medical publishing what printing did to whole monasteries full of scribes in the Middle Ages. However, it will do it in a few years rather than a few decades. We are entering the world of the endorsed medical and scientific publication, in which the assessments of those who support or disagree with one's electronically "published" work are going to be far more important than the name of the journal in which it appears. As a consequence, the distinction between a preprint and actual publication is effectively near death. Actually, when one considers the mathematical literature, the true distinction died there some time ago!

    As a professional health care communicator, and one with a particular interest in the application of the Internet to medical and health care communications, I would strongly encourage the BMJ to take a leadership position by implementing every possible step towards a new model of medical publishing on line. I repeat my warning. Others are going to do it anyway. If you don't, you will simply be left in their wake. E. Michael D. Scott
    President and Creative Director
    CoMed Communications
    210 West Washington Square
    Philadelphia, PA 19106
    Tel: 215 592 1363
    E-mail: mikes{at}

    Dec 11, 1996

    Will allow huge exposure to critical thinking and feedback. This must be beneficial for all parties.

    Leonard Sugarman
    SE London


    Dec 12, 1996

    I applaud the BMJ for putting this issue up for discussion. There is no doubt that future biomedical research publishing should take advantage of the speed and accessibility of the Internet, while retaining the value of peer review. The BMJ could take the lead in finally putting "The Ingelfinger Rule" to rest, and enable, rather than prevent, the free exchange of scientific thought. Biomedical journals are here to serve the "clients" - in this case, health care professionals amd scientists - not the opther way around.

    We have begun one aspect of the process you envision at PedsCCM, The Web Site for Pediatric Critical Care (, in collecting prospective trials seeking collaborators. It will take a publisher with the repute of the BMJ to see the paradigm through to its logical conclusion.

    Barry Markovitz

    Co-editor PedsCCM (

    Dec 15, 1996

    Preprints should be available for comments, as this will help in the peer review process. While the current paper-based process permits comments, they are published one or more months after the original study. Allowing concerns to be raised earlier in the process would be productive.

    However, preprints must be separated from the BMJ imprimatur, and their appearance on the BMJ website must be cloaked in a visual format which clearly separates them from "finished products." For this reason - avoidance of assumed approval - journals should be happy to have their contributors publish elsewhere (e.g. on their own websites). A journal should not concern itself with publications which lack its "seal of approval". It should adopt the philosophy, "If you didn't read it here, caveat lector."

    If "works in progress" are presented in a visually distinct manner, it is helpful to have them accessible from the BMJ site, so researchers can find them and provide constructive comments. This process can only improve the quality of published studies.

    Christopher K Smith


    Jan 1, 1997

    In the viewpoint against posting pre-prints on the Internet, it appears that there are two chief arguements. The first is that the lack of peer reviewed status of the articles will be an extra hurdle for already time pressured clinicians to tackle by requiring a higher level of vigilance in scanning for relevant information. The other view seems to be a fear that the media and the public will clutch their jaws on anything and uphold unfinished work as proof of a miracle breakthrough.

    Certainly that pre-prints on-line will add an extra degree of uncertainty online, but there will always be the reviewed, approved, and improved texts waiting in the final print. Being able to take a peek as what's to come is a special privledge to those who can spare the trouble to weed through an unfinished text. I don't think the intent was to make the pre-print versions the mainstays. As far as the increased speed of dissemination encouraging half finished and shoddy research being put on-line to beat rivals to the punch, the danger is certainly there, but having your words in electronic does not make them any less forgivable and being on-line does not negate needing to produce consistent work to uphold a reputation.

    As far as the public and media go, I think it's better that the information, even if half formulated, comes from a medical journal rather than from a wild rumor that became twisted from word of mouth to word of mouth and from pressroom to pressroom. The rumors will always be out there. If the actual pre-print is available, the limitations of the data that spawned the rumor will at least be available. Secrecy may produce blind devotees and even wilder rumors. Put the pre-print on-line with the authors discussion of the limitations of the data, even if only roughly explained, is a world better than hearing on the evening news that "scientists at Miracle U Labs have discovered a potential cure for AIDS."

    To add, I agree with everyone who said that the pre-prints need to be clearly labeled as such. With clear labels, I don't belive that the BMJ would be merely contributing to the sea of hysteria surrounding half-baked research and pseudo-science. I also believe that skepticism is an emergent trait of the seasoned Internet user because you encounter such polar views on anything and everything whether you want to or not. In the current state of the Internet, your beliefs will be certainly challenged and you must learn to decide on what to believe, lest the Net becomes another passive medium like TV. With experience, the information wise consumer, may learn to question before he believes. On the other hand, we have a long way to go before the majority of the Internet population come out of adolesence. Used to mediums like television, they may be all too ready to gobble up anything they run into.

    All flowery talk about the Internet changing the world aside, the underlying nature of the Internet is that of a conversation. Like in conversation, not everything said is wise nor appropriate, but all are learning experiences that can make (in this case) the arguements stronger in the long run - speeding up the process of colaborative viewpoint - bringing together the different parts of the elephant. If we look at the publishings of pre-prints in the old light of the one to many audiences characteristic of all formal writings, putting forth any work untested by the rigors of the checks and balances that someone mentioned will sound like an unwise choice. On the other hand, if we consider the where information exchange is heading, we see a many to many source to audience relationship with one or a few voices being more prominent. If you can imagine pre-prints as a more formal version of a conversation, it puts things in a different light.

    I agree with Dr. Chris Kirtley. Let the great conversation begin.

    Sheldon Chang


    Jan 2, 1997

    The day that doctors will succeed to place padlock on libraries or information is sad especially when the little people pay taxes to educate them and pay their salary

    During my triple by-pass I received blood product tainted by cjd.... this web page was my sole source of information and was the only help that our group of people (2000 in same situation) ever received.

    Jacques Pelletier



    Jan 28, 1997

    It seems to me, from the arguments I have read that there is mixed feelings about both the slowness of peer review but the potential dissemination of illfounded research data.

    I think the problem we face is a little more sinister. We all can see the value in having ones research evaluated by another suitably qualified scientist/clinician. However, we also know of many articles being published because the author knows the editor or has a reputation despite the research being of dubious quality. Similarly, the speed with which ones research or inital finds could be distributed via the Internet is tantalising, but we all know that just as much rubbish can be ditributed equally as quick. The problem, as I see it, lies with those of us involved in publishing our research findings. Unless we who publish, edit, review and recieve our research finds have high personal moral and ethical integrity, both methods for disseminating such information will be liable to corruption and misuse.


    May 4, 1997

    The flood of pre-prints will drown useful debate. To hope that the most appropriate people to comment on a paper will happen to come across it seems over-optimistic. One needs to ensure that these opinions are actively sought - a process pre-printing will not replace. If that process is well set up within the journal then finding other opinions is simply increasing the referee numbers, whilst decreasing their focus.

    Since most doctors and scientists have day jobs they cannot be expected to do an editor's job in a range of different journals (general journals like the BMJ as well as specialist journals) as well.

    The most immediate advantage the internet provides is the ability to send papers to referees immediately - and thus shorten the administrative component of editorial delay.

    I hope you will not be basing your decision on the balance of comments you receive at your website. People who got there are a selected population and cannot be considered as an appropriate sample - they will want Pre-prints "They would, would'nt they". Stick to the standards and demand an unbiased randomised sample.

    Geraint Fuller


    Sept 30, 1997

    Pre-prints will happen. I would prefer seeing this development controlled by a respected journal than just happen on homepages. Access could be controlled and appropriate "disclaimers" attached.

    The present peer review process, while important, is in my opinion potentially flawed. It is unnecessarily biased against any work that challenges accepted "wisdom". The reviewers often have a vested interest in the status quo, and are not likely to accept new ideas easily, regardless of the validity. Pre-prints would bring new ideas to light more quickly.

    In my small experience, I have seen reviewers' comments that clearly indicated the reviewer was ignorant regarding some aspects of the paper. Pre-prints would allow a greater number of reviewers and account for a broader base of expertise. The final publication could be much improved by this process.

    Regarding the fear of misleading the public, there is enough misinformation on the Web now that I cannot see how it would make a difference. We need to educate the public regarding the validity of health information on the WWW. Health on the Net (HON) is working on this. (

    I think a closed system, requiring registration for access to these works in progress, with clear distinction they are not finished, and a place like this for comments, should minimise any concerns and maximise the benifits of this technology.

    I do think journals will soon go out of print, and possibly very soon. But they can survive in an electronic format if they are foresighted enough.

    William A. Johnson,
    RVT (Registered Vascular Technologist)