Robert and Suzanne Fletcher are internists and epidemiologists. They graduated from Harvard Medical School in 1366, completed residency training at Stanford and Johns Hopkins, and served on the faculties of McGill University and the University of North Carolina. They were founding editors of the Journal General Internal Medicine and editors of Annals of lnternal Medicine (1990–94), where they studied the effectiveness of peer review. The Fletchers are currently professors of Harvard Medical School.Another, we believe, is the growing efforts from outside medicine to influence the contents of scientific research and medical journals. Some old themes are likely to continue but take a different form. Medical editors, faced with growing scepticism and impatience with traditional peer review, will develop new ways to promote the quality of journals' information. Finally, we predict that general medical journals will continue to occupy a central place in medicine, despite increasing specialisation.
Ann Intern Med 1997; 126:36-47 The Uncertain Value of the Definition for SIRS I n this issue of CHEST (see page 1533), Dr. Bossink and colleagues describe their experience with the systemic inflammatory response syndrome 1442 (SIRS) and sepsis criteria when applied to a large number of medical patients at their medical center.
However, a new generation of general journals, which summarise existing information, will offer better ways to look up information, and to keep up with new developments, and so rise in importance. Editing and publishing. Editing is directed by health professionals—typically, accomplished scholars either in clinical research or in medical journalism.
They are the peers of the journal's authors and readers, prepared by experience and interest to act on their behalf. The editors have a unique, central role in medicine, ensuring the quality of the information-base for scientific discovery and clinical decision-making. Editors select the best articles that are appropriate for their readers and improve them; they also promote ethical standards is the conduct of research, peer review, and reporting. The success of their work is judged by how well their journals are read, cited, and respected.
Publishing, on the other hand, includes all of the processes that bring the intellectual content of the journal to readers. Besides editing, these are maintenance of subscriber lists, printing and distribution, promotion, billing, solicitation and inclusion of commercial and classified advertisements, and sale of reprints.
The people who do this work are experts in marketing, sales, database management, and other business applications. The success of publishing is judged by how well it gets the information to those who want it and by profits. From paper to electronic publishing.Digital media can convey sound, colour, and movement—a gallop rhythm, jaundiced sclerae, abnormal gait, or fine tremor—whereas paper journals are restricted to written words and figures, with just a little colour (which is expensive). Electronic publication has no artificial limits on the length and number of articles, whereas paper journals operate within fixed page budgets. Electronic publication can eliminate the time lapse, commonly several months, from when a manuscript is accepted to when it is distributed to readers.
Duplicate publications, all too common in the present system. Different sectors of the medical community will adopt electronic journals at different rates. Young readers take to electronic media more readily than do older ones, who are not as familiar with computers. Computers are more widely used in some parts of the world than others. Some highly specialised groups of investigators now regularly share their work on the internet; in physics, for example, some groups have abandoned paper journals completely.
Journals with small circulations will move more quickly to electronic form because the print journal is too expensive for individual subscribers or even libraries. Let us not lament the decline of Lhe familiar paper journal any more than the demise of hand-copied bibles after Gutenberg's invention. Readers eserve the information they want in whatever medium they want it in, and it is up to the publisher to make sure they get it. This is solely a practical matter, on which the publisher's business will survive or fail.
If enough readers prefer paper journals, they will remain available. If not, paper journals will always be found in museums. Editing in the digital age. If the electronic age will change publishing, what will it do to editing?
Will peer review, the backbone of current efforts to maintain the quality and fairness of medical journals, survive the electronic age? Some have suggested that journal editing will no longer be necessary. Why not just post manuscripts as received, or perhaps after a bit of in-house editing, and let readers judge the quality for themselves?
Proponents of this approach argue that it would spare the delay, expense, and occasional hard feelings that attend traditional peer review. Perhaps on-line review would have these advantages. Unfortunately, we do not know, and the idea should be tested before it is accepted. There are many reasons to be Sceptical. The proposals, in our opinion, greatly overestimate readers' appetites for complexity and unsolicited work. Will some readers really take the time to scrutinise each posted article and offer feedback in the absence of the usual structure (a request to be a peer reviewer with a deadline) for causing this to happen?
Do readers in general really want to read manuscripts that have not been cleaned up beforehand? One study showed that manuscripts improved in 33 of 34 reporting elements after peer review and editing, and that the manuscripts farthest off the mark on submission improved the most.Editors and peer reviewers should not have a direct financial interest in any of the decisions in which they play a part. The participation of peer reviewers introduces a rich array of opinions into editorial deliberations. Moreover, the journals are directly accountable to their constituency in that authors will not submit their work, and readers will not subscribe, if they lose respect for the journals. Taken together, these safeguards make up an elaborate system of checks and balances that foster quality and integrity in journal articles.to make research results come out in favour of a sponsor.
Publicly supported research has long included well-considered, open processes for promoting fairness and accountability. Now it is industry's turn. Investigators, academic institutions, and industry need to work out ground rules—about the extent of the funder's ownership and access to the data, participation in data analyses and interpretation, and approval of publications—for their work together to protect the integrity of the research process when for-profit groups fund the work. Journals can insist that such agreements are in place and publish them with industry-sponsored articles.All journals will be financially stressed (causing them to lower their standards) if they lose traditional sources of advertising revenue either because of electronic publication or because advertising budgets are redirected to reach consumers directly or managed-care organisations instead of individual physicians.
Such stress may cause them to re-examine, and perhaps lower, efforts to keep editorial decisions free of commercial influence. Small journals (and most of the world's journals are small) are more vulnerable to commercial pressures and are less able to afford the luxury of high principles because their existence, not just economic prosperity, will be at stake. General medical journals such as The Lancet play a bridging function in medicine. They engage the interests of many different kinds of readers—from family physicians to neurosurgeons, and from molecular biologists to epidemiologists—in each issue, even within individual articles. They attempt to find a common language for all readers, even though the authors tend to be highly specialised investigators and many may have forgotten what people outside their specialty know and care about.
General journals communicate with clinical readers and those with highly specialised research careers, who tend to have different interests in the articles. Peer-reviewed medical journals are both strong and fragile. Efforts to modernise and improve communication in medicine could dismantle some of these journals' best features. To become better, and not just different, medical journals need the understanding and support of their owners, readers, and authors.
Social institutions (academic medical centres, government funding agencies) also have a stake in credible information to guide the care of patients and improve the health of the public. Continuing support cannot be assumed; there are already examples of successful journals that were dropped by their sponsoring societies.
International Committee of Medical Journal Editors.For a list of members of the Committee, see end of text. Inquiries and comments should be sent to Kathleen Case at the ICMJE secretariat office, Annals of Internal Medicine, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA, USA. Phone, 215-351-2661; fax, 215-351-2644; e-mail: [email protected]. This document may be copied and distributed without charge for not-for-profit, educational purposes. A digital version is available on various web sites, including ACP Online (Rates for 10 or more reprints are available from the American College of Physicians Customer Service Department, phone, 215-351-2600; fax, 215-351-2448. The Uniform Requirements has been published in several journals. Please cite a version that appeared in the primary journal literature on or after 1 January 1997.
A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually; gradually it has broadened its concerns.