A challenge to publishing conventions


Medscape: A new online journal sparks a debate over the importance of speed in the publication of original medical research.

October 24, 1999|By Jonathan Bor | Jonathan Bor,SUN STAFF

Recently, child psychiatrists at the University of Chicago completed a study on a fad treatment for autism. They found that the drug secretin did nothing to help autistic children speak or interact with others, contradicting claims that had been made on a network television show.

Dr. Edwin Cook, a well-known psychiatrist involved in the study, knew the results weren't going to make anyone happy. But he thought it was important to get the news out fast, if only to calm the hopes of desperate parents.

In the world of medical publishing, it can take six months or more to get an article into print. So rather than offering their report to a traditional print journal, they submitted it to Medscape General Medicine, an online journal that was able to publish it in only five weeks.

To the Chicago psychiatrists, speed mattered a great deal.

"We were getting a call an hour in the first few weeks after the program from parents who wanted to try this," says Cook, a researcher involved in the study. "There were doctors who were very much behind this. As recently as six months ago, one had given it to 140 kids."

Countless Web sites offer health information. But Medscape General Medicine (www.medscape.com/journal/medgenmed) is the first that attempts to compete with leading publications such as the New England Journal of Medicine and the Journal of the American Medical Association on their home ground: the publication of original medical research.

Since opening in April, the online journal has yet to attract blockbuster studies that might elevate it to the elite rank of medical publishing. But its editor, Dr. George Lundberg, thinks it's just a matter of time.

"The reason it's going to succeed is that it offers speed that the other journals don't approach," says Lundberg. "It's important because authors don't like to wait for their work to appear." Scientists "rely on other people's work to stimulate ideas -- and if they have to wait months and years, it delays scientific progress."

Lundberg, 66, knows a little about medical publishing. In January, he completed a 17-year tenure as editor-in-chief of JAMA, a prestigious journal that appears weekly on a few hundred pages of glossy paper. In his position, he also supervised an array of specialty journals.

Despite his association with the AMA, he became known as a risk-taker who didn't mind clashing with the medical establishment.

Under his leadership, JAMA increasingly became a forum for progressive ideas such as alternative medicine and a single-payer health system. This brought him into conflict with the AMA leadership, which fired him in January after he published a study on the sexual attitudes of college students that coincided with President Clinton's impeachment trial.

Lundberg moved to Medscape a month after his firing. He says it wasn't a huge leap, with his having kept his hand in computers for many years. In 1963, as a young Army doctor, he computerized California's tumor registry on a hulking IBM that filled rooms. Four years ago, he established JAMA's Web site.

Since 1995, Medscape (www.medscape.com) had operated a traditional Web site that offered medical news, continuing education and links to other Web sites. More recently, it opened a site that offers consumer health information.

But it is the online journal, launched in April, that is attracting the most attention, sparking a debate over the importance of speed in medical publishing.

At JAMA and the New England Journal of Medicine, articles take an average of seven months to appear in print. At both journals, most submissions are rejected, but those that are accepted take that long to go through various levels of editing and review, not to mention rewrites, printing and mailing. At the AMA's specialty journals, the turn-around time is closer to a year.

To some extent, the online journal publishes faster because it has done away with printing and mailing. But there is more to it than that. Experts who are called upon to review articles on the basis of originality and accuracy -- a process known as peer review -- are asked to spend three days on an article, rather than the 28 days allowed at JAMA.

Not everyone complies, Lundberg says, but most are getting the idea.

"It's mostly attitude," he says. "Until recently, medical publishing was functioning in Gutenberg time. Now, we're in Internet time."

Speed wasn't the only thing that appealed to the University of Chicago researchers. Leading print journals prefer articles about treatments that work and tend to look askance at "negative" studies like Cook's. The online journal, he said, was more open to information that is useful no matter what it shows, perhaps because it is less driven by traditional standards of newsworthiness.

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