To print this page, select "Print" from the File menu of your browser salon.com > Health & Body April 20, 1999 URL: http://www.salon.com/health/feature/1999/04/19/medscape Journal wars Will the debut of Medscape General Medicine, the first online publication of its kind, change the way health news is delivered? - - - - - - - - - - - - By Dawn MacKeen It was the beginning of the president's impeachment trial and the Journal of the American Medical Association published a story on how 59 percent of Midwestern college students don't consider oral sex -- or "orogenital contact," as it's known in medical circles -- to be, well, sex. No, not JAMA, screamed physicians who charged the publication was stooping to sensationalism. The decision to run the study, which was based on 8-year-old findings from the Kinsey Institute for Research in Sex, Gender and Reproduction, so angered Dr. E. Ratcliffe Anderson Jr., the association's vice president, that he apologized for the appearance of the article, said it was not JAMA's place to get involved in political debates and then fired the journal's longtime editor, Dr. George Lundberg, for bruising the association's reputation. During Lundberg's 17-year reign, he had made editorial decisions that ticked people off -- like devoting a whole issue of JAMA to that "quackery" field called alternative medicine and publishing "It's Over, Debbie," a physician's account of euthanasia on a cancer patient. Some say it was his fierce editorial independence that ended up getting him canned. In any case, he's credited with taking a journal "that was a second-rate mouthpiece for the association and turn[ing] it into one of the 'big five' medical journals worldwide," according to the British Medical Journal, which also belongs to this exclusive five-journal club, along with the New England Journal of Medicine, the Lancet and Annals of Internal Medicine. With that kind of legacy, it's probably not a surprise to his former colleagues that Lundberg is back. This month he announced that he's starting his own primary source, peer-reviewed, general medical journal -- challenging the big guns at their own game -- and that he's going to do it exclusively online. "George Lundberg coming up with a new idea is not exactly an earth-shattering story," says Dr. John Renner, president of the nonprofit National Council for Reliable Information and medical officer to the Web site HealthScout. "He is doing that every week." Lundberg says he's had the idea for more than a decade, and that the timing was finally right, both for the Internet as the forum and the company he now works for, Medscape, a respected Web site for physicians that already has several peer-reviewed specialty journals. The 4-year-old site is funded by advertisements, sponsorships and investments. "Medscape General Medicine" (or MedGenMed) will post clinical research, consensus reports, commentaries, policy papers, government reports, editorial reports and public health controversies. It will also be free, and published as soon as the article is edited and peer-reviewed. Lundberg says he can't speculate how his new journal will affect the other journals (most of which are weeklies), but says, "The fact that Medscape General Medicine won't be a weekly, quarterly or monthly has got to cause a rethinking of the whole process of medical news transfer." While the Internet has affected newsmagazines and daily papers with its continuous-publishing cycles, it had not dramatically affected the clique of general medical journals, and how quickly they get out their information. Although some, like the New England Journal of Medicine, do publish some articles on Web sites ahead of print publication several times a year, and others submit articles before publication to online databases like Medline, it has, in general, been business as usual. What Lundberg's journal will do to the old guard's publication process remains to be seen. "If you start getting into the mind-set that this is a race, I think potentially serious mistakes can be made," says Dr. Gregory Curfman, deputy editor of the New England Journal of Medicine. "What I've learned as a medical editor over the years is that the job has become harder, not easier, because you understand what the pitfalls are. There is too much at stake. If you make a mistake, people's health can be affected." Since this is clinical medicine, Curfman says that after an article is published, the information is sometimes applied to people right away. Make no mistake, Lundberg says, he will not speed up article publication to the point where it affects quality. He says he is fully aware of the consequences of a rushed-out article with inaccuracies. While Lundberg already launched his journal on April 9 with an article written by him, the launch was just that -- an announcement and call to researchers for material. He says he has already received submissions, and that several of them might work out, but does not know when the first complete issue will be posted. Whenever it fully launches, its ultimate success will depend on what the researchers think, according to Dr. David Frankel, North American editor of the international publication the Lancet. "Researchers are always looking to publish their work in a publication that has a high 'impact factor,'" says Frankel, referring to the defining term for how often articles are quoted by their colleagues in medical literature. But Frankel adds that in a world as fast-moving as the biomedical field, researchers might be excited about the prospect of having the publication process sped up. The gestation period for an article at the Lancet, for example, from peer review to publication, is anywhere from three to five months. "Researchers always want to be ahead of the competition. They want to be first," says Frankel. And there is fierce competition in almost every field. "If we look at the statins [cholesterol-lowering drugs] in heart disease or the efficacy of HIV drugs, we find that there are many research groups doing similar investigations. And researchers prefer to publish their work before their colleagues." Many of his colleagues believe that if anyone can pull off this new journal, it is Lundberg. But will he have the editorial freedom he craves? Lundberg says diplomatically, "I believe that Medscape will be an opportunity for strong, but rational statements about controversial issues, without excess concern for politics. I felt quite free to run controversial articles in JAMA for 17 years using the peer review process and a set of objectives ... [At Medscape], the measuring stick for what the consequences are will be calibrated in a different way." salon.com | April 20, 1999