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
Published April 19, 1999 1:29PM (EDT)

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
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
"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."

Dawn MacKeen

Dawn MacKeen is a former senior writer for Salon, and author of a forthcoming book about her grandfather’s survival of the Armenian Genocide, "The Hundred-Year Walk: An Armenian Odyssey" (Houghton Mifflin Harcourt, January 2016).

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