Adapting JAMA for tomorrow's physician readers: An interview with Howard C. Bauchner, MD

In an age when physicians can access a universe of medical evidence on their smartphones or iPads, medical journals face the daunting task of reaching time-squeezed practicing doctors in new ways while maintaining the value of their print products.

Add to that the continuing scrutiny medical journal editors face over how to properly disclose authors' potential conflicts of interest so that physicians and others can fairly evaluate research papers. All in all, it is a challenging time to assume leadership of one of the world's premier medical journals.

But Howard C. Bauchner, MD, the new editor-in-chief of The Journal of the American Medical Association, seems eager to make his mark at the seminal publication, which celebrated its 128th anniversary in July. He advocates a vigorous approach to disseminating timely, original research and provocative perspectives on medical affairs.

"We're going to have to make sure that our content can flow to readers in the way that they want it, not in the way that we think they should get it," says JAMA Editor-in-Chief Howard C. Bauchner, MD. Photo by Ted Grudzinski / AMA

Dr. Bauchner, who most recently served as editor-in-chief of the BMJ Publishing Group's Archives of Disease in Childhood, met with American Medical News during his first week on his new job in July to discuss his plans for JAMA and the Archives journals.

American Medical News: What do you think medical journals will look like to the next generation of physicians? Will today's readers recognize them?

Dr. Bauchner: Eight or 10 years ago, people began to speculate that print is going to die and go away. Well, eight or 10 years later, it hasn't gone away. I think print is going to be with us for a while. And in the readership surveys that we did at my old journal -- we did three over the course of eight years -- what was really striking was that the percentage of readers who wanted to get the journal only electronically didn't change over that eight-year period. It stayed at around 15% to 18%, and I would have expected it go up to 30% or 40%. ...

We're going to have to make sure that our content can flow to readers in the way that they want it, not in the way that we think they should get it. The structural communication of information is going to have to become more adaptive, more creative -- tablets, smartphones, audio files, video files. I can't speculate how every one of our readers will want information.

I hope that in the next year or so you'd see the debut of something called "JAMA in brief" or "JAMA & Archives in brief" -- a way in which information from JAMA and the Archives family of journals can flow to our readers in probably smaller, briefer amounts, so that they are smartphone-adaptable, and can be read on tablets and blogs, probably using less scientific language. We know that, although many of our readers do read all the original research, many browse the original research and then look at the other content. We need to be prepared to provide that other content in more creative ways than we have done in the past.

American Medical News: You mention expanding blogging. Some might say that blogging is precisely the opposite of the value delivered by medical journals -- bloviation instead of new knowledge that's clinically relevant and actionable. What is your response to that?

Dr. Bauchner: Well, that's one view of what medical journals are. But medical journals are in the communication business. People should never underestimate that. We will be blogging more. If our content is sitting in the corner, collecting dust, it's not doing anything for anyone. ... Some people who read the original research won't read the blog, and some people who read the blog won't read the original research.

Our goal in the blog would be to increase the number of people who get access to our content. It may be a different group of people or it may be the same. The benefit of blogs is that they can go viral in ways that an abstract cannot. We hope that the people blogging for the journals, that they'll present information that's factual, that represents no conflicts of interest. We'll have checks and balances about the blog.

American Medical News: More medical journal articles are being published online first. Is that something you plan to accelerate?

Dr. Bauchner: Yes, it will accelerate at JAMA and in the Archives family of journals. We shouldn't hold the material when we can make it available to people. Readers are entitled to it, and authors are entitled to it. It shouldn't sit in our shop electronically for four to six months when we could post it a month or six weeks after it's accepted. ...

We have a responsibility to our authors and to our readers to get them information in a timely fashion. ... The article will have been accepted, and gone through peer review, copyedited, and will meet every standard that JAMA and the Archives stands for.

American Medical News: Your predecessor as JAMA editor, Catherine DeAngelis, MD, MPH, worked with others in the International Committee of Medical Journal Editors to adopt a single form for authors to use in disclosing the presence of various rele vant relationships with industry, but that form does not ask them to tell how much money they received.

A Sept. 13, 2010, Archives of Internal Medicine study found that 32 orthopedics researchers received more than $1 million in industry payments in 2007 and did not disclose the amounts when publishing related research. Some critics say that is problematic and argue that authors should publicly disclose not just the presence of relevant financial relationships with industry, but the precise dollar figures involved. What is your response?

Dr. Bauchner: This is probably one of the preeminent issues in medical journalism, which is the appropriate declaration of potential conflicts of interest, and how you define conflicts of interest. ... Clearly, the new ICMJE disclosure form is an improvement, and I'm assuming that over the next three to five years it will continue to evolve.

It's hard to know what's the precise amount of money that people believe represents a substantial financial conflict of interest. I don't think it's the $5 tchotchke. I don't know what the vast majority of people in the medical world or nonmedical world think of $3,000 or $5,000. I think most people believe $1 million represents a substantial conflict of interest, but I don't know where that line is drawn.

I can assure every reader that I am committed to upholding the extraordinary standards that Dr. DeAngelis, Dr. [Drummond] Rennie and other senior deputies have established for JAMA and the Archives family. JAMA is a beacon of integrity and that will certainly not change under my leadership.

American Medical News: Any other words for our readers?

Dr. Bauchner: Yes. They need to write me with their ideas. Email me ([email protected]" target="_blank">link). I love hearing from our readers.