JAMA editor takes reins in a new communication age

A message to all physicians from Robert M. Wah, MD, chair of the AMA Board of Trustees.

By Robert M. Wah, MDis a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect. Posted Sept. 19, 2011.

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One of the crown jewels of our AMA and our profession is JAMA, the Journal of the American Medical Association. So when we have a new editor, it is a momentous occasion. I want to take this opportunity to welcome Howard Bauchner, MD, as the editor-in-chief of JAMA. In the world of modern medicine, where constant change is almost the norm, Dr. Bauchner is only the 16th editor in JAMA's 127-year-history.

Dr. Bauchner comes to the AMA from the Boston University Schools of Medicine and Public Health, where he served as a professor of pediatrics and community health sciences, vice chair of the Dept. of Pediatrics, and assistant dean of alumni affairs and continuing medical education. Since 2003, he was editor-in-chief of the Archives of Disease in Childhood, the official publication of the Royal College of Paediatrics and Child Health in the United Kingdom. He has served on many editorial boards and has published more than 125 papers in peer-reviewed journals.

Dr. Bauchner has taken over the reins at JAMA at a good time. The journal's value, readership and reputation are at an all-time high.

Under his predecessor, longtime editor Catherine DeAngelis, MD, MPH, we saw JAMA's impact factor -- the average number of citations articles receive over a given period -- increase from just more than 11 to 30. The journal's scientific integrity was fortified by her insistence that as a condition of publication, all clinical trials be listed in a public registry and that academic statisticians review results of all industry-sponsored trials. JAMA is also the most widely circulated medical journal in the world.

However, Dr. Bauchner is also coming to JAMA at a time when print-focused publications everywhere are under scrutiny.

For his first JAMA issue as editor, Dr. Bauchner wrote and podcasted about his goals for the journal, and it appears that his immediate focus is on information delivery. He reminded us that although medical journals are all about medicine, they also are about communication -- getting the best information to those people who need it. This resonates with me, because in another part of my world as chief medical officer at Computer Sciences Corp., I talk about how information technology is transforming health care with better information for better decisions by patients, doctors, hospitals, payers, government and researchers.

Not unexpectedly, Dr. Bauchner wants to make sure JAMA is effective and user-friendly in our wired world. His call for print and website redesign are a first step toward greater accessibility and a more contemporary look and feel.

But Dr. Bauchner is not stopping there. We are already reading many JAMA articles online before they appear in print. We also should expect to see JAMA and the Archives -- or excerpts -- on tablet computers, smartphones, audio files and video files. These "in brief" versions even may be presented in less scientific language. JAMA already has a blog, but soon there may be more blogging.

The "in brief" versions will be geared not only to meet the needs of the medical community, but also as a way of increasing the number of people who see JAMA content. His goal is to make JAMA and the Archives more adaptive and more creative in finding ways to get information to readers in the way they want it and "not the way we think they should get it."

However, lest we think the print version of JAMA is on the way out, Dr. Bauchner says "no." Emphatically.

He told American Medical News recently that during the eight years he was ADC editor, he conducted three readership surveys, expecting to see a declining interest in their printed journal. Instead, he said, the numbers barely changed. Those desiring to receive the journal only online remained at about 15% to 18% over all three surveys, meaning that a big majority still wanted to see it in print.

I, for one, am energized by Dr. Bauchner's goal of getting information to readers as they prefer to receive it.

Nowhere has electronic communication moved forward as fast as in the medical community. This is true not only for physicians and other medical professionals but also for patients and their families. Today, patients are part of the health care team. They need to -- and want to -- understand what options mean as they take part in making decisions about their care. JAMA can help make that happen.

Of course, as we move to new communication models, we will encounter challenges as well as opportunities. The instantaneousness of electronic communication can work at cross purposes with deliberate approaches. Broader dissemination runs greater risks of misunderstanding or misuse of information. Many clinical studies and other health information are reported in both the traditional and electronic media, often bringing only confusion to highly complex subjects. A confused public and unsure media need quick access to sources of information they can trust. JAMA and the AMA are solid, trusted sources in a sea of uncertainty.

There are other challenges for JAMA, like the NIH requirement that studies from NIH-funded research be offered free in the public domain. This offers a major threat to paid publications like JAMA -- unless we can find a creative and effective solution.

In 2009, ABC News collaborated with the medical news service MedPage Today to survey 800 specialists and medical historians. Their goal was to determine the top 10 medical advances in the new century. Information technology was ranked second.

The Internet and information technology have changed the way we practice medicine. We now can review a patient's medications instantly or look up clinical questions on the spot with a smartphone or tablet computer. Telemedicine is a viable alternative. As electronic medical records systems take form, the interconnectedness of the medical community promises changes we can only begin to see. The list is long and promising.

This is a new age for medicine. With Dr. Bauchner's goal of providing valuable medical information in the form his readers (or listeners) choose to receive it, JAMA will remain an invaluable, trusted resource for years to come. Please join me in welcoming Dr. Howard Bauchner as our new editor-in-chief at JAMA. Our patients and we physicians will benefit from his communication leadership.

Robert M. Wah, MD is a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect.

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