Ten years ago editors and publishers from the BMJ produced four scenarios on how the future of scientific and medical publishing might look. After I read Des Spence’s column arguing that the BMJ pay wall should be taken down and Peter Suber’s editorial on open access. I thought that it would be fun to revisit the scenarios and see how well we did in thinking about the future.

It’s important to understand that scenarios are not predictions. Rather they are stories of different but plausible futures. They are most useful as a liberating way of thinking about now and the near future. In those days we had very intense, emotional arguments about whether all BMJ content should be free online (as it was then), and the scenarios were a device to get away from the usual ways of thinking.

Three of our four scenarios described worlds different from the status quo of 2002—but one was close to what existed then. We named the scenarios after characters in the Simpsons, and luckily they are still going strong. The familiar world we named Homer, the lazy father: “Researchers continue to publish in the same old way because it’s familiar and doesn’t demand big changes in the academic reward system.”  Publishers of scientific journals continue to make substantial profits, and they “have increased the value they add to information—through filtering, distilling, and organising better.”

The world of open access we named Marge after the wise mother: “All original research is made available for free through the web—either through something like PubMed Central or on sites owned by universities, research institutions, or companies.”  The journals that are left have become free magazines. Academics are  electronically alerted to the research that matters to them, and their academic status is based  “partly on the number of hits received by [their] research on the web, partly on how much [their] research is mentioned in the magazines all doctors receive, and mostly on whether [their] research improves patient outcomes.”

Neither of these scenarios has come to pass exactly as we imagined, but there is considerable truth in both of them. Traditional journals are making as much money as ever—and perhaps even more judging by the profits of Elsevier, the world’s largest publisher of scientific journals. Publishers are as well adding value through “filtering, distilling, and organising better”—just look at the BMJ.

But at the same time the proportion of articles that are open access is steadily increasing—up to 41% of those on UK Pubmed Central from 33% in 2009. The recent announcements by the UK government and the European Commission on requiring publicly funded research to be open access will accelerate this trend, and we may be close to the point when publishers that use a subscription model will switch to an author pays model. Academics are increasingly notified of relevant research electronically, and Google Scholar has just introduced a service to do just this.

Article level metrics have been introduced, particularly by the Public Library of Science, but there is still a tendency to measure the value of a piece of research by the impact of the journal in which it is published. Importantly academics in Britain will be measured by the impact their research has in the real world, something that some of them have resisted.

Our most radical vision of the future we named Lisa after “the smart, well informed daughter,” and we described it as “a world of global conversations.” We imagined that people would  “be connected to a series of electronic communities who will keep [them] up to date with her interests.” Academic credit would come from the “buzz” in the communities. People would pick up general information from the mass media and from chat in their communities.  “When something interesting happens in medicine or health care,” we wrote, “it spreads very quickly, like gossip, through the linked communities.” Publishers would have only a small role.

When we wrote this neither Facebook nor Twitter existed, and Google was unknown to most people. Scientists and doctors have been slower than many other groups to adopt social media, but just this weekend I was reviewing an article urging them to use social media more. Academic credit does not yet come from “the ‘buzz’ in communities,” but many academics pay close attention to how often their articles are Tweeted—and one study shows a clear association between number of Tweets and number of subsequent citations (this may not, of course, be cause and effect). When something important is published word does spread rapidly through Twitter, Facebook, and other social media, and that’s the way that I usually find out something important.

We didn’t foresee blogs in 2002, but I posted the first blog in the BMJ in 2004. I now write about 100 blogs a year and about five articles. Currently my CV doesn’t include any of the 400 or so blogs I’ve written, but it does include a rapid response that the BMJ editors might select for publication in the paper journal. I think that blogs will become more important.

Our fourth world was named after Bart, the streetwise son, and we described it as a world where “the big guys have taken over.” Scientific and medical information would be provided increasingly by large organisations, particularly companies, “as a side product of their usual business.”  Traditional scientific, technical, and medical (STM) publishers would be gone, and editors would work for the large companies, and their job would not be to think for themselves, but to promote the mission of their employers. Nobody would worry about the independence of information, and the whole idea that information might be neutral would be seen as naive and old fashioned. The market in ideas and the money markets would be tied closely together, which would ensure that good ideas were quickly exploited.

This was the scariest of the worlds we imagined, and mostly it hasn’t happened. We do perhaps understand better in 2012 how dependent existing journals are on pharmaceutical companies, but probably greater value is placed now on the independence of information. Many commercial companies—particularly pharmaceutical and financial companies—have seen their reputations slide, and people are more not less suspicious of their pronouncements.

As I’ve said, the main value of scenario planning is not to predict the future but rather to free up thinking on the present, but the other value is to think about what will be important in all of the worlds. We ended our article trying to do this, and I want to end this blog by commenting (in italics) on how important these things are now.

• Community information (gossip) will be important in all of these worlds. As true as ever
• All the worlds are “global.” More true
• Patients are a growing audience in all of the worlds; patients’ evidence may become as important as doctors’ evidence. Patients are a growing audience, but only slowly are they becoming less passive. Websites like Patients Like Me, where patients can share experiences and data, will, I think, become much more important in the next decade
• A strategy that depends on publishing original research will work in only one of these futures—Homer world. It still works but may be coming to an end
• Producing distilled, value added material will be important in three of the worlds. Becoming ever more important
• Educational material will be important in three of the worlds. Still important
• Doctors don’t pay for the material in any of the worlds; money comes from large organisations or advertisers—meaning that “sales” is steadily more important and that relationships with many sorts of organisations may be important. Despite Bart not becoming as true as it might have done this trend persists
• The web is important in all the worlds, and so potentially are other means of delivery (handhelds, digital television)—emphasising the importance of producing information independent of platform. We wrote this before the existence of I-pads, and it’s increasingly important for publishers to let their material be available on many platforms
• Paper survives in three of the worlds. Paper is still with us but is a substantial cost for publishers, particularly publishers of newspapers, and using it less offers huge savings
• In all the worlds there may be increasing competition for doctors’ attention.  As true as ever
• Even in the Homer world there is ample room for innovation in delivering information. The scientific paper still looks much as it did in 2002 (and 1952), and we need more innovation

Competing interest: RS was the editor of the BMJ and chief executive of the BMJ Publishing Group in 2002 and wrote the first draft of the article on scenarios. He left in 2004 but served on the board of the Public Library Science from 2004 to 2011. Currently his only formal role in medical publishing is as chair of the Cochrane Library Oversight Committee. He’s also chair of Patients Know Best, a young company that uses information technology to enhance patient clinician relationships.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.