Editors, by definition, are different. The annual short course for medical journal editors brought together a bunch of bright energetic free thinkers—mostly doctors. These new editors bring their own perspective on the rapid changes in medical publishing: Journals are gradually migrating to the web, publishers are selling bundles, big journals are creating off shoots, and the author pays online only model is growing. Impact factor still beats all and beware your web metrics—what you think is a reader may be a computer. Libraries are under budgetary pressure, repositories are challenging publishers, and the major companies are going through a period of consolidation and mergers. Your journal is your brand, and you are not just promoting academic excellence, but marketing a product. One of the exercises was to think about creating new medical journals and their potential business model:

Three new online only medical journals: Sick, Cured, and Dead.

Sick. The sick will always be with us and, with disease mongering and overdiagnosis, this is a growing business. Medicine doesn’t seem very effective and as soon as we make any progress, there is  another condition waiting in the wings. Indeed, illnesses no longer queue up—multi morbidity is the current trend so a journal called Sick has a great future. Advertising will never be a problem because the sick are a high maintenance demographic and will buy anything. And, there is no shortage of suppliers trying to sell them something.

Cured. A low content journal. No much to fill this journal based on research published over past millennia and the future doesn’t look too bright either. Cancer research spends vast amounts of money to make incremental improvements, but few cancers are ever completely cured. A wider target audience might attract more submissions but, from a marketing perspective, a journal entitled Nearly Cured, A Few Months More, or Temporary Remission, doesn’t have the same attraction. The cured won’t attract much advertising revenue—there is nothing to sell them and, from an industry perspective, an unpromising market.

Dead.  A certainty. With mortality continuing at 100%, this journal will run and run. And, as long as the Sick and the Cured remain, there will be sufficient important and self important doctors to publish a journal made up entirely of obituaries.  And, doctors just love reading about themselves. The only problem may be the intellectual property associated with the title. Don’t call it The Dead—James Joyce got there first.

Domhnall MacAuley is primary care editor, BMJ