Elite medical journals are resource-rich but lower-tier journals struggle

I inhabit two editorial worlds. In one, I am head of research for The BMJ. In the other, I am a volunteer associate editor for two small subspecialty journals. As a BMJ editor I have access to top-level expertise and help of all kinds. As an editor for the smaller journals, things are very different.  Few spare a thought for the disparities between elite, high-impact journals and their lower tier brethren, but the gap between them has important consequences for the medical literature.  

Medical journals exist on a spectrum and any division into rich or poor, elite or non-elite is arbitrary. But clearly there are differences in financial resources, expertise, and standards, and these tend to track together. My comments apply to legitimate journals, not so-called predatory journals that deliberately shirk their responsibilities in order to maximise profits.

By any measure, top journals are resource-rich. They have experienced medical editors, professional statisticians, technical editors, and a bevy of other capable specialists. Their status and impact factor ensure that they have their pick of excellent papers from top researchers. Non-elite journals have few or none of these things. As a rule, they depend on volunteer editors whose skills and training vary. They receive a smaller and far less select set of papers.

But the gap between elite and non-elite journals isn’t just a matter of resources. Entanglements of interest are more common at non-elite journals too, often involving journal editors, society leaders, authors, peer reviewers, and the companies whose products are evaluated in studies submitted to the journal. These companies often are major donors to the professional societies that own some of these journals.  

Put these pieces together and the resulting picture isn’t pretty. There’s often a serious mismatch between the amount of scrutiny a research paper might need and the resources that a journal can or will bring to bear. Research papers submitted to major journals are usually improved by the attention they receive, but serious contenders are good to begin with. In contrast, submissions to lower-tier journals that would benefit from careful scrutiny are less likely to get it. Many such journals can and do publish excellent work, but it’s much easier for sub-par papers to get through.

What does this mean for the medical literature? Nothing good. Small, poorly reported studies, or those with other quality problems may enter the literature in lower-tier journals, but they don’t always stay there. Some eventually are bundled into systematic reviews and meta-analyses. These in turn may be published in top-tier journals. The result is an instant upgrade to the top of the evidence hierarchy. It’s not unlike the packaging of junk bonds.  

What can be done? Perhaps we should not tolerate such major resource inequalities among journals. Some groups are making an effort to address disparities. The World Association of Medical Editors and the Committee on Publication Ethics, for example, work to improve editorial standards and professionalism. They provide accessible resources and advice that are free or low-cost. The African Journal Partnership Project pairs major journals, including The BMJ, with smaller journals in Africa. The scheme provides material and technical support in addition to advice and mentorship. More projects like this, and on a larger scale, certainly would help, but the challenge seems bigger than that.

At present the gap is widening, in part because the journal system is a winner-takes-all scheme. This particular scheme makes losers of us all, though. The problems are clear, but the solutions are less obvious. Meanwhile, we should all mind the gap.

Elizabeth Loder is head of research, The BMJ.