Liz Wager: Spreading the word

Liz WagerA journal editor told me he was once asked to act as an expert witness defending a doctor accused of negligence for failing to diagnose a rare condition. The defence hinged on how soon a doctor could reasonably be expected to be aware of a medical development after it had been reported in a journal. To my friend’s relief, but my disappointment, as I’d have liked to have heard his answer, the case was settled without his expert testimony, but his story set me thinking. Journals are in the business of transmitting knowledge and ideas, but most seem content with the most old-fashioned and passive mechanisms and virtually never try to find out what methods work best.Still pondering about how ideas spread, I was asked to give some talks about how the guidelines on Good Publication Practice for Pharmaceutical Companies (GPP) were developed. I decided to use these opportunities (a couple in the US, and one in UK) to ask my audience of medical writers and publication planners from drug companies and communications agencies just how and when they had heard about GPP.

Journal editors, and anybody who thinks that publishing something in a peer-reviewed journal is a speedy and effective way to influence people, take note! The GPP guidelines were published in 2003. We had no budget for promotion, but a few evangelists joined me in spreading the word when we weren’t too busy with our day jobs or other distractions. I created a very basic website and that’s all the marketing we did.

But although we started consulting 10 years ago and finally published the guidelines nearly 7 years ago, most of my audience learned about GPP only 2-3 years ago. Virtually nobody had found the article in a literature search, but around 70% had heard about GPP at meetings or from colleagues. I’m sure the journal article gave us credibility, but, by itself, it didn’t get the message across. Word of mouth still beats ink on paper, and several years after the publication, the word is still seeping out but usually through a ‘grey literature’ of company guidelines, not directly via the journal.

I’d still love to know how long it is reasonable to expect a medical development to leap from a journal’s page into a doctor’s practice (and I expect the answer is, boringly, ‘it depends’ on all sorts of fascinating factors that most journal editors couldn’t even start to imagine). While I’m waiting for an answer I’d like to challenge editors to think about the after-life of their publications and whether the current model really is the best way to get ideas across. With all the clever methods we now have at our disposal of whizzing information around the world, people still seem to be most influenced by face-to-face encounters with other human beings. But if you’re reading this, and it’s set you thinking, maybe I’ve just disproved my own argument.

Liz Wager is a freelance writer, trainer and publications consultant who works for a number of pharmaceutical companies, communication agencies, publishers and academic institutions. She is also the Chair of COPE (the Committee On Publication Ethics) and a member of the BMJ’s Ethics Committee.