Paddington Bear was at the end of the platform. And, he is still there 15 years later as I travel through London on my way to the BMJ office – still a children’s favourite. But, medical publishing has changed dramatically. Working with Pippa Smart on a training course for medical editors highlighted the transformation. When I first attended this course as a delegate, papers were still paper and they came to me every week in a large brown parcel of new submissions, referees opinions, and revisions. Now, paper is seldom part of the process and no research submission need even see ink- it’s a flashing light in the in-box and a file in cyberspace. And, although the BMJ still exists in paper format, more readers read online than turn pages. All submissions arrive on the web, are read on screen, sent for review on the touch of a button, and editors type notes on a shared space. Our editorial committee need not even meet face to face and, when I chaired a recent virtual editorial meeting from home, we had seven editors in different locations in five countries.
 
As part of the initial introductions on the course, editors held up a recent copy of their journal- three editors (of 25)  just waved their laptops. Technological innovation facilitates these opportunities even if the academic world still hankers for the familiarity of traditional publication. We grappled with online only publishing, electronic manuscript handling systems, open access, social networking, and content bundling, but we also struggled with plagiarism, authorship, honesty, and integrity. The BMJ, positioning itself at the leading edge, attracted criticism for PICO, the magazine type content, and perceived lack of academic depth. Funny how, after two days of discussion, editors began to suggest innovations for their own journals that looked remarkably similar.
 
One area that has changed little is the peer review process. To my surprise, the BMJ was the only journal with open peer review. Many editors were resistant to a transparent review process – their main argument was that anonymity was needed to protect juniors. Another recurring theme was how our clinical readers could critically appraise the increasing volume of research. But, do you need to read everything? Probably not, and I was particularly taken by Ian Wacogne’s (Archives of Disease in Childhood)  analogy that if you are building a house, you don’t need to examine every brick in detail to understand the building. 
 
Professor Graham Richards, guest speaker at the course dinner, reflected that although the Prime Minister had just returned from a trade mission to China, there is already a long and successful relationship with academic publishing in China, particularly in science. His discipline, chemistry, had first seen an increase in the volume of submissions followed by an improvement in quality. There has been a noticeable increase in the number of research submissions from China to the BMJ, and when Chinese research consistently meets quality thresholds, UK researchers will find it difficult to compete with work supported by their immense sample frames. He was also very worried about the threat to the publishing industry if Google get the rights to academic research.
 
But, for all the repeated threats of publishing Armageddon over recent years, journal numbers continue to grow even if the model has evolved. And, for anyone who doubts the enduring value of paper, this weeks glitzy photographs of a recent film premiere remind us of one of the greatest successes of recent years. Educationalists and parents expected computer games to herald the decline of reading. Children weren’t as fickle. Along came JK Rowling and confounded the doomsayers. Harry Potter and the power of the written word.

Domhnall Macauley is primary care editor, BMJ