Richard Smith: The death throes of national medical journals

richard_smith_2014Earlier this week the Canadian Medical Association fired the editor of the CMAJ and dissolved the journal’s oversight committee, which was supposed to protect editorial independence. While doing so, the board of the CMA—with impressive hypocrisy—reaffirmed its commitment to editorial independence. That’s two editors the CMA has fired and two it has “let go” in the past 10 years. The Australian Medical Association fired the editor of the MJA last May, two years after firing the previous editor. The Norwegians have also fired an editor. What does all this firing signify?

In short, it signifies the death throes of these journals.

When founded in the 19th century every medical association and medical college wanted a journal. It was a status symbol that showed a commitment to science, and for the associations it was a fig leaf hiding their naked ambition to get more money and better conditions for their members. Local academics could publish their studies—albeit not their best ones—in the journals and were pleased. If they were lucky or well managed the journals made money for the associations through selling subscriptions and advertisements, and everybody was happy: there was science and profit.

The world has, however, changed. One of the major changes is that authors have become obsessed with impact factors of journals—because they are measured by the impact factor of the journals in which they publish. This is what drives British authors to publish in American journals, and authors from “small countries” like Canada and Australia to publish in American, European, and British journals. This trend has accelerated, and it has become harder and harder for small national journals to attract the best studies. That means their impact factors go down and downward spirals begin.

At the same time “megajournals” like PLoS One, BMJ Open, and many others have appeared, meaning that authors can get their studies published rapidly and easily (because these journals don’t select for importance and originality). And these megajournals increasingly have higher impact factors than the local, national journals.

Then journals of medical associations have always struggled with their main readers being local clinicians who are mostly not interested in original research. If the journal is mostly research then readers stop reading and advertisers stop advertising. And in a world where we are bombarded with information and stimulation, much of it free, both readers and advertisers have many other places to go. In the “attention economy” medical journals compete with Hollywood, the Premier League, and the Huffington Post—and are mostly unequal to the task. The editors have to find material other than original science to try and interest their readers—material like obituaries, news, and educational articles. Some of that other material had to be paid for, increasing costs. So money enters the picture.

If journals make money for their owners then they can go their own sweet way—so long as they aren’t too heavy handed in compromising the political interests of their owners. But once the medical associations have to support their journals the questions begin. What is this journal for? Why do we need it? Couldn’t we have something that would be more supportive of what we’re trying to achieve? Some journals make lots of money, why doesn’t ours? These questions come from members and from the boards of the associations, most of whom are clueless about publishing.

The CMA demonstrates this ignorance. They have fired the editor in order “to recast CMAJ as a world-class leading journal.” They have no chance of doing this, even if they were willing to throw money at the challenge, which of course they are not. They are swimming against a strong tide. Journals are on their way out not in: even the top journals are likely to disappear—or to transform into something very different—within a few years. And what Canadian researchers, let alone international researchers, are going to send their best work to the CMA, when the owners get rid of four editors in ten years and are so cavalier about editorial independence? Does it occur to the CMA, I wonder, that they may be the main architects of the downfall of the CMAJ?

The CMA and other medical associations need to think hard about what they want from their journals. Their best bet, I suggest, is to produce a cheap and cheerful publication that will entertain their members so that they are pleased to receive and read it. Advertisers might then follow, and if they are very lucky they can cover their costs. But forget about publishing serious research and boring journals that nobody reads.

Competing interest: RS was the editor of The BMJ and chief executive of the BMJ Publishing Group. He was once on the editorial board of the CMAJ and advised the then chair of the CMAJ Oversight Committee a few years ago. John Fletcher, the sacked editor, was employed by The BMJ when RS was the editor. He once wrote a column in the MJA, spoke at the centenary meeting of the MJA in 2014 on how journals had no future, and he was a friend of Steve Leeder, the sacked editor of the MJA.

Richard Smith was the editor of The BMJ until 2004.