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Medical Research Journals-The Rise and Fall(?) Part 1

The Bill & Melinda Gates Foundation spends $4billion a year supporting scientific endeavors, much of it on medical research. But you won’t be reading about any of their breakthroughs in JAMA, New England Journal of Medicine, or The Lancet. No, as of last week the Foundation is doing an end-run around medical journals, requiring that all research findings be freely available in an online repository.

This move reflects the Foundation’s – and many others’ – frustration with medical research journal publishers’ controlling of access to studies and the resulting slow dissemination of research findings.

The origins of journals

Since the first issue of the Philosophical Transactions of the Royal Society in 1665, researchers far-flung across countries and then across countries communicated their research findings to one another on paper in the form of journals.

As this method of dissemination gained in popularity, rules were set into place. Medical research results can only be published in one journal. An editor decides whether an article might be appealing to a journal’s readers. A review system of outside peers judges the scientific rigor of research submitted for publication.

These rules all aimed to make what medical research journals are today: a method of communicating legitimized research results to a wider audience.

Publishers wield control

Along the way, other rules have come into being that aren’t as helpful, or as benevolent. After years of data gathering and analysis, countless rewrites, and addressing the suggestions of reviewers, the authors of medical research articles submit the final version to be published. . . along with a statement giving away copyright of their own work to the journal. The researchers no longer own their own work. With few exceptions (British Medical Journal being one of them), researchers are no longer are in control of their own words. The journal owns the paper.

Big business of journals

The New York Times building in New York. Photo by Haxorjoe. CC BY-SA 3.0

No longer are medical research journals simply vehicles for communication among researchers – published findings quickly make their way through social, broadcast, and print media. Non-researchers – from medical clinicians to patients – now can easily listen in on the conversation.

Medical research prominently covered on the front page of the New York Times can bring attention to the researchers’ institution.

Journals get a bump in their prestige, which leads to higher subscription fees (libraries pay thousands of dollars for the New England Journal of Medicine). Researchers get a prominent publication on their curriculum vitae and the promise of further grant money to support their research. The paid speaking gigs, often sponsored by a pharmaceutical company, can be lucrative.

The Ingelfinger Rule

In 1969, Franz Ingelfinger, MD, editor in chief of a state medical society journal (New England Journal of Medicine), realized that a newspaper article or evening news story that started with “According to a new study in the New England Journal of Medicine” could dramatically increase the stature of the journal and the (largely Boston-based) researchers publishing in it.

He developed what was later called the “Ingelfinger Rule,” which threatened researchers that their study would not be published if they shared their research findings before publication. In this way, the Journal could orchestrate the dissemination of new studies. The journal carefully controlled – and still controls – how medical research is publicized, “embargoing” research findings until 12 hours before publication. In this way the medical research findings are linked to the journal itself.

Journals making money, limiting access to research

It was a business move, transforming the journal into the leading publication in medicine. It also did great things for the Massachusetts Medical Society. JAMA – the journal of the American Medical Association – brings in significant money for that society.

The Ingelfinger rule is now the standard for medical research journals. Researchers disseminating their own work risk having the article pulled before publication. Not so for publications in other disciplines, where preprints are widely circulated before actual publication. The National Institutes of Health is pushing the use of preprints. Nodding to the Ingelfinger rule, they caution “some disciplines” (and their leading journals) to explore the use of preprints more slowly than other disciplines.

The fall of medical research journals?

From humble beginnings to mega-money-makers, medical journals have evolved to the point where, instead of spreading research findings, they keep it housed behind paywalls. The heyday for journals, however, might be coming to an end. In my next post, I will summarize the current state of journals-as-disseminators and talk about the role of rapidly expanding role of social media.

Featured Image Credit: Remains of the Library of Celsus at Ephesus. Photo by Benh LIEU SONG CC BY-SA 3.0

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