Is Paper Medical Publishing Dead?

Forbes has a fantastic article about some of the economics of ebooks and epublishing.  This correctly portends the inevitabe replacement of a significant amount of publishing (most?) by electronic replacements.  Several tends and technologies are poised to help push this trend.  As the British medical Journal says “Electronic Publishing in Science - The Revolution is Only Just Beginning”

My Basic Observations:

1) Electronic Publishing is Here to Stay. More on the to below.

2) The Internet is Open Source.  No need to explain.  Just look to wikipedia or the Citizendium project

3) Electronic Readers Exist and Are Getting Better.  Despite the predicted failure of the Sony E-book reader it is a great idea and takes ebooks a step ahead with its low power use of OLED e-paper.  I predict we will see better versions in the future.  For today, I read e-pubs on my Motorola Q windows-based smartphone that reads word files, html, and pdf’s just fine.  My wife thinks I should not do this while driving down the highway but hey, the law only says hands-free cell-phone calls.

Background From Outside of Medicine:  In other segments of the publishing marketplace, e-publishing is hitting an all time high.  Readers love the instant access and ability to read on their PDA-du jour, publishers love the low distribution costs, and new writers are allowed to take risks in their work that might be too costly in the print only world.  Check out Michele Lang’s work for an example. [Full disclosure:  This brilliant writer is also my wife and a Harvard Law trained litigator] She writes futuristics and urban fantasies – her first book, Ms. Pendragon, tells the story of a NYC lawyer who finds she is a reincarnation of Queen Guinevere and has to go back to Camelot to save King Arthur from an ancient curse.  Her work appears in both print and electronically, and she has shown me the explosion of e-pub in fiction literature.  She agrees with Doctorow (a print and epub writer himself and the Forbes article author) – each distribution medium has the potential to amplify the other.  Ms. Pendragon first came out electronically, and interest was strong enough for her publisher to put the book out in print form and more and more new and seasoned authors are coming out in e-pub.  She also tells me that fiction e-pub growth remains in the double digits for the past few years.  Borders and Barnes and Noble should pay attention to what happened to Tower Records.  As soon as the literature killer-app equivalent of the iPod comes out they are in serious trouble.  They have to adapt to what’s coming and learn to use open source electronic publishing to enhance print publishing, or they will suffer the erosions that the music industry has, and worse.
The Medical Tie In :  I am involved with several traditional  print medical journals as a reviewer. A fascinating recent discussion I had with the Editor of JMIG, Dr. Stephen Corson, of world-wide trends in medical research publishing, clearly shows the direction we are heading.  Virtually all of the lead tier medical journals have established electronic distribution of their journals.  I can access almost any article for papers I write fully electronically. Some Journals this year have announced that they are going electronic only (in addition to the new “start-up” journals founded this way).  We are approaching the first year where the number of articles published electronically only will equal the number published in traditional print.  What a change this will represent!  The reasons are clear.  If you look at your bank or electric company they quickly learned about the increased efficiency and cost-savings of electronic billing, statements, and payments.  I received communication recently from one of our major health insurance companies– not only do they require electronic submission of claims but now all bills by MD’s will only be paid electronically as direct deposits.  Save the money on postage mailing and personnel.  For medical publishers the costs to print and mail are even greater.

Advantages of E-Publishing Medical Journals:

1) quicker lead time from submission to publication.  The slow turn around is frustrating to authors and risks a major finding getting published elsewhere first. It can take up to 8-12 months for an accepted article to make it to print.  Submission to e-journals allows the article to come out significantly faster. 

2) quicker advance electronic publishing of significant articles.  This is why the lead journals are now doing advance electronic releases- same issues as #1 above.  Most of the major journals now offer a rapid release or advance publication option where a hot article gets e-published before they release it in print.  The journal Fertility & Sterility now also offers direct access to articles in press - accepted but not yet released. 

3) eliminate shipping costs.  As journal numbers increase and docs get more frugal profits are down for the journals.

4) ability to sell articles a-la-carte to lay public- this was a big incentive but will be replaced by a shift to open access to all medical literature- see below

5) direct links to medical literature search engines  I do the majority of my work this way now.  I search in OVID or PUBMED then click onthe direct link to the PDF of the article.  These search engines, as well as the individual journal’s search engines, now all offer an option to provide full access in every form to the article.  I can download it as a pdf or a can view it in html.  If I view it in html then every reference becomes a hotlink that I can click on and then vew that complete article.  I cannot begin to tell you the HOURS this used to take with paper journals- to pull a paper, find a significant reference then go and pull that one.  Foracadmic research or late night clinical case research this saves incredible time and ease of use means it gets done much more often.  Last, each reference I find can be directly exported in a standardized format to bibliography formatting programs like endnote, procite, or reference manager.  Typing these reference in by hand also used to take HOURS!

6) E-Journals help with presentations: See #5 about the ease of research and bibliographies.  What’s more, several journals (such as Human Reproduction) are now offering the full text in open editable format (see open source above) including access to high resolution photos and tables so researches can easily export them to presentations and powerpoint.  Gone are the days of endless scanning!

7) deals with explosion in volume of medical research publications  The sheer volume of information in every specialty is grwing exponentially

addresses increasing international submissions and reviewers.  Many US-based journals now reporting equal (or greater) numbers of submissions coming from abroad compared with domestic submissions.  Most journals have already gone to full electronic submissions and reviews (all that I review for have done so).  Statistics from major journals (JAMA, The Archives series, etc) show a shift from <10% international submissions in 1989 to 20%+ in 2000 to recent reports of 50% or more for some journals.  Acceptance rates have followed a similar trend.  You can read an editorial about the volume of articles coming from abroad and the shifting domestic:international ratios here.  The reasons behind this shift and what it portends for the future of American Academic Medicine is the subject for a whole separate discussion…

9) Potentially address negative publication bias.  This is the well-known fact that well done studies with negative results (ie the drug did not work) are less likely to get accepted for publication.  Unfortunately this vital information is then lost and inaccessible to doctors. 

Many in medical publishing see the writing on the wall and are predicitng in the near future all medical literature publishing will go electronic only.  Interestingly, there is also a trend towards free open-source access to all medical literature.  The internet model is open source and there is an opportunity for industry sponsorship.  I can certain forsee a situation where the medical literature becomes freely accessible by all (not just the literature search but the full articles). One of the most pre-eminent medical journals inthe world BMJ (the British Medicial Journal) has already done so.  They have gone open access for all articles (keeping with this spirit here is the open access article BMJ article on medical journals going open access).  The rest of medical publishing will follow…

Problems need to be overcome:  The implementation of these systems requires innovative solutions to major issues- primarily funding.  The editor Dr. Corson told me “The move to electronic journals only will pose a greater problem for the publisher than the journal; how does one make a buck (or a euro)? I don’t believe non peer reviewed journals of a professional nature will be viable, nor will author-based indexing. It’s not too hard to construct a system for electronic subscriptions, but advertising support is a necessity.”  I just hope herbal viagra won’t be sponsoring J Urology’s review article on impotence!

For further information outstanding reviews of medical e-publishing can be found in this free presentaion and here.

Check back for an upcoming interview and podcast about these trends with a major medical journal editor- Dr. Stephen Corson Editor of JMIG the largest international gyn endoscopy journal.  This will be DITM’s first in a series of interviews.  Our Podcasts have already begun.

Update:  The BBC posted a review of the problems newspapers are having as they grapple with online content, distribution and the implications for advertising revenue.

Update:   Some have even suggested that articles should go so open source that the the raw data and article itself could be online and annotatable…