»In my view, this is probably the most challenging time that medical journals have ever had. Over the last couple of decades, things have become disruptive with the challenge of going online, the whole notion of open access, etc. Being very resilient, medical journals have continued very much in the same way despite the challenges. But I think it has become much more acute now with the digital transformation and people getting their information from social media, predatory and fraudulent publications. What we saw during the pandemic was that people were debating science and data on social media. The sense of trying to regulate that conversation and ideally promoting or publishing reasonable arguments has all gone out the window on social media. People will say and interpret research and data in the way they want to. It’s created a whole issue around how you trust information, and that has created a very precarious situation for medical journals«.
»I think the responsibility of medical journals now is to stick to their principles. Of course, try to publish the best science and rely on real transparency and trust. When we get it wrong, and occasionally we do, we have to be very clear and proactive and correct or retract research if needed. We also need to bring back the debate from where it’s been sort of hijacked by social media and say if you want to have a serious conversation about research, that we published, our journals are the place to have that conversation«.
»Historically they haven’t listened. I would say that our content isn’t getting the influence, it deserves amongst policymakers. Understanding evidence is central to good clinical practice and good policy making, but the problem is that these skills are not very well understood by the public, the politicians, and the media outside of scientific journals. And even amongst health professionals themselves. Health professionals did promote poor science during the pandemic and even do to this day. At the very least we should be doing a better job of training health professionals in critical appraisal and research methods. If we get that bit right, then at least the conversation we then have with the media, the public, and the politicians are somehow more consistent«.
»In the BMJ we’ve always tackled this issue of overmedication, overtreatment, overdiagnosis, and too much medicine. People are automatically attracted to new treatments, companies want to promote them, politicians become very attracted to doing something high profile, that resonates with people, and I think the evidence is clear that there’s publication bias, which means that when a new intervention or test becomes available, the initial research around it is all very positive. Then later, when all the negative research is published and you find out it’s harmful or doesn’t work, it becomes hard to stop the treatment or prescription again. So, I think that’s a major problem«.
»There are two competing things going on here. First of all, we want more openness and transparency around scientific data. At BMJ, we introduced a policy this year, that with any randomized controlled trials we publish, the authors will have to share their data in a repository, where anybody can access the data and analyze it for themselves. We are one of the few medical journals, that does that. Ethically, that’s the right thing to do, but the problem of course becomes about protecting patients’ confidentiality. One of the issues is, that there are many different systems for collecting data, and generally governments and national systems aren’t very good at managing those data. But I think there are systems now in place where you can protect people’s anonymity in trusted research environments. So, I don’t think there’s any excuse not to do it well now«.
»It seems to me, they are the right things to do. It’s certainly not unique to Denmark, that care has become hospital-based, and that there’s been more investment in specialist hospital care rather than community care. It’s something, we’ve certainly seen in the UK as well. Which also means, that the workforce has been more attracted to working in hospital and specialist care. So, it does need a rebalancing. But how do you incentivize people to work in community settings primarily, but also in areas where they may be less attracted to, more deprived areas? Do we lock people and say: ‘You have to work for a number of years in a particular part of the country?’ I don’t really know. Perhaps you need to do both. Something needs to be done«.
»It’s in a mess. It dates back to before the pandemic, but certainly, since the pandemic, it hasn’t recovered at all. For many years, we’ve had politically short-term decisions, that have favored hospital care and not favored community care and public health. We’ve got low baseline population health, the social care system has been suboptimal, and it puts pressure on hospital care specialists. Our new government seems to be taking the issue much more seriously with the change of financial flows from hospital to community care. They want to have a long-term strategy for health, which is unusual in the UK. But our health service has been underfunded for years, with hospitals falling apart and facilities not fit for their purpose, and we need money to get waiting lists down to normal, to make sure the staff are adequately paid and improve children’s welfare«.
»At BMJ, we don’t really have that problem. We see ourselves as an international medical journal. We publish the best science and research from anywhere. We have about 150.000 doctors, that the BMJ goes out to in print every week – but only in the UK. Online we reach two to three million worldwide a month. So, we generally view our website as an international website, while we create a very UK-tailored product for readers in the UK in print. There certainly are other challenges of being owned by a member organization. We’re fortunate at BMJ, that we have editorial freedom from British Medical Association, and I think we all accept, that there will be times, where we might publish something, that doesn’t agree with the BMA policy. But that isn’t the case for all publications«.
»One of our values is to be patient-centered. So, we have a team of patient editors, a patient partnership strategy, and a patient partnership advisory board. It took us a lot of effort to get to that point. I can’t point you to any hard data, but we do think it’s worthwhile and improves, what we do. But it’s also a signal – saying this is how we want health care to be because there is evidence that if you involve patients and the public in the design of health services, in setting research questions, in interpreting how research findings might be implemented, it all leads to improvement. We want to show that it’s important to work together«.
»It’s very interesting. I mean, there are some problems with this particular suit as far as I can tell. One of the complaints is that several journals should consider the same paper at the same time. Actually, we have discussed this kind of option at the BMJ, but we haven’t come down in favor of it because potentially one paper will get peer-reviewed – in this case – by six journals. In itself, that is problematic and unethical because you’re duplicating all of the effort and using up peer reviewers’ time. I don’t think it’s the right way to go. Whereas a model whereby for example, people posted a pre-print version of their article in one place and said, ‘If anybody wants to publish it, here it is.’ I think that’s potentially feasible«.
»It’s important for us to speak up. So, we do. Our mission is really about prioritizing outcomes related to health and well-being for people on the planet. And health and well-being outcomes are not only derived from the health sector. Only 20-30% of those outcomes are as a result of what happens in the health sector. Climate, living in conflict zones, housing, transport, and labor – all this have an impact on people’s health. And we very much firmly believe at BMJ that we do have to comment on these issues«.