A challenge to publishing conventions; Medscape: A new online journal sparks a debate over the importance of speed in the publication of original medical research.


Recently, child psychiatrists at the University of Chicago completed a study on a fad treatment for autism. They found that the drug secretin did nothing to help autistic children speak or interact with others, contradicting claims that had been made on a network television show.

Dr. Edwin Cook, a well-known psychiatrist involved in the study, knew the results weren't going to make anyone happy. But he thought it was important to get the news out fast, if only to calm the hopes of desperate parents.

In the world of medical publishing, it can take six months or more to get an article into print. So rather than offering their report to a traditional print journal, they submitted it to Medscape General Medicine, an online journal that was able to publish it in only five weeks.

To the Chicago psychiatrists, speed mattered a great deal.

"We were getting a call an hour in the first few weeks after the program from parents who wanted to try this," says Cook, a researcher involved in the study. "There were doctors who were very much behind this. As recently as six months ago, one had given it to 140 kids."

Countless Web sites offer health information. But Medscape General Medicine (www.medscape.com/journal/medgenmed) is the first that attempts to compete with leading publications such as the New England Journal of Medicine and the Journal of the American Medical Association on their home ground: the publication of original medical research.

Since opening in April, the online journal has yet to attract blockbuster studies that might elevate it to the elite rank of medical publishing. But its editor, Dr. George Lundberg, thinks it's just a matter of time.

"The reason it's going to succeed is that it offers speed that the other journals don't approach," says Lundberg. "It's important because authors don't like to wait for their work to appear." Scientists "rely on other people's work to stimulate ideas -- and if they have to wait months and years, it delays scientific progress."

Lundberg, 66, knows a little about medical publishing. In January, he completed a 17-year tenure as editor-in-chief of JAMA, a prestigious journal that appears weekly on a few hundred pages of glossy paper. In his position, he also supervised an array of specialty journals.

Despite his association with the AMA, he became known as a risk-taker who didn't mind clashing with the medical establishment.

Under his leadership, JAMA increasingly became a forum for progressive ideas such as alternative medicine and a single-payer health system. This brought him into conflict with the AMA leadership, which fired him in January after he published a study on the sexual attitudes of college students that coincided with President Clinton's impeachment trial.

Lundberg moved to Medscape a month after his firing. He says it wasn't a huge leap, with his having kept his hand in computers for many years. In 1963, as a young Army doctor, he computerized California's tumor registry on a hulking IBM that filled rooms. Four years ago, he established JAMA's Web site.

Since 1995, Medscape (www.medscape.com) had operated a traditional Web site that offered medical news, continuing education and links to other Web sites. More recently, it opened a site that offers consumer health information.

But it is the online journal, launched in April, that is attracting the most attention, sparking a debate over the importance of speed in medical publishing.

At JAMA and the New England Journal of Medicine, articles take an average of seven months to appear in print. At both journals, most submissions are rejected, but those that are accepted take that long to go through various levels of editing and review, not to mention rewrites, printing and mailing. At the AMA's specialty journals, the turn-around time is closer to a year.

To some extent, the online journal publishes faster because it has done away with printing and mailing. But there is more to it than that. Experts who are called upon to review articles on the basis of originality and accuracy -- a process known as peer review -- are asked to spend three days on an article, rather than the 28 days allowed at JAMA.

Not everyone complies, Lundberg says, but most are getting the idea.

"It's mostly attitude," he says. "Until recently, medical publishing was functioning in Gutenberg time. Now, we're in Internet time."

Speed wasn't the only thing that appealed to the University of Chicago researchers. Leading print journals prefer articles about treatments that work and tend to look askance at "negative" studies like Cook's. The online journal, he said, was more open to information that is useful no matter what it shows, perhaps because it is less driven by traditional standards of newsworthiness.

Editorial sniping over Medscape's ambitions surfaced in the spring when Lundberg said he had published an article about the treatment of tuberculosis in Ethiopia in 39 days. Dr. Jerome Kassirer, the former editor-in-chief of the New England Journal of Medicine, dismissed the boast as a "gimmick," saying the research was hardly vital to the human race.

"That was simply a demonstration," Lundberg says. "It was an important public-health issue, but a few weeks or months would not have made a big difference. But it's a pretty good example of what we can do."

Dr. Marcia Angell, who is now the top editor at the New England Journal, is not impressed either.

"It's just advertising, marketing," she says. "Accuracy is far more important than speed. And even their greater speed is not that much greater."

Angell points out that the Journal can shave a few months off its publication time if the editors think an article is important to public health. Occasionally, the journal will lift its usual media embargo and allow doctors to talk publicly about their research before an article appears in print.

Dr. Sidney Wolfe, a consumer advocate who heads Public Health Research Group, worries that online journals will compromise peer review in the interest of speed.

"The question is whether peer review is going to be short-circuited," he says. "If it isn't, that's fine. But when you speed things up, you can cut corners." Like Angell, he noted that the traditional publications have made a practice of "fast-tracking" articles that are important to the public health.

Lundberg says he will prove the critics wrong.

"People can say these things, but they don't know how we work," he says. "We have the same number of reviewers and the same quality of reviewers." And they can be tough. Last week, he says, he rejected an article that he originally liked but upon which the reviewers were split.

"It isn't magic," he says. "You still have to go to the people who know the most."

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