The 1665 publication of the first English-language scientific journal, Philosophical Transactions of the Royal Society, was guided by the scientific methods advocated by Sir Francis Bacon (1561–1626). This was in the midst of the European scientific revolution, which began with the publication of, among others, De Humani Corporis Fabrica (“On the Fabric of the Human Body”) by Vesalius in 1543. The structure of scholarly publications under the reign of Charles II remains intact today. Indeed, if Bacon were to be reanimated into the 21st century, I dare say he would feel entirely comfortable with and would recognize the configuration of the articles published in this journal. Reader, is this something in which we should take pride? Let me prove to you why your answer should be a loud and strident “No!”
But first, let us take a look at the status quo for scholarly publications and at the forces that have tried and either failed or partially succeeded in disrupting the status quo. The producers of scientific knowledge are the authors and their assistants. Those authors start with a hypothesis, seek funding to investigate that hypothesis, carry out studies to support or refute their arguments, and then share their new-found knowledge with the rest of the world. In the “pre-Internet world” (PIW), the completed manuscript representing the authors’ findings would be mailed to a journal through a publisher. That journal, once again through the publisher, would mail out the work to peer reviewers who would recommend acceptance, modification, or rejection. The accepted manuscript would then usually have the copyrights signed over to the publisher, who would then typeset the article, print the journal containing the article, and deliver that journal to subscribers. Because a specific journal had a readership that had common interests, publishers could sell advertising for goods and services for which the readership had an interest. The publishers’ business model of the PIW relies on a combination of subscriptions and advertising.
How have things changed in the “Internet world” (IW)? Substantively, not one iota! The differences between the PIW and the IW center around electronic submissions and peer review, with a little bit of online reading capability thrown in to stay “modern.” To be fair, there is a move toward elimination of the printed page by publishing online only, but this is aimed at improving publishers’ revenue margins more than redesigning the online experience. Subscribers will still pay and publishers will still profit. But hold the phone! There is a move afoot to use an “Open Access” model for scientific articles. This model states that the author pays the publisher to publish the article and the reader gets free access. Open Access preserves the business model of the publishers, shifting the cost from readers to authors. This makes sense for works that have been funded through tax payer–supported agencies, but for a substantial amount of scholarly research, especially in the clinical sciences, funding is through private or industry sponsorship. Nevertheless, organizations such as Public Library of Science and Biomed Central have used this model effectively to provide quality information to their readership. There are many arguments for and against this model, but this is not the place to engage them.
Open Access is a first step, but it is still grounded in the PIW. The Internet is the great leveler of information availability. Knowledge can be shared at the push of a button—no postage stamp required. In the IW, we need to not only provide the works of our researchers to the masses but also provide incentive to the masses to share their experience and knowledge with each other. The “publish or perish” adage does not work for the masses of the IW. What would be an incentive to get the majority of physicians, who may not be faculty members of academic institutions, to share what they know? It requires a few steps. First, change the item of value from the journal to the article. This should sound familiar to anyone who has downloaded a song for his/her iPod. In the iTunes store, the item of value is the song, not the album. Second, develop a community of ongoing peer reviewers, after publication, who comment on and rate the articles. Let crowd sourcing act as the sequel to peer review. Third, publish the articles immediately, not 6 to 12 months from submission. Let them be fresh and relevant. Fourth, eliminate subscription fees and open access fees completely. Fifth, sell each article for a reasonable price. Use the iTunes model and allow ownership of the article for less than a couple of dollars. And make that article available on every device owned by the reader without additional cost. And most importantly, sixth, the authors should be given the revenue from readers downloading the articles. After all, it is their toil and labor that resulted in new knowledge being shared with the world. Let the marketplace either reward or punish the authors on the basis of interest and quality.
The online experience has to be inviting, simple to use, and interactive. The next time you are in your surgeons’ lounge, take note of the percentage of people with their noses in their mobile phones. The content delivery must be mobile and not just a difficult-to-navigate-and-read website narrowed down for a small screen. Authors deserve to have their works presented in a way that encourages engagement and interactivity. Readers need to look forward to the opportunity to communicate with authors and fellow readers.
Whether this will occur depends on factors under our control. We are the producers of information, and we are the consumers of that information. It may seem like anathema to propose such a shift in scholarly publications, but not to everyone. In his landmark book, The Structure of Scientific Revolutions, Kuhn1 states that paradigms shift not by the thought of leaders adopting a new “truth” but by those leaders ceding control to the next generation of information producers and consumers. Those new leaders are our residents, fellows, and junior faculty—and they are online, are paperless, and deserve to be allowed to participate in the scientific marketplace.