Does your journal have any influence

1
Does your journal have any influence?

• Richard Smith
• Editor, BMJ
• Chief executive, BMJ Publishing Group

2
What I want to talk about?

• Why does the BMJ Publishing Group care about
  influence?
• Definitions of influence
• How can we recognise influence?
• How might we measure it?

3
Why do we care about influence?

• The mission of the BMJ Publishing Group has two
  parts
• INFLUENCE To serve the needs of doctors and
  others, to influence the international debate on
  health
• PROFIT to make enough money to support the
  mission of influence

4
Why do we care about influence?

• Profit is easily measured--down to the last penny
• We are not quite sure what influence is, which
  makes it hard to measure
• Yet influence is the first part of our mission
  and profit the second
• We mustnt allow the important to be displaced by
  the measurable

5
Definitions of influence

• The power of producing an effect, especially
  unobtrusively Chambers dictionary
• (Mark Twain said If you dont mind who gets the
  credit you can do anything.)
• Influence is in some ways a polite word for
  power.
• Influence is also something to do with brand. A
  stronger brandmore influence.

6
What is influence?

• Level one something changes because of what we
  have published
• Doctors change what they do.
• Ministers change policy.
• WHO decides to do things differently.
• Drugs are prescribed more or less.
• New techniques or methods are adopted. Old ones
  are abandoned.

7
What is influence?

• Written information on its own rarely leads to
  change
• All journals do is take in other peoples
  washing
• This sort of influence is probably rare and is
  hard to identify.
• Many different factors usually contribute to a
  particular change so even if something we
  published contributed it could not be described
  as the cause.

8
Examples of change caused by research articles I

• Photodynamic therapy with a new drug might cause
  severe burns
• Hettiaratchy S, Clarke J, Taubel J, Besa C. Burns
  after photodynamic therapy. BMJ 2000 320 1245

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Examples of change caused by research articles II

• The use of albumin in critically ill patients may
  be dangerous
• Cochrane Injuries Group Albumin Reviewers. Human
  albumin administration in critically ill
  patients a systematic review of randomised
  controlled trials. BMJ 1998 317 235-240

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Examples of change caused by research articles III

• Minocycline should not be used as the first line
  treatment of acne
• Made the front page of the Daily Mail, which
  might be Britains most influential newspaper
• Gough A, Chapman S, Wagstaff K, Emery P, Elias E.
  Minocycline induced autoimmune hepatitis and
  systemic lupus erythematosus-like syndrome. BMJ
  1996312169-72

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15
What is influence?

• Level two setting an agenda or legitimising an
  issue
• Examples of where the BMJ might have done this,
  at least in Britain
• Evidence based medicine
• Inequalities in health
• Prison health care
• Medical error

16
What is influence?

• Level three leading by example and being folowed
• Possible examples
• bmj.com is free
• open peer review
• BMJ ethics committee
• rapid responses on bmj.com
• collected resources on bmj.com

17
What is influence?

• Level four being quoted/cited
• The only thing worse than being talked about is
  not being talked about. Oscar Wilde

18
What is influence?

• Where might you be quoted?
• Other journals (impact factor)
• Cochrane reviews
• Guidelines
• Mass media
• Parliament (Hansard)
• Evidence Based Medicine/Journalwatch
• Important policy documents (for example,
  Institute of Medicine report)
• Presentations

19
What is influence?

• Level five being paid attention to
• Readership (preferably judged by others)
• Website hits (in a week or over time)
• Sales

20
What is influence?

• Level six being known about
• Widely known even if not quoted or read among
  international health professionals, political
  leaders, the public
• If George Bush knows about you thats more
  influential than if your mum does--sadly

21
Scoring influence

• Level one creating change
• Several clear cases 5 points
• One case 3 points
• Level two setting agendas and legitimising
  issues
• Several cases 5 points
• One case 3 points

22
Scoring influence

• Level three leading by example
• Several clear cases 5 points
• One case 2 points
• Level four being quoted
• Hundreds of quotes in all outlets 5 points
• Hundreds of quotes in some outlets 4 points
• Tens of quotes in all outlets 3 points
• Tens of quotes in some outlets 2 points
• A few quotes in a few outlets 1 point

23
Scoring influence

• Level five being paid attention to
• tens of thousands of readers, hits on the website
  and sales 5 points
• thousands 4 points
• hundreds 1 point
• Level six being known about
• All health professionals and world leaders 2
  points
• Many health professionals 1 point

24
Conclusion

• Its important to try and measure the influence
  of journals
• We might agree on levels of influence achieving
  change is the highest level
• Ive proposed a scoring system
• It might be the beginning of something useful
  then again it might not