New Forum for Medical Research

The Computer Age has helped spur medical breakthroughs to a galloping pace as researchers decode the human genetic structure and invent whole forms of treatment based on the new science. Among the holdouts from a more leisurely era, however, are medical journals, which can take a year or more from an article’s acceptance to its publication. These journals are slowing the momentum of fast-moving fields like genetic engineering. In an important response, Harold Varmus, director of the National Institutes of Health, has proposed putting medical research online in a publicly funded journal to be called E-biomed.

Varmus has proposed an advisory board of scientists, computer experts and medical editors to plan E-biomed. He contemplates having powerful search engines, editions customized to readers’ interests and complex graphic and animation capabilities. Established medical journals are planning online versions that might have similar features, but Varmus’ idea has two advantages: objectivity and affordability.

* Objectivity. Medical journals rake in huge profits, mostly from pharmaceutical advertising. In 1996, medical journal publishers received $723 million in ad revenue, 23% more than the previous year. There’s no evidence that commercial pressure dictates their choices, but given that E-biomed would not rely on ads, it logically would be less susceptible to such pressures. The print journals publish relatively few reports about the inefficacy or harm of prescription drugs. One mission of E-biomed, Varmus says, would be to publish such negative reports.

* Affordability. E-biomed would be offered free--a boon to researchers, clinicians and libraries, especially in poor countries, that cannot afford medical journal subscriptions, which cost up to $15,000 a year. An online journal eliminates paper, printing and mailing costs, and Varmus proposes to offset some remaining costs by charging moderate fees for submissions.


Old-guard medical publishers like the New England Journal of Medicine are lining up in opposition. A recent editorial in the journal acknowledges its self-interest (“a flourishing E-biomed system . . . would very likely reduce the submissions, paid circulation, and income of most clinical journals”) but asserts a nobler concern--that E-biomed would erode peer review, the rigorous approval system that ensures the scientific value of medical journal articles. But there’s no reason why peer review for an Internet journal would be any less rigorous than for conventional journals.

Rather than reflexively opposing Varmus’ idea, leading medical journals should accept his invitation to help form an advisory board. Publishers with something to lose from E-biomed--like the Massachusetts Medical Society, which produces the New England Journal--may be reluctant to aid a potential threat to their profits. But Varmus, a Nobel Prize-winning scientist, expects most top medical journal article reviewers, who are unpaid, to be eager to join his venture.

E-biomed could, with the right help, become what electronic medical publishing needs. Quack medicine sites are already common and expected to proliferate on the Web, along with E-commerce. E-biomed will give researchers, clinicians and even interested consumers online information that they know is not motivated by a commercial agenda.