Does your journal have any influence? Richard Smith Editor, BMJ Chief executive, BMJ Publishing Group
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?
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
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 mustn’t allow the important to be displaced by the measurable
Definitions of influence • “The power of producing an effect, especially unobtrusively” Chambers dictionary • (Mark Twain said: “If you don’t 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 brand=more influence.
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.
What is influence? • Written information on its own rarely leads to change • “All journals do is take in other people’s 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.
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
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
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 Britain’s most influential newspaper • Gough A, Chapman S, Wagstaff K, Emery P, Elias E. Minocycline induced autoimmune hepatitis and systemic lupus erythematosus-like syndrome. BMJ 1996;312:169-72
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
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
What is influence? • Level four: being quoted/cited • “The only thing worse than being talked about is not being talked about.” Oscar Wilde
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
What is influence? • Level five: being paid attention to • Readership (preferably judged by others) • Website hits (in a week or over time) • Sales
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 that’s more influential than if your mum does--sadly
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
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
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
Conclusion • It’s important to try and measure the influence of journals • We might agree on levels of influence; achieving change is the highest level • I’ve proposed a scoring system • It might be the beginning of something useful; then again it might not