Q. You’re currently the editor of the British Archives of Disease in Childhood. What got you interested in journal editing, and why JAMA?
A. I’m a journal junkie. They’re really interesting to me — both their content as well as how they’ve evolved over the last 10 years. JAMA is among a handful of journals that really contributes to the discourse in medicine both in the United States and around the world.
Q. I assume part of that evolution involves a change in audience. Most journals are now readily available on the Internet — at least the abstracts are, if not the full research studies.
A. The hits on the websites are extraordinary. The audience is far broader than it ever was before. Besides being physicians, it’s patients, politicians, people who run hospitals. Seventy percent of our hits [at the Archives of Disease in Childhood] come through
Q. Do you foresee making any specific changes to the journal to accommodate this audience?
A. The journal needs to pursue intelligent innovation. The website needs a redo. We need to look at the print [version] to see if we can make it more attractive.
Q. Right now, people can look at the abstracts for free, but have to pay for everything else. Would you ever consider making JAMA articles free on the Internet?
A. Its such a complicated issue. Right now, the agreement at most of the major journals, is if it’s [federally-funded] research, or funded by some foundations, it’s made free after some period of time, but the abstracts are free. We’ll have to see how it evolves over the next couple years to understand what would be best.
Q. What about the role that a journal like JAMA plays in ferreting out potential conflict of interests by researchers?
A. [My predecessor Catherine DeAngelis’s] leadership has been extraordinary about that. What was acceptable five years ago is no longer acceptable. We will continue to follow Cathy’s lead around conflicts of interest.
Q. Do journals have some responsibility to be more proactive about conflicts of interest, instead of just relying on doctors to disclose potential conflicts?
A. We know that certain specialties are more likely than others to have financial relationships with industry. If you get an article from a group of psychiatrists [for instance] and no conflicts of interest are declared, it may be worth calling them to see if they really understood the [disclosure] form.
Q. As editor of JAMA you will have a bully pulpit and be able to draw attention and headlines around the world. What issues do you see making your own in the job?
A. Equity in our health care system is important to me. I believe that most people who live in the US actually believe everybody in the US should have health care. The issue is how to deliver it in a way that’s affordable. I’m also struck that we’ve become a very risk-averse society. The balance between evidence-based medicine and narrative-based medicine — I think you saw that played out around mammography, when [a government panel] changed its recommendations [suggesting women get fewer mammograms]. There you have tension between patient-centered care and what potentially was evidence-based care. The journal needs to be a platform for those types of discussions.
This article has been edited and condensed. Karen Weintraub can be reached at firstname.lastname@example.org.