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Does your journal have any influence?
Richard SmithEditor, 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 leaders2 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