Featured topic and speakers
Kirsten Bibbins-Domingo, PhD, MD, MAS, editor-in-chief of JAMA® and JAMA Network™, and Stephen Parodi, MD, executive vice president of The Permanente Federation, discuss how medical journals and research are evolving to build trust, meet the needs of physicians and leverage AI. Learn more in the first part of a two-part episode of the Moving Medicine podcast.
Speakers
- Kirsten Bibbins-Domingo, PhD, MD, MAS, editor-in-chief, JAMA® and JAMA Network™
- Stephen Parodi, MD, executive vice president, The Permanente Federation
Host
- Todd Unger, chief experience officer, AMA
Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
Unger: Welcome to Moving Medicine, a podcast by the American Medical Association. Today’s episode was produced in collaboration with The Kaiser Permanente Federation’s virtual event, The Reinvention of Research. It features Dr. Kirsten Bibbins-Domingo, editor-in-chief of JAMA® and JAMA Network™, along with host Dr. Stephen Parodi, associate executive director of The Permanente Medical Group. They’ll talk about the evolving landscape of medical journals and research. Here’s Dr. Parodi.
Dr. Parodi: Hello everyone, I am Stephen Parodi, executive vice president of the Permanente Federation and the Permanente Medical Group. I'm really looking forward to a robust discussion with our esteemed guest, Dr. Kirsten Bibbins-Domingo. She is the 17th editor-in-chief of JAMA and the JAMA Network, a peer-reviewed medical journal, publishing original research, reviews and editorials covering all aspects of biomedicine. A nationally recognized physician-scientist and leading voice for equitable health care, Dr. Bibbins-Domingo has been named one of modern health care's 100 most influential people in health care two years in a row, and we are thrilled to have her as a guest here today.
For more than a century, journals like JAMA have been held in high esteem by physicians, scientists and even the general public. But recently some have questioned if traditional peer-reviewed processes are outdated. How are medical journals connecting research to real-world results? Are they still effective in sharing scientific breakthroughs that improve patient care and address inequities? How can physicians use peer-reviewed research to build trust? And with all of this, what role does artificial intelligence play?
Dr. Bibbins-Domingo, thank you so much for joining us today.
Dr. Bibbins-Domingo: I'm really thrilled to be here. Thank you for the invitation.
Dr. Parodi: It's really great to see you. So let me just kick this off with a question around the democratization of medicine and the need for equitable access to information. And broadly, where do you see peer-reviewed medical journals fitting in, particularly in the United States?
Dr. Bibbins-Domingo: Sure. I mean, I think the goal that we have as scientists, that we have as therefore the journal that is trying to publish the work of scientists, of other thought leaders in the field, that work is only as good as the next scientist can actually read it to do the next experiment. The clinician who wants to apply it has access to it. That others who are making decisions for health systems or for health policy can think about how to make an evidence-based decision. And so access is everything.
And so then the question is how do we achieve that goal? The reality is we are, at this time, through multiple models to figure out how to achieve a goal that I think everyone shares. As you all know, to have high quality work, it does require resources, but the models of subscription-based journals are really falling by the wayside. And so many have advocated open models, open access. Those have other benefits because it's more accessible, but they have other risks. And I think we've seen during a lot of the open access period, the rise in more journals, more people stepping in, shifting costs to other places. And so we haven't quite figured out the perfect model.
In our JAMA Network we're really proud to have open access models as well as subscription models. And we've taken the idea of having access very seriously. So one of the small things is, if you are on any of our social platforms, everything is free on our social platforms. If you click on the link, you'll always read it for free. Anyone around the entire world, even if they have no access to JAMA, my subscription reads for free on our social platforms. If you subscribe to our email links, you do.
It's not a perfect way to think about it, but I would have to say what you are talking about is a goal that I think all of us have a responsibility to achieve, because otherwise we are not doing what science and medicine fundamentally is there is to learn from one another and then to share that knowledge for others to be able to do this.
Dr. Parodi: Kirsten, you raised a couple of really interesting points, and so let me touch on something here. You talked about, in my mind, a broader audience for medical information and medical journals as opposed to maybe the traditional way that I was brought up. Now I'm starting to be an old guy here. But the fact that you're talking about a broader audience, who are we talking to today from a JAMA perspective?
Dr. Bibbins-Domingo: Yeah, such a great question. I've been in this job two and a half years, and that is the question. It's always like, "Who are we trying to reach?" So for me, our audience is always the broadest audience. It is clinicians first and foremost. That's our sweet spot. We are publishing science, but science is oftentimes published for those who are going to also do the science, right? Those might be physician scientists, but they might be others who are not as tied to clinical practice. So that's our core, publishing for clinicians, publishing for other scientists who are going to read that work.
But then the audience is always the broader lay audience, the patient audience. We publish patient pages. The health system leaders, the health policy makers. We have a global audience. Even though we are a U.S.-based journal, more than half of our traffic comes from outside the U.S.
Subscribe to free AMA email newsletters
Get the latest news from the AMA on the topics that matter to you—delivered to your inbox.
So how do I think about that? I want us to always have the broadest reach, but then I also want to be able to tailor information to give clinicians what they need to actually put something into practice, to give scientists what they need to reproduce an experiment, and to give those who might not be steeped in science and medicine―a lay audience―those types of things. So in that way, we have to think broadly. And journals, now that's our challenge, is not to be traditional, the way you've started us off, Steve. We all know this. There are lots of organizations trying to communicate across multiple platforms, and medical journals have to do the same thing.
Dr. Parodi: Now … talk about taking over during a tumultuous time in the last couple of years, right? And so now you've been in the role for editor-in-chief of JAMA for a little bit, and you had to chart a new vision. Maybe you could talk to us a little bit about what priorities you've set, and how are you advancing them as the editor?
Dr. Bibbins-Domingo: Yeah. So in many ways it's charting a new vision with each new editor-in-chief, but it's also 141 years at JAMA. That's how long we've been in existence. The JAMA Network is 13 journals, all of whom are at the top of their respective fields. So this is a strong network with a long tradition. But I think for me, I didn't come from a background of journal editing. I had never done this before. I came from being an avid reader of journals and being a physician scientist who published. One of my first publications is in JAMA. And so I have that perspective of an author and a reader. And it turns out that that's not a bad perspective to bring to a really strong existing organization. So I have tried to really think through, "What would I want to read? What would I want to know in a field I know nothing about?"
I still do clinic in San Francisco, and I ask my colleagues and they say, "We can't find this thing. I really like this that you published, but I hate this because I don't have the tools I need for my patients." And that's what I want to listen to much more. And so we've focused a lot on listening to authors, listening to our readers, thinking about the readers in different segments of our broad audience. And that's really where we've focused. And so I think you will see us doing many of the same things we traditionally have done, vetting the science, applying our editorial process, but then really expanding out the things that we do to really try to reach the audiences that we're trying to reach.
Dr. Parodi: It's really interesting to hear you're getting feedback in real time in some cases. We were also talking a little bit about ... you run a pretty large shop in terms of people at JAMA. How does that work? How do you vet new ideas with your staff? What's the feedback loop there?
Dr. Bibbins-Domingo: Yeah, it's really great. We have about 100 people in editorial in Chicago. That's where JAMA is based. And 100 people in publishing. And that's really the professional staff of the organization. Across our 13 journals, each have their own editors-in-chief, and so they're academic editors and they're dispersed. And so we're a pretty large shop, but we have a way of making decisions. I'm really interested in getting the feedback from our teams because they've all brought a lot of expertise. They all know their fields. That's why we chose them. And so we do spend a lot of time. I learned first from my fellow editors-in-chief, how they make decisions, how they function, what they do when something goes wrong, because occasionally things go wrong. How they think about their audience. Who are they trying to reach? What is the hottest thing in neurology right now? What do you think about in infectious diseases, where we don't have a journal, but we have a lot of infectious disease content. So our editors work together within each journal, and then across the journals, across the editors-in-chief. And then with publishing, because publishing is really where we're thinking about how do we create new ways of thinking about delivering content that somebody really wants to see as opposed to trying to fight it against the massive content that we actually publish? So that's the fun part of it.
Dr. Parodi: There's a lot in there, and very interesting. So I'm curious, and you've referenced infectious disease, which is near and dear to my heart because I'm an ID specialist. But what trends are you seeing in terms of research today? What kind of topical areas are active? What do you see as the future over the next couple of years?
Dr. Bibbins-Domingo: Yeah. Well, this is a very exciting time, I think for the scientific advancement. You look across so many fields, cancer, infectious diseases, neurology, certainly in endocrinology, where we know so much more about the mechanisms of disease that we're seeing more targeted therapy. So we're seeing an explosion of new therapeutics. And that of course is always interesting, and it offers its own challenges when we think about actually implementation in clinical practice and we think about the larger system effects of all of these new medications. GLP-1's would be a great example of that.
But it's an exciting time. And for a journal like ours where we're really focused at that intersection in clinical practice, what is particularly exciting is trying to think about how do we explain mechanisms? Because that's not really our sweet spot, but we sometimes think it's good to help clinical readership to understand the mechanisms because we can think through them much more. And then also to think about the science as it's published, and then to think about the broader implications for clinical practice, for health policy, for other types of things like that. So that's the largest trend that I think I'm most excited about.
And then of course, we can't get out of this conversation without talking about AI, which is artificial intelligence, something that's been with us for a very long time, but has made this big, incrementally large leap that is really going to transform how we practice medicine, how we conduct science, how we publish.
And JAMA took this on from the very beginning, right after ChatGPT was launched, and really said, "This is a good spot for us." Because what's good for us is being able to try to bring more people into a new advance, help more people to understand why this will be important. And what I learned from the early set of interviews I did with leaders in this field is that we can't just leave it to the computer science experts who are going to give us a new advance. We all, even if we're not coders ourselves, have to really understand how this new technology works, what are the pitfalls, what is the promise? And I think having our journal think about how do we publish the best science, but also how do we play our role in explaining and bringing more people in? That's what's really exciting. So I hope you'll let me talk more about AI.
Unger: Dr. Parodi and Dr. Bibbins-Domingo will talk about AI in part two of this conversation. Don’t miss it—subscribe to Moving Medicine today. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
