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In today’s AMA Update, JAMA Editor-in-Chief Kirsten Bibbins-Domingo, MD, PhD, joins to discuss the latest developments in medical research and trending topics from The Journal of the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Kirsten Bibbins-Domingo, MD, PhD, editor-in-chief, JAMA
Transcript
Unger: Hello and welcome to a special AMA Update video and podcast. Today, we have our first ever in-studio interview here at the AMA headquarters in Chicago, and I'm joined by JAMA Editor-in-Chief, Dr. Kirsten Bibbins-Domingo, to talk about the latest developments with JAMA and trending topics in research. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome, Dr. Bibbins-Domingo.
Dr. Bibbins-Domingo: Thanks for having me.
Unger: Thanks. We're always innovating here at the AMA. And since we work in the same building, we thought why not actually get together.
Dr. Bibbins-Domingo: What a good idea.
Unger: So let me just start off by saying congratulations. For a second year in a row, you were named as a one of the top 50 influential people in science medicine and health by STAT. Congratulations, that's a big accomplishment.
Dr. Bibbins-Domingo: Thank you very much, yes. It was quite a surprise. So I was named one of their 46, I think named after the number of chromosomes. And I was named last year, before I even became the Editor-in-Chief of JAMA, and really for work that many of us had been doing in the community during the pandemic and also related to science communication, communicating with communities about what was happening in the pandemic, but not at all related to the work that I'm doing now at JAMA. And so to have this recognition now was particularly special, because it is about a lot of the work that we're doing at JAMA.
Unger: Well, let's talk a little bit more about that. You've got eight months at the helm now. You're making lots of changes. I want to talk about a few of those. The first is about kind of the open access policy. So let's talk a little bit about this paradigm in scientific research and how it has kind of changed the way that you're approaching things at JAMA.
Dr. Bibbins-Domingo: Sure. So basically, one of the hallmarks that is important for science is that we get information out quickly. We get it out quickly to other scientists who need to do more experiments. We get it quickly out to clinicians and practitioners. So really, to the broadest possible group who needs to receive a new scientific discovery.
We of course know that at JAMA, people subscribe to JAMA or they get JAMA as a benefit of their membership with the AMA. And so in some ways, that restricts the number of people who have access when we're publishing a new article. So our public access policy basically says that when an author's manuscript is accepted at JAMA, on the day we publish it in JAMA, the author can deposit that manuscript into a public repository.
And that public repository then is available to everyone. It's available in countries that might not have subscription access to JAMA. It's available to other scientists at institutions. It's available to lots of people, to everybody, essentially. And we think that's important because it's a fundamental principle of science, and that's what we want to be part of so.
Unger: This is kind of a business-y question, but how does that then affect what you talked about before, which is subscriptions?
Dr. Bibbins-Domingo: Yeah, so that's a really—thanks for giving me the opportunity to answer that question. So we know that it—we have a lot of confidence and a lot of pride in what we do at JAMA. That is the value add that we bring. Not just to the author has their manuscript and we vet that manuscript.
But we also do a lot of other things. We make sure we have fantastic figures and graphics so that it's clear. We make sure that we are following an article over time so if something has to get changed or retracted in an article, that we're following that. We produce audio content, video content.
We do a lot to make sure that the work of an author is amplified in a lot of ways that different audiences can receive the content. And we publish things other than science. We publish viewpoints, we publish editorials, we publish clinical reviews. We do continuing medical education. That's part of the content that we publish.
All of that is what the subscription to JAMA, all of that is what the membership for AMA is getting. And all of that, we are very proud of. So we're very clear on what we are bringing to the table, but we also want to be part of the process to make sure that the numbers, the exact data from a scientific study is available to the broadest audience at the same time.
Unger: That makes a lot of sense. I've been in digital media for a long time, and there's a lot about the package.
Dr. Bibbins-Domingo: There is.
And we are very confident in that package. And we know that's one of the reasons authors like to come to JAMA, actually, is our broad reach, is all of these things that we bring to table to actually amplify the work that they're doing.
Unger: Well, one other thing I wanted to ask you about too is this idea of JAMA Express.
Dr. Bibbins-Domingo: Oh, yes.
Unger: Tell us about that.
Dr. Bibbins-Domingo: Well, during the pandemic, one of the things that became clear—again, we've already talked about the broad reach of scientific content. But we also want to get things out as quickly as possible. During the pandemic, a lot of information was going out over social media, was going out on preprint servers, was going out in news releases.
And that's appropriate, to some extent. But we know there's a value to what the journals like ours bring, which is the peer review process, which is vetting a scientific study and that people trust when things have gone through that process.
But fast is also good. And so JAMA Express is our way to meet the needs of getting things out quickly while also keeping to our high standards of peer review. So JAMA Express says, if you send us an inquiry and we accept your inquiry into this pathway, because it's a late breaking study that's going to be published at a big meeting, it is a study of timely importance for clinical or public health relevance, that we will not—we will accelerate our process, not compromise on the process, but take it from submission to publication within four weeks.
And let me tell you the good news. So in the first few weeks that we got—we launched JAMA Express, one of the inquiries we got was about from a group of ophthalmologists who had findings from, that they were concerned about infections that were associated with use of some artificial tears. We just published those this last week.
It coincided with the CDC announcing that, in fact, people had had very serious pseudomonas infections from these eye drops. The CDC does the public health part. Ours is the vetted scientific content published in JAMA Ophthalmology, as a part of our JAMA Express.
Unger: Wow, just in the first few minutes of just talking to you, it's funny to think about these—I'll call them the fundamentals of the old way of doing things, that you're in the midst of like a very dramatically changing environment. And it's so neat to hear how you're responding so fast.
Dr. Bibbins-Domingo: Yeah, I think that's exactly right. And it's wonderful to come into an organization like JAMA and the JAMA Network that knows what it's doing, does it very well. But then to think about, well, what else can we do to be responsive? Not defensive in the face of these other these other forces but to say, well, we can do that. We can do faster. We can do broader access. And I have to say the team has been wonderful and really responsive to all of these things.
Unger: That's amazing. One of the other things that I know you've put an emphasis on is different voices, different perspectives. Again, I think really a response to the times. Talk to us a little bit more about why that's so important right now.
Dr. Bibbins-Domingo: Yeah, I mean, I think we want to be a journal that is has trusted content that's relevant to the important issues in medicine and science and public health. And we know those issues are broad. They affect many different communities, that we know—even if we just take the issues of interest to medicine, we know that people are at different phases in their training. We know that people practice in different parts of the country.
We know that the health issues are so dramatically different across different communities. And in order for us as a journal to really be at the forefront for providing scientific, medical and the commentaries related to these fundamental issues, we have to have people at the table, people who are part of our team that understand these different experiences.
And that's what we have been doing, both in the way we do outreach to authors, in the way we've built our editorial team and the way we think about our editorial board, in the way we think about who is commenting on studies that we're publishing. We have a lot of work to still do, but we've made a lot of progress. And I think it is what good journals have to do to keep pace with the important issues.
Unger: Now, you get a front row seat, of course, for a lot of the latest research that's coming out. I'm curious, what's on your radar screen right now that you think physicians should know about?
Dr. Bibbins-Domingo: Well, so you probably have heard of this thing called ChatGPT, which is driving all of us a little crazy right now. I think ChatGPT is one of those these large language models that really represents an incremental jump in the artificial intelligence that we know are going to shape what we do in clinical practice.
They are certainly shaping how we are thinking about publications. They're thinking about a lot of things. And I think our job is to keep pace on those. Is not to sort of shut down and say, well, we are only going to do things the way we've traditionally done it.
But to recognize that a new advance in artificial intelligence, that a journal like ours both has to understand how these tools really will change medicine to be at the forefront. That forefront means wanting to find the best science, but also wanting to find the voices that are questioning and cautioning at the same time.
To think about its impact on publishing, because it does have an impact even on how we think about the work that we do in publishing. And so I think we will all be talking about artificial intelligence more in the future, by what it does for our clinical practice and what it does in publications
Unger: I think it's a little bit of the wild west right now. And there are just so many issues, especially in health care and publishing. I think if I read it properly, that there was maybe even ChatGPT being indexed as an author in a publication?
Dr. Bibbins-Domingo: Yes. Yes.
Unger: You know—
Dr. Bibbins-Domingo: It's amazing how fast things happen. So when the chat bot was introduced and then we've, of course, have many other large language models that have really come to the fore. Very quickly someone noticed that groups had listed ChatGPT as one of the authors on papers and it's already indexed in PubMed as an author.
We took a position very early on, our editorial team—a position that I think is the right one and many have followed suit since that time, to basically say, this is a tool. It's like any other tool. If you use a tool when you send us a paper, you should tell us that you've used this tool. ChatGPT cannot be an author. Only humans take responsibility for what they publish. Only humans can talk about their conflicts of interest, can say, yes, I've looked through all of these citations.
So our position is only humans can be authors. Humans take responsibility. This is a tool. If you use this tool, you have to tell us. And I think what we're learning with these tools, like ChatGPT, is that they can make many things remarkably easier and that we also have to be cautious, because they have this wonderful authoritative way in which information comes forward from them, and that sometimes it's misleading or false or biased, and we have to be thinking about this.
Unger: I especially love that term, hallucinate.
It's funny, because I was thinking a lot about this. It's like that movie I Robot, or the Asimov's rules for robots. We don't have those rules. And I'm glad to hear that you have some rules, at least in the early time, and we'll evolve. Because words like citations, they don't really exist right now necessarily in ChatGPT. And so a lot of the credit, recognition, impact of all of this research can't just come out in a un-cited answer.
Dr. Bibbins-Domingo: Exactly right. And in fact, ChatGPT is notorious for making up citations. So one of my colleagues, who's an editor of another journal, noticed—this was not in publication, but he had noticed this in somebody's commentary and he realized that they had put together his name and his colleagues name in a fake citation.
And so there's a way in which these tools, like all of the tools we have available to us, do some things well, and in this case, can be very misleading. We've also published some interesting work that shows that it is good at doing some tasks that we take for granted in clinical practice. How we give routine medical advice. There's a wonderful empathetic way that ChatGPT has been shown in some of these studies to actually provide answers to some of these questions.
So I think our job is not to say, oh, there's no role for this, but to understand where can this make the lives of physicians in clinical practice better? Where can we do some things better for patients? And where is the science that tells us what the state of affairs is? And that's where we definitely want to be at JAMA.
Unger: So many exciting things coming our way. One of the other kind of big conversations out there is around how science should be funded, and how it's regulated, how it's conducted. Where would you like to see things go kind of in this realm?
Dr. Bibbins-Domingo: Yeah, this is a really big area. I think that we are at a crossroads in many ways, where we know that in the U.S., the ways in which we've invested in our biomedical enterprise, the ways in which companies and federal funders and private funders and the universities, and increasingly, large clinical practices are involved in research, has brought us many things that are really important for discovery.
We also know it probably costs too much. It's going a little bit too slow, and it's not quite as symbol for what the things we—we as clinicians want to have the answers for the patient that's sitting in front of us. So we don't always have the right answer at the right time.
And so one of the things we want to be doing at JAMA is not just to be the passive recipient of the science coming to us, but to also actively say, we also are having conversations about how science should be done. How can we do science that is more relevant to the doctor and patient at the bedside?
And so you will see us coming up this fall launching our JAMA Summit, which will be the first time we have an in-person collection of thought leaders in the areas of clinical trials, talking about how could we do our clinical trials more efficiently? How can we have more answers that are relevant to patients and to doctors?
And I think it is—it's a timely conversation. And I think at JAMA, we don't want to be just, again, passively sitting by and saying, well, we'll wait for others to figure it out. We want to say, we're a part of the biomedical enterprise. We're a part of this. And we want to be—our role, that we think is important, is to convene and to have some of these discussions that I think will be important for shaping science and medicine.
Unger: You know, I'm so glad we got to do this together today, because I feel it coming through sitting here with you. If I had to describe one kind of word, it's faster. So I feel it, and I'm excited to see what comes in the next few months.
Dr. Bibbins-Domingo: Wonderful.
Unger: Thank you so much for joining us today. That's it for today's episode. And we'll be back soon with another episode. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
