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