JAMA editor-in-chief: Why medical journals must move fast with Kirsten Bibbins-Domingo, MD, PhD [Podcast]


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AMA Update

JAMA editor-in-chief: Why medical journals must move fast with Kirsten Bibbins-Domingo, MD, PhD

Sep 25, 2023

JAMA Editor-in-Chief Kirsten Bibbins-Domingo, MD, PhD, joins to discuss how JAMA and the JAMA Network are moving faster and adapting to the rapid changes in medical research after the pandemic. AMA Chief Experience Officer Todd Unger hosts.

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  • Kirsten Bibbins-Domingo, MD, PhD, editor-in-chief, JAMA

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Unger: Hello and welcome to the AMA Update video and podcast. Today we're discussing some major trends in medical research and getting a behind the scenes look at the latest changes at JAMA. Joining me in our Chicago studio is editor-in-chief of JAMA and the JAMA Network, Dr. Kirsten Bibbins-Domingo. I'm Todd Unger, AMA's chief experience officer. Dr. Bibbins-Domingo, we're glad to have you back.

Dr. Bibbins-Domingo: I'm thrilled to be here.

Unger: Well, the last time we talked, which was several months ago, we were talking about the need to get research out faster, especially during the pandemic. Obviously, the pace of pandemic research has kind of gotten steady at this point. But what about in other areas of medicine? Do you see that same need exist?

Dr. Bibbins-Domingo: Right, so science works because we can communicate a finding out so that other scientists can do another experiment, can use what somebody else has done to build off of, so we can build the body of knowledge we need in medicine, or so that a clinician or a health system can take that knowledge and use it and apply it to patients. All of that, we'd like to happen as fast as possible while still being careful that we really understand the high quality of the work.

So I would argue that the idea that journals should be sitting on work for a long period of time is not useful to our core mission. It's not useful for authors who want their work out faster. It's certainly not useful for readers. And so we want to be careful, but we want to do things as fast as possible, while being careful.

Unger: Well, speaking of fast, it's been about six months since the launch of JAMA Express. Tell us a little bit about how that's going on. What are you learning?

Dr. Bibbins-Domingo: Good. So, well, JAMA Express is one particular pathway that's reserved for those submissions we get to JAMA that are of timely clinical or public health importance, or that are late breakers for meetings. So for those types of submissions, our goal is to move from submission to publication within four weeks, but not compromising on our peer review, on our editorial review, on all the things that we know are important for communicating. It's one of the ways that we've tried to make our process at JAMA more timely.

So even our regular lane is moving faster. It's not just our express lane. We're also trying to make things faster so that when an author comes to us at JAMA, we can get them to another journal within our network, if that's the right pace. But for these special cases for JAMA Express, we've been really happy with how things have worked. So our very first pace that came through was actually one of public health importance. Eyedrops that were contaminated with a multidrug resistant organism ended up being published in JAMA Ophthalmology, but really, again, timely, important to get the word out because people were actually getting sick and dying.

We've been fortunate to have several large trials, trials of new drugs, trials that change how we think about a particular condition, that have come in through this pathway. And I think we are happy with how we've been able to do this because we've also executed by not compromising our standards and being able to deliver faster.

Unger: Well, speaking of which, you had recently a landmark study that was published through JAMA Express. Take us kind of behind the scenes here. What changed and how did that go down?

Dr. Bibbins-Domingo: Right, so we rely a lot on experienced editors. When an author first inquires about whether a submission is suitable for this, this was a study of a phase three trial of an Alzheimer's drug called donanemab. And so we knew that this was a highly anticipated findings from a very large study of this Alzheimer's drug. So it came in. Again, we don't want to compromise our standards so it was extensively peer reviewed, editorial review, all of those same things.

But then the entire team at JAMA worked with the authors to make sure that we were able to publish it simultaneous to its release at the major Alzheimer's meeting. Not only do we want to publish the work and be faithful to what the authors have submitted to us, but JAMA is known for publishing also the context to help you not just understand the science, but say, what does it mean to you as a clinician? What does it mean to a health system?

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And so we ended up publishing four editorials with this trial, four editorials that really helped, I hope, others to put the findings of this really important trial in context of what it means for doctors, for health systems, for payers, for other types of things, in an important disease like Alzheimer's.

Unger: Well, first of all, just congratulations to you and your team. That's a big paradigm shift, and I think what I hear you saying is, you hold quality constant and increase speed. And that's kind of like a whole new use case for research. So you have that now, and in parallel, we've got torrents of information—and I'll just call it misinformation—that we started seeing in the pandemic. Do you see a role in this kind of faster cycle time now for this kind of scientific research to help combat that?

Dr. Bibbins-Domingo: Right, so you're bringing up a really important point. One of the things that I think our team, we have to hold each other in check is to say, we're not sure we're going to move this to the regular lane. We're going to do that extra step. So we don't want to focus so much on speed that we compromise at any point. I think people come to JAMA because they trust what they're going to read on the pages.

Authors submit to JAMA because they trust we're going to handle their work with care. That means not just handling their work with care so it's accurate and you can trust that, but that we're going to tell you the other things you need to know. So if we think a graphic is important for you understanding what the science is here, our graphic team is going to work on pulling that together.

But if we can't do it to the standards we hold, if we're worried that you're going to start to not trust what we're publishing, we either have to step back and say we're going to move that to the regular lane and take our time, or to rethink our processes. That's the standard. A journal only has the trust that authors and readers place in the journal, and we never want to lose that.

Unger: Absolutely. You talked about context. Obviously, the context we live in today—increasing skepticism about medicine, anti-science aggression. How are you thinking about that, and how are you addressing that at the journal?

Dr. Bibbins-Domingo: Right. It's a really important one. I have to say, we have seen concern from authors that their work might be perceived or used in a different way. We have had concern after we published things, when we see how it's used by by other groups. And so we value the freedom of expression and the freedom of speech, but the work is oftentimes used by by people who have an interest in other interests, let's just say.

So our goal, of course, is to publish and to publish a range of ways in which we think about the science and we think about the context, but also to publish about this environment that we're in right now. One of the things we're excited to launch is a series about how clinicians communicate with patients in practice. To really help clinicians to have those conversations with patients, we want to better equip doctors and patients with a way to understand scientific information.

And the goal of this series, called Communicating Medicine, is going to be to just help doctors and patients to think about how we can do this better. We have to work on a lot of different fronts, but this is our attempt, especially for our core audience of clinicians, to think about how to do that.

Unger: And I love that idea because despite the context that's out there, there just seems to be so much wide-ranging interest in medical research right now. And the steps that you're taking really play to that level of interest. Do you feel like—I don't know—the steps that you're taking right now, I'll just call it shaking it up a little bit in an industry that maybe hasn't been used to that. Do you feel like others are following your lead?

Dr. Bibbins-Domingo: Well, I think I don't know whether others. I'm not as much focused on others as what we're doing. And I think the guide for me is that people are getting health information. As you suggest, there's so much interest in health information. And they're getting it from a whole bunch of other sources if journals don't step in. So they're getting them from newspapers. They're getting them from YouTube videos. They're getting them from TikTok. They're getting them from wherever they are. There are a lot of people who are communicating, as you know.

And so it's our job not to say, well, we're better so you should just come to us, but to say, wow, there's a reason that these other platforms actually capture the attention and imagination of people. We don't want to compromise our standards, but we have to recognize, we're competing for attention, for interest. We're competing for clinicians, for scientists, and for patients and an audience.

And so we have to adopt some of those approaches to make sure we can publish work in an interesting way and an informative way, in a way that recognizes people want to consume things more immediately. And I think it's just adopting that. And I think that's our obligation as an organization that's trying to communicate science.

Unger: Dr. Bibbins-Domingo, it is always so much fun to have you, and I just love tracking your progress and the team's progress at JAMA. Thank you so much for being here today. That's it for today's episode, and we'll be back soon with another AMA Update. 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.