A new world order for medical journals
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2009)

A global financial crisis and a war in Palestine are a painful beginning to 2009. These climactic events are a reminder that health is a hostage to decisions made by people in control of machineries of finance and war.

Our world is ruled by powerful financiers and mighty generals, which may be the natural and correct order of hierarchy. But imagine if humanity were run by people whose primary concern is health? What if a country's ministry of health was more important than defence, finance and foreign affairs? What would our world look like if government priorities were driven by eradication of poverty, improving public health and – in a nod to Hippocrates – avoiding doing harm to our fellow human beings? It might be a complete disaster but the current state of the planet already feels like a disaster to plenty of the word's inhabitants.

Leading medical journals have always strived to be at the heart of the broader debate on health – usually to the anger of some readers. While research papers and clinical cases may be the essential ingredients of a good journal, debate and analysis are the most read. And this debate should not be confined to narrow clinical topics but should envelop politics and socioeconomic issues.

If journals are to provide a properly educational role then their editors must accept that clinical medicine is not one-dimensional. This month's journal shows how clinical decisions can be influenced by politics (JRSM 2009;102:11–14), conscience (JRSM 2009;102:38–9), misinformation (JRSM 2009;102:21–6), resilience (JRSM 2009;102:15–20), tradition (JRSM 2008;102:7–10) and vanity (JRSM 2009;102:2–3).

You may not be surprised to learn that the decisions of medical editors may too be influenced unsatisfactorily (JRSM 2009;102:4–5). Journals face a crisis. Research results will be increasingly released first at meetings and on non-journal websites. What will medical journals do once they have lost their most valuable commodity?

The answers are several but revolve around two themes. First, journals should have sufficient confidence in their ability to take research findings and present them in a way that engages, informs, and educates their readerships. Secondly, journals must build their non-research content, developing high-quality editorials, analytic and comment pieces. Both these solutions require editorial skills and not just clinical expertise, hence the fear among publishers and editors alike.

Specifically, the JRSM will continue to develop its current mix of material. You will see more editorials, comment and education. But you will also continue to benefit from reading research papers of relevance to UK clinicians. The JRSM will not worry that research might have been first announced at a meeting or released on an institutional or national website. Each paper's case will be considered without reference to unfair restrictions.

To accommodate more research – submissions continue to rise – as well as more editorials and comment, the JRSM will introduce publish ahead of print this year, whereby research papers will be first published on the JRSM's website (http://www.jrsm.rsmjournals.com) before appearing in the print version. The next step, will be to publish short versions of research papers – for example, an extended abstract – in the print version, while the full version appears on the JRSM's website.

These moves will help ensure that the debate on UK medicine has an unrestricted home, and it is a debate that will continue to be influenced by the effects of the global financial crisis and the conflicts raging around the world. The new world order for medical journals – a world that demands innovation and editorial skills – is upon us.