Webinar on medical research: AI, building trust, and JAMA’s vision

Watch the replay of “The Reinvention of Research,” hosted by Steven Parodi, MD, and guest Kirsten Bibbins-Domingo, PhD, MD, MAS, editor-in-chief of JAMA and the JAMA Network. In this replay of our webinar on medical research, Dr. Bibbins-Domingo discussed the transformation of medical journals, emphasizing equitable access to scientific knowledge, innovative approaches to peer review, and how JAMA is integrating AI to expand their reach.

She addressed critical topics such as the rise in retracted papers, the implications of open-access publishing, and the balance between maintaining trust and adapting to evolving communication methods. She also discussed new initiatives connecting artificial intelligence advancements with clinical practice, and the need to foster research participation among practicing physicians.

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Stephen Parodi: Hello everyone and welcome to our Permanente Live webinar, “The Reinvention of Research.” 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. [She is] a nationally recognized physician scientist and leading voice for equitable health care. Dr. Bibbins-Domingo has been named one of the 100 most influential people in health care two years in a row by Modern Healthcare. We are thrilled to have her as a guest here today.

Medical research clearly informs and improves patient care and peer review journals have long been the mainstay for sharing reliable and evidence-based findings. 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 But recently some have questioned if traditional peer reviewed processes are outdated. Critics argue that restricted access to medical journals can deepen disparities and raise questions around ethics and credibility. With these challenges in mind, there are several important questions to consider. 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? So before we discuss these questions with Dr. Bibbins-Domingo, just a bit of housekeeping. You can join the conversation on social media using the handle #permliveleadership. Dr. Bibbins-Domingo, thank you so much for joining us today.

Kirsten Bibbins-Domingo: I’m really thrilled to be here. Thank you for the invitation.

The democratization of medicine and equitable access to information

SP: It’s really great to see you and enjoyed our earlier conversation. So let me just kick this off with the 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?

KBD: I think the goal that we have as scientists, as the journal that is trying to publish the work of scientists [and] 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. So access is everything. And 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 does require resources. But the models of subscription-based journals are really falling by the wayside.

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. 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.

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 by 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 for, to learn from one another and then to share that knowledge so others are be able to do this.

The importance of reaching broader audiences

SP: Kirsten, you raised a couple of really interesting points, 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. Who are we talking to today, from a JAMA perspective?

KBD: Such a great question. I’ve been in this job 2 1/2 years, and the question is always, who are we trying to reach? 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. 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.

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. [For] journals now, our challenge is not to be traditional. We all know there are lots of organizations trying to communicate across multiple platforms and medical journals have to do the same thing.

JAMA’s vision for the future

SP: 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?

KBD: 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 their first publications in JAMA. 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 my colleagues say, we can’t find this thing. I really like this that you publish, 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 focused a lot on listening to authors, listening to our readers, thinking about the readers in different segments of our broad audience. I think you’ll 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.

Building trust in medicine through feedback

SP: It’s really interesting to hear you’re getting feedback in real time in some cases. We were also talking a little bit about the pretty large shop you run, in terms of people, at JAMA. How does that work? How do you vet new ideas with your staff, what’s the feedback loop?

KBD: It’s really great. We have about a hundred people in editorial in Chicago where JAMA is based and a hundred people in publishing. Across our 13 journals each have their own editors-in-chief, and so they’re academic editors and they’re dispersed. 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 mass of content that we actually publish. So that’s the fun part of it.

Trends in medical journals and research

SP: There’s a lot in there, and very interesting. I’m curious — and you referenced infectious disease, which is near and dear to my heart because I’m an ID specialist — what trends are you seeing in terms of research today? What kind of topical areas are active? What do you see as the future of the next couple of years?

KBD: Yeah. Well, this is a very exciting time for 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 therapies. 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 actual implementation in clinical practice and we think about the larger system effects of all of these new medications. GLP-1s would be a great example of that. But it’s an exciting time. For a journal like ours that’s focused on 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 biggest 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 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 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.

The role of AI in medical journal publishing

SP: Kirsten, I was going to compliment you because we had managed to make it through the first 10 minutes of a webinar in medicine and not talk about AI. But in all seriousness, the question I have for you around AI is how does it fit in from either a publishing perspective or writing. People are using ChatGPT to compose not just email and responses to patients, but maybe even publishing medical science? So how are you sorting that out? Is ChatGPT now an author on a number of these papers? What’s that look like?

KBD: Oh, such a good question. We think about this issue a lot in publishing. We are quite bullish on what generative AI is going to do for the field of medical publishing. One of the things that’s still hard for us as a journal is figuring out how to communicate across multiple, different levels of literacy, how to allow authors who might not speak English as their primary language to navigate our process seamlessly, how to make sure that we publish across many different types of ways of explaining a particular scientific content. I think the tools with generative AI are really going to allow us many more options to be able to do the thing we want to do. I think with many things, as I’m sure you are thinking about as well in clinical practice, it’s not without some risks or understanding how to use a new technology most effectively.

Soon after ChatGPT first came on the scene, we realized that we had to come out strongly and help guide authors. In January 2023, we published an editorial that said only humans can be authors on articles. And you would think that that would be self-evident, but at that time ChatGPT had already been indexed as an author in PubMed on multiple articles. So we said to authors, look, you can use this tool, you need to tell us how to use this. And depending on how you use this, you need to give us more information so that we can be upfront with our readers about how you’ve used it. We can take that into account when we’re vetting the science. Only a human can testify to the integrity of the work. So humans still have to do that. But AI is a powerful tool, and that’s our commitment to our readers as well: whenever we use AI as a tool in anything that we publish or anything in our publication process, we will also be upfront. We are bullish on it, but we also think part of our job is to help guide authors and readers in how to use it responsibly.

On peer review and ensuring integrity and quality in medical publications

SP: Talk about challenging the rubric of what we think research looks like and how you publish! Let’s dig into this a little bit more. So I want to talk to you about peer review, and of course there’ve been critiques around traditional approaches to peer review, particularly during the pandemic. I’m reflecting on the speed at which publications were coming, and questions around timeliness, relevance, are the publications actionable? What do you think about that debate, in terms of the nature of peer review as it has been done? Are there changes that need to happen? Is it all fine? What’s your sense of that?

KBD: It is definitely not a perfect system. I think though that many of the criticisms that I view as failures of the entire biomedical process oftentimes fall on the lap of peer review. They say, well, peer review should have caught this. If somebody is out to commit fraud, if somebody is sloppy in their science, peer review is critical, but it should not be the only fail-safe. I think the challenge of the pandemic was the rush, the need, the desire to get information out quickly. The fact that we had multiple journals, that oftentimes poses an additional challenge to the body of literature. I would say during this time, we take very seriously finding high-quality peer reviewers. We’re going to launch a new initiative in the upcoming year to make sure that we provide resources to educate people on how to do peer review effectively so they know what we are looking for. We take the conflicts of interest of peer reviewers very seriously. That’s very much part of our process.

The one thing I want to make sure that every reader of JAMA knows is that peer review is only one input into the editorial decision. We’re constantly looking at peer reviewers who are volunteers who provide us essential input. But it’s one piece of input and we are always trying to get as much as we can. And then to publish in a way that recognizes work is not perfect, that work always has its limitations, and we have responsibility to also give voice to that. I think as a clinical journal, we have a particular responsibility to provide the clinician an understanding of, is this ready for primetime? Should we be able to act on this? Is this a preliminary finding? And so you’ll see all of our work is published with editorials around them to really give a reader the sense of, well, what does this actually mean? And I mostly think the world is nuanced and complex and we have to embrace that, do as we have to do our job, as good as we can possibly do it, but we also have to embrace a little bit of the complexity to communicate with our readers.

SP: I appreciate the amount of work that takes and the complexity. We have our own Permanente Journal that’s peer reviewed and open access. The amount of work to have strict integrity to the system, building that whole peer review network and maintaining it, is an incredible commitment. So thank you.

Following up on that question here, which is peer review and shoring up that whole process. Amazingly in 2023, there were more than 10,000 academic papers that were retracted, which was an all-time high, both in health and health care. What’s your take on why retractions appear to be increasing and what does that mean from the standpoint of credibility? Does it actually enhance credibility because we’re just being better stewards or does it decrease credibility?

KBD: Let me just say, I think part of the process that I think journal servant JAMA takes very seriously is the post-publication process, which is about somebody flagging something that needs to be corrected in an article, somebody raising concerns about the legitimacy of an article; ultimately if it’s found that the article does need to be retracted is retracting it for the sake of the scientific record. But what you’re talking about is critically important to highlight and to probe a little bit deeper about what this means. First of all, I would say some of this reflects just the larger volume of publications we have. I alluded to this at the beginning, the good side of open access is, in fact, enhancing access. The downside is that when you align the paying per article, which is the model that open access currently exists, it’s meant that more journals have flooded into the market, including journals that are clearly predatory journals.

These are predatory journals that are rogue journals. There are other clearly substandard journals. I say this because they oftentimes are delisted as certified publications And there are also paper mills that are basically submitting large volumes because of other types of pressures for publication. If you look at the mountain of retractions and the increasing volume, some of it is just more literature out there. Some of it is the good thing that we do want to retract bad science. And some of it is this dark underbelly of medical publishing, which is predatory journals, the paper mills, those types of things, which, when they’re detected, they feed a lot of these retractions.

I have made the case, and I say this every time I’m asked to speak, is that it’s fine for me to say, this wasn’t an article we retracted at JAMA. We don’t have the problem of massive retractions. It’s fine to say, oh, you esteemed scientist, your paper is not being retracted. But when science is being retracted at such a high rate, it affects the credibility, it affects the trustworthiness of the entire enterprise. When it makes it on the front page of major news outlets, it means that people start not to trust what’s published in a scientific journal, the lay audience starts not to trust. “Well, how do we know what science is actually doing? You guys, you are retracting articles all the time. How do I trust that?” And I think we have to reckon with that aspect of it, all of us, even if we are not directly contributing to that dark underbelly, and figure out what can we do? Because the system is ultimately built on trust.

SP: That’s absolutely right. And I’m glad that I got the JAMA editor-in-chief to talk about the dark underbelly of medicine. We’ve got a lot of great questions coming in, so please don’t forget to submit those questions. We’ll get to them in just a second.

How medical journals can help physicians rebuild trust

I do want to touch on this question of trustworthiness because it’s very much a conversation within medicine and researchers. But you’ve also referenced that part of the audience here are people that are making decisions around policy and health care policy. From your standpoint, what can medical journal editors do to rebuild public trust? I think that has been very much a point of discussion in the current environment that we’re in. And let me just follow up with a second piece to that, which is medical misinformation and what do we do to help physicians like myself who are practicing in an exam room to have the trust of our patients and regain some of that. I think we’ve lost a little bit of that over the last couple of years.

KBD: I think that’s right. Well, let me start with the clinician side of it. You and I are both practicing physicians. I am sure you have the experiences I do, that we oftentimes have to convey information to patients who might have a different level of understanding, who have different backgrounds, who might have a very different worldview than we have. And I think good clinicians know how to have those conversations, sometimes over time, sometimes framing things a little bit differently using whatever it is that we have at our disposal to explain, engage. I think the challenge for us who are thinking about how to scale it is, how does that scale? I have that same goal that I have when communicating with a patient is the same goal I have when I’m publishing a journal and trying to help authors to communicate to multiple audiences. But that means I have to try to figure out how to scale all those things that we’re doing in practice. How do you frame differently for different audiences? How do you paint the nuance in a way that doesn’t get overwhelming, but allows somebody who wants to delve a little bit deeper to see the complexity and then arrive at the decision that they want to arrive at? I think that takes a little more time, it’s harder to do in the moment, it’s more complex and it’s a little bit messier in that way, but I think what we are required to do.

I will tell you one of the things that’s amazing to me how consistent this finding is, is that while the trust in scientific institutions is waning, the trust in the doctor is as high as it has ever been, regardless of political affiliation, regardless of where you are in the country. As a journal that prides itself on communicating science, publishing science for a clinical audience, part of what we’re trying to do is really give clinicians more tools so that they have the tools to have these conversations. That is one of the ways I think we can do that.

We started a series called Communicating Medicine, which is just about how do you communicate ideas, how do you communicate in the doctor-patient encounter? I think there’s been a real interest and hunger for that. Some of the ways we try is with our multimedia teams and our videos and our podcasts and our explainers and our graphics designed to give people more tools to think about that. I don’t have the answer, and clearly everything in the environment is telling us we have to be able to do this. So we’re trying many approaches, but one of them is definitely to try to make sure that we’re focused on the clinician because I think really the frontline clinicians are the trusted source of information. And if we can reach them in a way that also gives voice to the complexity, I think we’re at least part of the way on the right track.

SP: It is so interesting what you’re talking about here, because going back to medical school, one of the first courses in terms of working with patients was how to communicate with patients. And then that was the end of it. We never had another course about it. So I’m really interested in what you’re touching on here. I’m thinking about some of the real-world conversations that I was having around vaccines and learning, by the school of hard knocks, how to have these conversations, particularly if somebody has a different point of view that may or may not be informed by science. I’m interested in how did JAMA think about that in terms of needing to focus on communications? And I guess there’s a second piece here, which is you were referencing modalities of how people learn. The traditional of you’re going to get something in the mail and read a paper journal, that’s no longer the model. So what does that evolution look like from a JAMA perspective?

KBD: You’re so right. Let me start on the second part first. We’re all overloaded with information, and we are consuming it in many ways. When I started at JAMA, some of the in-house editors would laugh at me and the team would say, oh, Kirsten always reads on her phone. And I’m like, well, everybody I know reads on their phone. And there’s a tendency to think well, this is a generational thing. And I’m like, it’s not even quite a generational thing. One of my most esteemed board members said in a board meeting who’s a very senior now-emeritus professor, he says, your abstracts are too long. You need to get to the point quicker. Nobody has time to read all this. We have so many things we’re reading. So that is one of the things we have to think about.

My view is that journals have to do the job they’ve traditionally done: vetting the science, making sure you the high integrity of the science, understanding the limitations. They have to do that the same way they’ve always done it and is the best that they’ve ever done it. And then we have to do something we’ve never done, which is to then take that piece and then say, okay, let’s now put it in a shorter form. Let’s put it in a form that really, a busy clinician can come to the key points very quickly. Let’s have the video explainers, let’s have the podcast if you’re running on the treadmill on Saturday morning and you want to hear just the highlights, Let’s make sure there’s a patient page to accompany that … you get the idea. We’re trying many different types of ways to do this.

We’re also going to play a little bit with how things are framed. We come at it in the, well, here’s the hazard ratio, and so therefore it means this. And there are many ways to frame what is the scientific finding. It doesn’t mean we change what we do with the vetting or change how we publish the methods or the rigor of all that. It changes in, well, what’s the bottom line we’re trying to communicate and how can we communicate that as clear as possible for multiple audiences. Especially audiences that may not come at it from the, oh, well, it was published in JAMA, I’m inclined to believe it. Many of the things that we publish through multimedia are discoverable by the lay public who doesn’t read JAMA, who might not know what JAMA is. But those types of things have to be compelling and interesting for that audience too if we’re to do our job because we know a lot of the other things that are not good scientific information are dispersed mainly on these types of platforms.

The future of medical publishing

SP: This is great, Kirsten. I’m going to turn to the audience questions here. How do you foresee the role of medical journals evolving over the next decade?

KBD: Oh, you start off with an easy one! I think the issue of trust, the issue of access, the models of publishing that right now have led to an explosion of journals and a little bit of the, as I say, the dark underbelly. I think we have to figure out how we get the best from our publishing models and minimize the worst. I don’t think journals can think about this by themselves. They have to think about this with academic communities, with the main readers of journals. I don’t where it’s going, I just don’t think that we are going to continue in exactly the same path that we’re on right now. So it’s a little bit of an unsettling time.

I will say that at JAMA, we’re very proud to be independently published. Our publishers, the business side of the house, works closely with us, the editorial side of the house. We are firewalled where we need to be, but we’re on the same page on our goals of publishing the best science. Most journals right now are part of these big commercial publishers where it’s sort of a very different economic incentive, I think. There’s a risk for some of the smaller journals, and you’ll see that over time as well.

I know that right now we are focused a lot at JAMA on how we can make sure that we’re disseminating science across these blog platforms to reach a broad audience and then vetting the science in the best way we’ve ever done it. But as a field as a whole, I think there’s a lot to suggest that we’re in a little bit of flux.

Making space for medical research in clinical practice

SP: I’m going to pivot us here with a different topic. This is really interesting because at Kaiser Permanente and amongst the [Permanente] Medical Groups, we’ve got a number of clinicians that also practice as researchers and vice versa. Because of your background and expertise, what practical tips do you have to foster more research amongst physicians who have limited time? They’re practicing physicians balancing clinical load then also pursuing research interests.

KBD: This is a major one. I am on leave from University of California, San Francisco, but that’s one of the issues that I’ve thought a lot about at UCSF. I am very excited about the many advances in trying to integrate clinical trials or clinical studies into the practice of medicine. And my hope would be that we continue to find models that allow physicians who are in practice, who do see patients, who practice medicine, to also take part in this as a part of what they do. I think that the grand vision of having us learn all the time from what we’re doing in clinical practice, whether in structured ways or in more decentralized, unstructured ways, is actually the goal that serves us well, both scientifically and clinically. My hope would be that we find systems of care that recognize the value of having practicing physicians participate in research. We’re not there, but if we believe that science is essential to the best practice of medicine, having that more closely integrated, as it is in many places, is a goal that we should aspire to and then therefore protect some of the time for physicians to be able to do that.

SP: That’s fantastic. It’s always a balancing act in terms of trying to figure that that out.

Balancing science and opinion

I have a question that we touched on earlier, but I’m going to delve into it a little bit more. I noticed JAMA does have editorials., there are viewpoint articles, and then there are of course the traditional, as you were referencing, an abstract with an actual publication in terms of manuscript. So talk to me a little bit about how you think about the publishing of hard science versus opinion and viewpoint and is that a good thing to have those juxtaposed? Does it conflict? How do you think about that as an editor?

KBD: It’s one of the areas I think of challenge, but the challenge is easier once you’re clear on what the mission is and why you have a section called viewpoints or a section called editorials. For us, this is about the art and science of medicine. We know medicine is, a lot of it is art. A lot of it requires nuance. And if we only stuck to the thing that was going to survive peer review of the science or the well-researched clinical review, we would leave out a lot of the important texture to the practice of medicine. That is what the editorials allow us to do. It’s what the viewpoints allow us to do.

For example, we published the phase 3 trial of donanemab for Alzheimer’s disease. We published that with 4 editorials, so a really important phase 3 clinical trial, clear implications for practice. One touched on the issues of the underrepresentation of certain patient populations in those trials and what that means for the practice. We published an editorial on the cost of these medications. We published one on the mechanisms and we published one on the implications from the geriatricians on what does this mean for clinical practice. That is the reality of what you grapple with when you have a new drug that is powerful. And so for us just to publish that, I don’t think is in keeping with what our responsibility is. The viewpoints, I think we want to keep on viewpoints that are really related to clinical practice. So we are not interested in things that are tangential to that. We try to stay in that lane. We’re not going to always publish thing that it’s everyone’s cup of tea. That’s the nature of viewpoints.

But I’ll tell you, the top viewed viewpoints in the last few months at JAMA are related to how do you actually use the GLP-1s in clinical practice? How do you integrate that with your recommendations for healthy diet? What does it mean that a lot of our patients are discontinuing GLP-1s? Those are really important topics for us to grapple with because we all know as clinicians, that is what you see in practice. And if we waited until we had a great review or a great clinical study, we’re not going to get there. We published a viewpoint that’s highly viewed on why do we have so few pediatricians right now? And that is one that everybody who’s in a system, we know that to be the case. These are peer reviewed. Also, we use our editorial judgment, but I do think they’re important to the conversations that we have in medicine that we don’t yet have the science and they are about that broader texture. But it’s one where there’s a lot of, should we be doing this? Is this really what we want to be doing? We ask that question as editors all the time.

SP: That’s great. What I really enjoy about hearing your thoughts on this is that you’re talking about real-world issues that we’re grappling with day-to-day in our clinical practices, whether that’s in the exam room, whether it’s as a department or even as a system.

Providing audiences with high-quality medical information

So let me touch on this. This question’s a good one because it’s talking about the speed of information that’s getting out there. Now it’s at the speed of light, essentially, when you think about social media and what can get posted on there and the spread of scientific misinformation. The question here is, should our profession, should the research committee, should medical literature put more efforts into combating misinformation? And what would that look like or should that look like?

KBD: I don’t know what it looks like. There are people who have suggested that what our job should be is to be more vocal about disinformation. And the challenge of doing that is oftentimes that looks self-serving. Medical journals are oftentimes criticized if we’re publishing studies that were done with pharma companies or with other types of institutional practices of medicine. So I think the people who need to hear the messages about disinformation are not necessarily those who are going to take kindly to the finger-wagging of major journals telling you that.

What we’ve chosen to do instead is to say, there’s a big gap of a lot of people who just don’t have high-quality information. And my job is to put more high-quality information out there for a lot of different types of readers, a lot of different types of consumers, and that’s my job. My job is also to educate clinicians because they’re on the front lines of talking to people one-on-one. And to give people more tools to do that, I think we have to use the same tactics as others who are using information for other goals, to use the information for the goals we have of providing the best evidence to inform the practice of medicine. And so we focus more on those things, the high quality and doing that across multiple platforms, but it’s not an easy one to do.

The implications of “pay to play” publishing models

SP: This touches on another question, and again, goes back to the original discussion we were having around democratization. The question that the audience is asking here, which is an interesting one, is what are your thoughts on high fees involved in article publication, the culture of pay to play in journal publishing? Do you have concerns about the implications of this model, both for researchers in general and then for the ones that are less well funded?

KBD: This is what I’ve alluded to before. So full disclosure, JAMA Network has two open access journals. We are proud to have open access options for all of our other journals as well. But the model for open access is the author pays for the publication to publish, and for many those fees are extraordinarily high. You’ll see some journals oftentimes, ironically from the major commercial publishers, with exorbitantly high fees. What JAMA and the JAMA Network took the position on about six months after I joined, we decided that all of our science will be publicly accessible. So authors can deposit their articles in public repositories without any fees at the time of publication. And this is because we believe in the accessibility of science.

But I think that the pay to play unfortunately crowds out many authors, authors who might be earlier in their careers, authors who are in less well-funded disciplines, authors from less well-funded institutions. That’s not good for science at all. So I think we have to collectively think about better models for publishing. I think that there needs to be a process, particularly with clinical journals, that involves peer review, the editorial review, some of this that we are trying to do at JAMA with really thinking about how do we disseminate across multiple audiences that doesn’t come for free. And then thinking about how you keep access in mind, but also get the value that you get from publishing is important. And I really don’t think that the pay for play model is in fact the open access model. When you say open access, no one is against it. We all want more access. But the pay to play model, that is one where some of the downsides are also part of it, including what’s led to all the retractions. And I don’t think that’s sustainable.

SP: This next question’s kind of interesting because I’ve not seen the word “influencers” used with researchers, but here it is. We all know that the work of researchers that are powerhouse influencers in a field carry more weight as references to comparatively more obscure or less well-known authors. What kind of expectations does JAMA have for citations?

KBD: I think I understand the question. It’s probably getting at we worry about the powerhouse influencers, and then they’re overrepresented in the citations, and then that reinforces that they’re influencers and things like that. I think that it’s an area that we take quite seriously. We’re particularly concerned about it in our review articles, because the reviews end up being the summary of a field and they can really be weighted in a way. This is something we oftentimes ask for peer reviewers to look through, but that’s a limitation that we have. It is something our editorial team thinks a lot about. I would say that the concern that this questioner has is a real concern, but it’s one I probably have less of because we’re such a high-touch journal and we’re constantly vigilant on these things.

We have to probably think about it in much more systematic ways. And it’s one of those ways that many of our technology tools that look at how many times are we citing, how many times do we just have the same people weighing in on the same types of articles? That’s the types of processes we have to put in place to sometimes make sure we have a broader peer reviewer pool that we’re thinking about, a broader group if we’ve invited the same person to always comment on these types of articles. That’s one way we put in some checks into our system because we’re probably going to notice, oh, we’re really skewed on this one side. But I think the issue that we’re pointing out is a real one.

A peek into the future with JAMA+ AI

SP: Kirsten, final question for you to end on an optimistic note: What are your upcoming initiatives for JAMA? What are you most excited about?

KBD: So just two months ago in October, we launched JAMA+ AI. JAMA+ AI sounds like a new journal but if you go to the website, it is actually a window into AI across the JAMA Network, updated weekly with all of the newest content. And because we’re focused on clinical practice in the way we think about the science of AI, it allows a reader who wants to come in to learn a little bit more to get access to that content. And it allows those computer scientists who have never published in JAMA, they don’t read JAMA, but they really want to make sure that their innovation has clinical applicability. They’ve designed their studies in a way that we can help them to actually have that science reach a clinical audience.

So that’s what we’re excited about. JAMA+ AI has a new editor-in-chief who’s a psychiatrist at Mass General who uses AI. And what he’s very passionate about is bringing more people into the discussion. He has a wonderful podcast series. It’s focused on clinical practice, but he himself is very skilled in this as well and is really helping all of our journals to do better. I don’t think what we need right now is more journals, at least for us at the JAMA Network. I think what we need is to basically help people to find the content that they want to find, to find it at the level they want to read, and access that content. JAMA+ AI is a channel that’s where we want to be going, and I think you’ll see us launching more and more of these things so that you can come in to see the work we are publishing across the JAMA Network, but you’re going to find the thing that you want to read, hopefully use for your patient care, maybe explore something new that you haven’t thought about before, and that we’re going to be able to help that experience be a good one for all of our readers and our authors.

SP: That’s a really exciting way to end this conversation because it really gives me hope compared to when we first introduced the electronic health record and it was this disembodied thing that wasn’t part of medicine. We’ve got an opportunity to reset is what I’m hearing from you, to actually have the computer scientists integrated with medical science and medical publishing. What an exciting time. Kirsten, thank you so much for this conversation and I want to thank everyone who joined us today.

Be sure to follow Permanente Medicine on social media to learn more about future programming. Check out permanente.org for our library of past videos and podcasts. As we continue to drive the future of value-based care at Kaiser Permanente, collaboration between health care, clinicians, researchers, and academic journals will be crucial in shaping a more efficient, effective, and patient-centered system. By fostering an open dialogue and emphasizing the importance of research and care delivery, we can collectively create a better health and better outcomes for our patients. Thank you all for joining us today.