Square One

Richard Smith reviews Nigel Crisp‘s  Turning the World Upside Down: The Search for Global Health in the 21st Century in this week’s BMJ. The striking comment in the review was an explanation for health workforce brain drain in Africa:

His case for “turning the world upside down” might begin with the stark facts that Africa has 25% of the world’s burden of disease but only 3% of its healthcare resources and 1% of health workers. North America, in contrast, has 3% of the disease burden but 25% of healthcare resources and 30% of health workers.

Rich countries are plundering health workers from poor countries, and one reason that’s happening is that rich countries have exported their outdated health systems and ways of thinking—meaning that health workers in poor countries are trained inappropriately and feel more comfortable in rich settings.

It has just occurred to me that developing countries might indeed be in the best position to redefine the health worker for the 21st century in the light of America’s super-expensive over-doctored system, and the sheer effect of grappling with chronic illnesses on health systems globally.

The full review is here.

Can we trust traditional peer review? If it’s broken, how might we fix it?

Former BMJ editor Richard Smith, Medscape founder Peter Frishauf, peer review researcher Liz Wager, health policy researcher Alex Jadad, and computer scientist Thomas (Bo) Adler discuss peer review in this podcast by the Journal of Participatory Medicine (JPM).

This stimulating discussion follows two interesting articles on the subject in JPM’s inaugural issue: In Search of an Optimal Peer Review System, by Richard Smith, and Reputation Systems: A New Vision for Publishing and Peer Review by Peter Frishauf.

The podcast and its transcript can be downloaded here.

“Something has just happened that will almost certainly end the tyranny of impact factors and may well mark another step towards the extinction of most scientific journals,” writes Richard Smith triumphantly in his latest blog post on BMJ. He continues:

It was the appearance of something called rather clunkily “Article-Level Metrics.” These are a variety of scores and other bits of information attached to each article in the publications of the Public Library of Science. They shift attention from journals to articles, particularly for the academic bean counters anxious to find a convenient and low cost way of ranking academics.

Richard Smith concludes, after explaining that Article-Level Metrics works by tracking each article’s online usage including citations from scholarly literature, social bookmarks, comments left by readers, notes left within articles, blog posts, and ratings, saying:

Increasingly governments and research funders are interested not just in the number of times an article is cited in other publications (an incestuous and self serving measure) but on the impact they have in the real world, the changes they lead to.

So that’s why article level metrics might doom the impact factor, but why might they signal an end to many journals? It’s because they lead to articles rather than journals being what matters, and the articles can then be published quickly on databases rather than in journals…

The edifice of journals is beginning to crack—and not before time.

The full post that does justice to how the Article-Level Metrics works is here.

The Public Library of Science gives a background explanation of the Article-Level Metrics here and here, where Mark Patterson was wise enough to remind us that:

It’s also important to emphasize that online usage should not be seen as an absolute indicator of quality for any given article, and such data must be interpreted with caution.

There is an example of how the Article-Level Metrics statistics and graph look here.

After several months of trying, former BMJ editor Richard Smith finally has access to his online medical records, being the first of his GP practice’s 8000 patients to demand access. Here is a pithy excerpt from his BMJ blog about what more he would have wanted to see in the records:

It was an anticlimax. My records contain almost no information about me. You’d have no idea from these records who I was, what I did, what I thought, or what I care about. You’d know more about me after two minutes on the world wide web than you would from reading everything in my medical record. It’s probably unreasonable of me to expect my medical records to say much about me, but I’d like them to say more. I would, for example, like them to say something about my values. If, for example, this train I’m writing on crashes and I’m severely brain damaged should the doctors do everything possible to keep me alive? The answer’s no, and I like that to be in my records. I’m also happy for every bit of me that’s usable to be put into others. That should be there too, and the doctors in Cheltenham, where the train might crash, should be able to access the records.