Deposed Journal of the American Medical Association editor George Lundberg, M.D., is going head-on against his former publication with the launch of what appears to be the first online-only general medical journal.
Medscape General Medicine will be free to anyone accessing the Internet site of Lundberg's employer, New York-based Medscape, an online healthcare information service. Lundberg announced the journal's formation April 9 on the company's site.
"It is our intent at this time to limit paper use to the paper the reader chooses to download, so those people who want to read medical articles in the bathtub may do so," Lundberg said in an interview.
Not only will there be no print version, there also won't be a regular publication schedule. Original, peer-reviewed articles, clinical research and trials data, policy papers and other articles will be posted on Medscape as soon as they're available.
"Why wait?" Lundberg asked in his online letter.
Recent surveys, including one released in January by the California HealthCare Foundation, have shown that more physicians -- especially younger ones -- are warming up to online research. Meanwhile, other journals (including JAMA) are putting some of their print copy on the Internet.
But Medscape is doing more than gearing up to compete with other journal publishers. Setting up MedGenMed is a way for the company to attract attention in the suddenly hot healthcare information sector.
Analysts expect the upcoming initial public offerings of companies such as Atlanta-based WebMD and Austin, Texas-based drkoop.com will have the same sort of incredible demand as other ".com" IPOs over the past year (see related story on page 8). Medscape has not filed for an IPO, but it does have financial backing from major venture capital companies and media giant Hearst Corp. of San Francisco.
However, Medscape President Paul Shiels says investors are not the journal's target audience.
"What we do is position ourselves for the user of Medscape," Shiels says.
Lundberg says he's been thinking about launching an online journal at Medscape since his Feb. 27 hiring as editor-in-chief. He joined Medscape after his 17-year career as JAMA's editor came to a sudden halt Jan. 16.
AMA Executive Vice President E. Ratcliffe Anderson Jr., M.D., fired Lundberg for printing a study about how college students define sex. The article appeared in the journal at the time of President Clinton's impeachment trial. While Lundberg's penchant for publishing controversial articles was too much for the AMA, he says MedGenMed will welcome controversial articles.
Getting articles may be the new journal's toughest job, says Edward Huth, M.D.
From 1991 to 1995, Huth was editor of the Online Journal of Current Clinical Trials, the first online-only clinical journal. The publication withered after a primary sponsor, the American Association for the Advancement of Science, pulled its funding.
Huth acknowledges that the journal was "out front too early" but says some researchers may feel having their work appear only in bytes makes it seem less important. Also, Huth says developing articles and an audience is easier when a journal has the backing of a foundation or association. Before going online, Huth was editor of the print journal Annals of Internal Medicine, published by the American College of Physicians-American Society of Internal Medicine.
Medscape hopes to overcome these potential problems with its "stellar editorial board," the makeup of which has not been announced; its commitment to established international medical journal standards; and its employ of Lundberg.
Medscape is targeting the same article base and physician audience that JAMA and the Massachusetts Medical Society's New England Journal of Medicine, both weeklies, have sought for more than 100 years.
JAMA says it has 340,000 subscribers, with an annual subscription rate of $75 for AMA members and $145 for nonmembers. NEJM claims 240,000 subscribers at a base rate of $129 per year. That means roughly $30 million in annual revenues for each publication, not counting advertising. Neither journal would release revenue or earnings figures.
Medscape, meanwhile, claims more than 1 million people have registered on its site. It says a new physician signs on every five minutes, but it has not released a total number. Still, that number likely is greater than the 125,000 doctors who had signed on as of late last year.
Medscape also is in discussions with pharmaceutical manufacturers and others about advertising on its journal site. Advertising is expected to make up the bulk of MedGenMed's revenues.
JAMA would not comment on Medscape's venture. NEJM, meanwhile, is not exactly shaking in its wingtips.
"In the short run, I doubt it" will have any effect on NEJM, says Deputy Editor Gregory Kurfman. "I think that the future of exclusively online journals remains to be determined. It's a subject we're very interested in."
Both journals have Internet sites on which they publish articles. JAMA has a women's health journal on its site, and the NEJM sometimes publishes key stories online before they appear in print. The first of these was a 1996 report about the dangers of then-popular "fen-phen" diet drugs.
JAMA and NEJM also compete for attention in the mainstream press. During Lundberg's tenure at JAMA, outsiders questioned whether he sometimes worried less about the scientific validity of the information published in the journal and more about how it would be received in the mainstream media. But Lundberg says since patients will have direct, free access to Medscape, he likely won't need to court mass media to disseminate MedGenMed information.
"We would hope that the quality of the articles and the nature and timeliness of the articles in Medscape General Medicine content will attract media people who would wish to write about this based on their merits," Lundberg says.