1. bmj.com: new initiatives Tony Delamothe web editor bmj.com http://bmj.com/misc/talks tdelamothe@bmj.com

2. Where I stand 1995 2000 ? ? Traditional paper journal Traditional electronic journal The paradigm breaks down

3. Early lessons The gap between idea and robust implementation on the web is as long or longer than elsewhere Listen to your customers

4. The common trajectory paper electronic

5. We are in great haste to construct a magnetic telegraph from Maine to Texas; but Maine and Texas, it may be, have nothing important to communicate. Walden, Thoreau

6. New solutions for old frustrations Letters to the editor Papers The distance between us Peer review

7. The mystery of decision making at the centre tdelamothe@bmj.com Yes, if No unsolicitedsolicited ?

8. Moving from black box to jellyfish tdelamothe@bmj.com Yes, if No unsolicitedsolicited ?

9. Global voices on the AIDS catastrophe War 2002 Evaluating the quality of health information on the internet The limits of medicine and the medicalisation of human experience Road traffic crashes Neurodegenerative diseases Doctors' well being What is a good doctor and how can we make one Managing chronic diseases Doctor-patient communication and relationships What doesn't work and how to show it Theme issues chosen by readers tdelamothe@bmj.com

10. Transferring power This is meant to be a cautionary tale. I choose to read it the other way. “Perhaps the chief lesson of the whole story [is] the capacity of the internet to transfer absolute power to the consumer…. “For years now, companies have been complaining quietly of their loss of influence over their customers. It may be, of course, that as the internet matures, they will be able to reassert themselves. If not, the tech frenzy could turn out not so much to have exaggerated the internet's promise as to have missed the danger it poses.” FT’s review of Dot.com: the greatest story ever sold

11. New solutions for old frustrations Letters to the editor Papers The distance between us Peer review

12. Peer review and our dance of the seven veils Revelation of reviewer’s identity to a co-reviewer Revelation of reviewer’s identity to the author (led to signed reviewer’s opinion from 1999) Revelation of reviewer’s signed opinion to the entire world

13. Peer review: who needs it? The eprint server free, full text, fast vs slow, expensive, and peer reviewed

14. Exploiting new possibilities Organization/discovery of material Alerts (including email a friend) Tracking behavior New material/new platforms

16. Email a friend

17. Tracking behavior Email a friend Hit parade Annual online questionnaire (see About us on bmj.com)

18. Exploiting new possibilities Organization/discovery of material Alerts (including email a friend) Tracking behavior New material/new platforms

19. With increasing divergence, which is “the” journal? paper electronic

20. Complementarity Remember, paper currently beats electronic for: readability portability durability cost Conclusion: we should exploit the best of both media

21. “Despite the availability of the electronic journal, I want to keep receiving the paper journal” (BMA members, 2001)

22. Free: the upsides Readership Manuscript submissions Impact factor Site traffic Influence

23. Readership: nearly doubled in 4 years paper (120 000) electronic (116 000) Overlap 16 000

24. Manuscript submissions Non-UK submissions

25. Free: the upsides Readership Manuscript submissions Impact factor Site traffic Influence

26. NEJM 9411 BMJ 13040 Lancet 30 538 Annals133 507 JAMA830 647 Average traffic rating Source http://www.alexa.com

27. Free: the downside(?)

28. Looking ahead 1995 2000 ? ?

29. Looking ahead 1995 2000 ? ? the forms may change but the aims of scientific publication remain the same

30. What were scientific journals for? The permanent record The glue to keep a community together “Communication” To make money?

31. The purpose of journals: looking ahead Paper is brief and beautiful and I love it, but it’s a wholly inadequate medium to conduct the conversations that humanity has to have. What were journals created for in the first place? To enable knowledge creation by conversation, except that every exchange took six months. What we need is much more proficient knowledge creation. - Bela Hartnavy, 1996

32. Understanding what’s happened to journals using the model of automation Electrification Enhancement Evolution – Valerie Florance, 1996

33. New paradigm for problem solving: tapping into the collective intelligence made possible by the internet “The power of bringing together the right minds around a subject in an on-line dialogue, well facilitated, well deliberated, I think has enormous potential to help us get through issues that we’ve never solved before. You see this embodied in the open source model for software creation. But that same model could apply to policy issues, social issues, educational issues.” - Mario Morino (transcript at: http://www.nlm.nih.gov/onceandfutureweb/database/secc/case3.html