1. Does your journal have any influence? Richard Smith Editor, BMJ Chief executive, BMJ Publishing Group

2. What I want to talk about? Why does the BMJ Publishing Group care about influence? Definitions of influence How can we recognise influence? How might we measure it?

3. Why do we care about influence? The mission of the BMJ Publishing Group has two parts –INFLUENCE: To serve the needs of doctors and others, to influence the international debate on health –PROFIT: to make enough money to support the mission of influence

4. Why do we care about influence? Profit is easily measured--down to the last penny We are not quite sure what influence is, which makes it hard to measure Yet influence is the first part of our mission and profit the second We mustn’t allow the important to be displaced by the measurable

5. Definitions of influence “The power of producing an effect, especially unobtrusively” Chambers dictionary (Mark Twain said: “If you don’t mind who gets the credit you can do anything.”) Influence is in some ways a polite word for power. Influence is also something to do with brand. A stronger brand=more influence.

6. What is influence? Level one: something changes because of what we have published –Doctors change what they do. –Ministers change policy. –WHO decides to do things differently. –Drugs are prescribed more or less. –New techniques or methods are adopted. Old ones are abandoned.

7. What is influence? Written information on its own rarely leads to change “All journals do is take in other people’s washing” This sort of influence is probably rare and is hard to identify. Many different factors usually contribute to a particular change: so even if something we published contributed it could not be described as the cause.

8. Examples of change caused by research articles I Photodynamic therapy with a new drug might cause severe burns Hettiaratchy S, Clarke J, Taubel J, Besa C. Burns after photodynamic therapy. BMJ 2000; 320: 1245

11. Examples of change caused by research articles II The use of albumin in critically ill patients may be dangerous Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: a systematic review of randomised controlled trials. BMJ 1998; 317: 235-240

13. Examples of change caused by research articles III Minocycline should not be used as the first line treatment of acne Made the front page of the Daily Mail, which might be Britain’s most influential newspaper Gough A, Chapman S, Wagstaff K, Emery P, Elias E. Minocycline induced autoimmune hepatitis and systemic lupus erythematosus-like syndrome. BMJ 1996;312:169-72

15. What is influence? Level two: setting an agenda or legitimising an issue Examples of where the BMJ might have done this, at least in Britain –Evidence based medicine –Inequalities in health –Prison health care –Medical error

16. What is influence? Level three: leading by example and being folowed Possible examples –bmj.com is free –open peer review –BMJ ethics committee –rapid responses on bmj.com –collected resources on bmj.com

17. What is influence? Level four: being quoted/cited “The only thing worse than being talked about is not being talked about.” Oscar Wilde

18. What is influence? Where might you be quoted? –Other journals (impact factor) –Cochrane reviews –Guidelines –Mass media –Parliament (Hansard) –Evidence Based Medicine/Journalwatch –Important policy documents (for example, Institute of Medicine report) –Presentations

19. What is influence? Level five: being paid attention to –Readership (preferably judged by others) –Website hits (in a week or over time) –Sales

20. What is influence? Level six: being known about –Widely known even if not quoted or read among international health professionals, political leaders, the public If George Bush knows about you that’s more influential than if your mum does--sadly

21. Scoring influence Level one: creating change –Several clear cases5 points –One case3 points Level two: setting agendas and legitimising issues –Several cases5 points –One case3 points

22. Scoring influence Level three: leading by example –Several clear cases5 points –One case2 points Level four: being quoted –Hundreds of quotes in all outlets5 points –Hundreds of quotes in some outlets4 points –Tens of quotes in all outlets3 points –Tens of quotes in some outlets2 points –A few quotes in a few outlets1 point

23. Scoring influence Level five: being paid attention to –tens of thousands of readers, hits on the website and sales5 points –thousands4 points –hundreds1 point Level six: being known about –All health professionals and world leaders2 points –Many health professionals1 point

24. Conclusion It’s important to try and measure the influence of journals We might agree on levels of influence; achieving change is the highest level I’ve proposed a scoring system It might be the beginning of something useful; then again it might not