Open access in medical journals

Rebecca Aris interviews Richard Smith, former editor-in-chief of the BMJ

In our medical communications month, former editor-in-chief of the BMJ, Richard Smith speaks with pharmaphorum about the importance of the open access model of journal publishing.

Richard Smith worked at the BMJ for 25 years, during which time he served as editor-in chief for 13 years. Throughout his career, he has observed a lot of changes and trends in journal publishing, which he shares with us in this interview.

He speaks with us about the importance of open access in medical publishing and on why he expects scientific publishing to look very different in twenty years’ time.

To listen to the full interview, please click on the play button below, with a shortened transcript further below.



0:15 – Richard’s background and current focus.

01:52 – Some of the biggest challenges Richard faced as editor of the BMJ.

03:56 – What changes Richard has noted in scientific publishing over the course of his career.

05:48 – What he blogs about.

07:05 – Why libel action is such a big issue and what problems it causes.

10:03 – Why the open access model in medical journals is so important.

13:01 – What changes we can anticipate in scientific publishing over the course of the next ten years.

Interview summary

RA: Richard, thank you for agreeing to take part, for those not familiar with you, could you please introduce yourself?

RS: I always introduce myself by saying I am best known for what I’m not. I was the editor of the BMJ, and also the chief executive of the BMJ Publishing Group, but I’m not anymore. And I’m not Arthur Smith the comedian, but I am his brother.

These days the main thing I do is direct the UnitedHealth Chronic Disease Initiative. The UnitedHealth is a $120 billion US health and wellbeing company, but I run a philanthropic campaign whereby together with the National Heart, Lung and Blood Institute, which is part of the National Institute of Health in the US, we have 11 centres in lower middle income countries doing research, developing capacity, and creating policy around non-communicable disease, meaning heart disease, diabetes, chronic obstructive pulmonary disease and common cancers.

There’s a pandemic of these diseases sweeping through lower middle income countries, and up until now not much has been done.

I’m also a professor of sorts at both Imperial College and Warwick, I’m the chair of a start-up called Patients Know Best and, I’m the chair of the Cochrane library oversight committee.


“…we’ve a long way to go with fully transforming the publishing of science.”


RA: What were some of the biggest challenges you faced as editor of the BMJ?

RS: Initially it was to move the journal on from being too close to the British Medical Association (BMA). When I started as editor of the journal in 1991 we used to have about 10 pages of the journal devoted to reporting on BMA issues, which seemed disproportionate. So we cut that down to one, which caused quite a lot of problems within the BMA, and there were big debates about it.

And of course this was the time when the internet first appeared. We saw early on that this was quite an opportunity for the BMJ, because it’s not as dependent on subscriptions as other journals. When we began putting the BMJ on the web in about 1994 I think there were only several thousand websites in the world, whereas now there are multiple millions.

We put the journal on the web for free but keeping it free and open-access was quite a challenge. After I left in 2004 the BMJ did begin to charge for access to the value-added material, the editorials and suchlike. Although the research I’m pleased to say has always remained free within the BMJ, and fully open access.


“In a nutshell, libel is restricting scientific debate…”


RA: What changes have you noticed in the scientific publishing over the course of your career?

RS: In some ways things have changed quite a lot in so far as when I began there were no electronic versions of journals. In fact when I was first at the BMJ in 1979, the journal was set in hot metal, you’d have to go into a museum now to see a printing press like that! I can remember when we debated whether it was important to have an electronic version and nobody was very sure how anybody was going to make money out of it.

But I’d say overall I think we still haven’t used the full possibilities of the web. Other industries have been transformed by the appearance of the internet but that’s not really true with journals. In many ways they are remarkably similar to how they were a very long time ago.

Just before I left the BMJ we published the 50-year results of the British Doctors study, and we published the first results some 50 years earlier. The two papers were remarkably similar. So we’ve a long way to go with fully transforming the publishing of science.


“Other industries have been transformed by the appearance of the internet but that’s not really true with journals.”


RA: You discussed in a recent blog post the threat of libel action towards the BMJ, why do you think this is such a big issue and what problems does it cause?

RS: There’s been a lot of publicity recently for some of the awful problems that have been caused by libel. In a nutshell, libel is restricting scientific debate. If there appears to be a problem with a drug or device and somebody wants to publish on it, manufacturers of those products may be tempted to try to block disclosure of that information.

Libel is a big problem here in England, it’s not such a problem in many other countries. While I was at the BMJ we spent a lot of money to have things reviewed by libel lawyers before we could publish them.

Before I was editor, the BMJ was involved in one of the longest running libel cases in English legal history. The BMJ had submitted to it a scientific article that said that when people were given intravenous anaesthesia for dentistry, which used to be quite common, they often developed abnormal heart rhythms. Then they suggested that really this was a dangerous procedure, and there were examples of people having died in the dentist chair. The BMJ accompanied this article with an editorial saying that this practice really ought to stop. Now one particular Harley Street dentist, Drum and Jackson, were very much associated with this technique. They argued that the technique had been criticised unjustly and that in doing so they had libelled him. My predecessor as editor, Stephen Lock spent some 11 weeks in court back in the 60s. In the end it was settled out of court for an enormous sum of money. But that can’t be a good way for going about a scientific debate.

RA: Why do you think the open access model in medical journals is so important?

RS: Personally I think – and governments are beginning to recognise this – that it’s very important to share the ideas of science with everybody. Locking them away behind access controls is a very bad idea, and it stands in the way of scientific development.

There’s a famous example used by Bernard Shaw, if one person has an apple and another had a banana, and they exchanged them, there’s still only one apple and one banana, whereas if one person has an idea and another person has an idea, and they exchange them each of them has got two ideas.

In that sense ideas and information are very different from objects. By sharing scientific information as widely as possible, particularly with people in lower middle income countries who often don’t have access, we can hugely increase the value of science.

There are also a lot of ways that you can use the material with open access. I can reuse the material in any way I want. I can use it for teaching, I can print 1,000 copies and give them to people, all I need to do is to cite where the article appeared initially.

There’s a lot of debate about the economics, but I am convinced that we could give everybody in the world access to scientific material, and it wouldn’t cost us any more than now, in fact it might cost us much less. Another argument is that almost all research is funded with public money, so if the public has to pay for the research and then has to pay for libraries and universities to access the materials it’s effectively paying twice.

I’ve been arguing since the mid-90s that sooner or later open access had to come. Only about 10 to 15% of all scientific articles are open access, but increasingly funders are arguing that the research must be made available for free, and the British government actually is taking the lead on this. It is insisting that all research that it funds be available to everybody for reuse very quickly. So sooner or later all material will be open access, but there’s a lot of vested interest opposing it.


“I think we’ll soon move to a position where everything will be open access.”


RA: Finally, what changes do you think we can anticipate in scientific publishing over the course of the next 10 years?

RS: I think we’ll soon move to a position where everything will be open access. But more importantly we will move to a position of publishing all data with the scientific articles.

For a long time scientists have been very protective of their data, they have been reluctant to share it with others, so just as sharing the papers is extremely valuable, sharing the data is possibly even more valuable in so  far as other scientists can manipulate those data sets to arrive at new thoughts, new ideas, new experiments.

I also think that we may well move away from journals as they are now to large databases – you can see signs of that happening already.

I think too that peer review will become a much more transparent open process than it tends to be at the moment. And we may eventually move to a world where the peer review doesn’t take place before publication, but takes place after publication as the world works out what really matters and what doesn’t matter so much. I see signs of that happening already.

We’re likely to see many more changes. Things have really moved rather slowly, but I would expect them to accelerate from now on. Maybe things won’t be that different in five years, but I’m pretty sure that in 20 years things will look very different!

RA: Richard, thank you very much for your time today.

RS: Thank you.

About the interviewee:

Richard Smith is a British medical doctor who worked at the British Medical Journal for 25 years.

He is the winner of three awards for journalism, and has written for journals, the lay press and he regularly blogs for the BMJ and the Guardian newspaper.

He has made several television programmes and is the author of the book The Trouble with Medical Journals.

Richard is an honorary professor at the University of Warwick and a member of the governing council of St George’s, University of London. In addition, he is chair of the board of Patients Know Best. Furthermore, he sits on the Board of Directors of the Public Library of Science.

When will all scientific content be open access?