Medicine 2.0: Online peer review? Facebook for physicians?

What lies ahead for patients and practitioners as the world of information technology converges ever deeply with the art and science of medicine and research?

That was among the questions informing a lively conversation last week between Dr. John Hoey, former editor-in-chief of the Canadian Medical Association Journal, and Dr. Richard Smith, former editor-in-chief of the British Medical Journal and author of The Trouble with Medical Journals (2006).

The discussion, held at U of T’s Trinity College, was the prelude to a fundraiser for Open Medicine, an open-access peer-reviewed journal that is itself part of a social movement to ensure access to scientific knowledge is free and content is widely disseminated (see MaRS blog last spring).

A long-time advocate of open-access medical publishing – the BMJ first posted its content free online for non-British users nearly a decade ago – Smith offered a range of sacred-cow tipping opinions, delivered with classic Brit candor and self-deprecating irreverence, on the evolution of medical publishing, the influence of Web 2.0 and the challenge of finding sustainable financial models for open-access journals.

Would the author-pays model of Public Library of Science (where he is an unpaid board member) hold if the venerable Nature and Science journals charged, say, $10,000+ a paper? (Smith thinks so, although in my non-academic view such steep fees would seem to set the bar precipitously high for a new investigator still building grant-writing prowess or an institution with lighter pocketbooks.)

If a journal’s research is freely available, should it charge instead for the premium analysis or opinion pieces it offers? What’s the role of social networking technologies like Facebook, as a tool for physicians to exchange information with each other? Are Google-informed patients starting to level the informational playing field and subsequent power balance by forcing doctors to more openly acknowledge the current limits of medical practice?

Smith also challenged the audience to consider the capricious “black box” that is the peer-review process itself in publishing. Why not open it up, he suggested: Post journal submissions online and invite the wider community, as well as the author, to debate the merits of research findings wiki-style.

Medicine 2.0 is no doubt good news for consumers in search of empowering information. But is the conventional, hierarchical research enterprise — whether sponsored by government, industry or private foundations — truly ready for the kind of open scrutiny and culture change associated with a wiki-like approach to creating and sharing knowledge?

Scientists, physicians, what say you?

Further reading on Medicine 2.0