ST. LOUIS — It’s been eight months since Kirsten Bibbins-Domingo, a general internist, cardiovascular researcher, and epidemiologist became the 17th editor in chief of the Journal of the American Medical Association and its network of journals. Bibbins-Domingo, who previously worked at the University of California, San Francisco, was named this week as a member of the 2023 STATUS List of people making a difference in health care and life sciences.
She recently spoke at the annual conference of the Association of Health Care Journalists, in St. Louis, where STAT’s Usha Lee McFarling sat down with her to learn more about the changes she’s implemented at the journal, including a new open access policy. Under this policy, most JAMA articles remain accessible only to subscribers, but authors can publicly post their manuscripts the day they are published, and they are not charged open access fees as many journals do. Bibbins-Domingo also spoke about what lies ahead for JAMA.
This interview has been edited and condensed for clarity.
I’ll start by asking how things are going at JAMA and what your biggest challenges have been, aside from adapting to the Chicago winter.
It’s a very big change. I knew that this was going to be a big learning experience. What I’ve started with is figuring out the logistics, and also thinking about how an organization that has done things in a very strong way, for a very long time — we’re 140 years old this year — can change in an environment that’s rapidly changing.
What’s been the most important focus for you?
We are asking ourselves what are the issues at the forefront of medicine and how does JAMA stay not only relevant to those issues, but bring those issues to light for our readers? How do we make sure that many different voices and perspectives can be found on our pages? We’re asking, how does this network of journals keep pace with the times and really shine a light on the most important issues in medicine?
You were chosen to lead JAMA after a controversy over how the journal handled the issue of structural racism in medicine, which is something many journals are confronting. You’ve since announced a number of new hires and diversity editors at each journal. What are these editors bringing to the publication process?
All of our journals have an editor focused on issues of equity, diversity, and inclusion and they work in different ways. These editors are part of the editorial team that is reviewing papers, but they have a particular lens or perspective they might bring to those papers. When we have a manuscript, we want to put science in context with an editorial, and they can play a role in the important choice of who writes these editorials. We are also launching programs to bring more people in to be part of our editorial teams through fellowships and these editors have an important role in shaping these programs.
The issue for equity for me is not that one person should hold that for the organization, but it should be the approach the entire organization takes. What these editors do is help think about that. Over time, you’ll see these editors thinking across the journals and writing about what we at medical journals can do better in this area. You’ll see us building on the power of having 13 or 14 people thinking about this.
Open access is a huge issue in scientific publishing right now. You’ve called broad access a “cornerstone of transparency” that’s critical to trust in science. Can you explain JAMA’s new policy and how it was developed?
Scientific findings need to be available to as broad an audience as possible to enable scientists to do better experiments and translate science into improvements in health. The movement behind open science is about that. As it turns out, with most things, this involves that people pay for what makes this information great — journals vetting the content and conveying it in multiple formats to reach readers, for example. I don’t want to stand in opposition to open science.
So what we decided as a journal was that authors, on the day we publish their work, can make their work available to any public repository and post it. So if you want to find the results of an article and you’re in a country or at an institution that doesn’t subscribe to our journals, you can still find that science because it’s available in a public repository. This decision is rooted in the principles of what’s good for science and it’s rooted in equity, frankly, because not all institutions, and not all people, have a subscription to JAMA.
This public access approach is also rooted in the principles of equity of who can publish. Open access has focused on mostly making sure there’s equity in what’s accessible to read, but that’s on the backs of sometimes very high fees that authors pay to publish in open access journals. What we’re saying is we believe in open access — and also believe in the value of what we do. We still think people will pay to subscribe to JAMA because there is value in the final version of record, the graphics editors making the figures, the podcasts, the corrections that get posted because things do change over time, that is what that subscription is buying you, all of those pieces.
But we can’t have open access fees put publishing out of reach for authors that might be early-career, or in disciplines or at institutions that aren’t as well-funded. We’re really pleased that the National Institutes of Health just announced and posted for public comment that this is the approach they are considering for all funded researchers in the NIH.
I’d also like to ask you about another topic that has some editors quaking in their boots: ChatGPT and other AI tools in publishing.
I have to say there’s a lot of technology that comes across and we think of it as a fundamental shift and an existential threat, but I view a lot of these as tools. In so much of what we do as scientists, as publishers, as clinicians, we need to be able to find ways to access information better and these are tools that appear to be helpful. I don’t think it’s useful to ban a tool that is going to fill a need, but I do think we have to ask what it means for us.
Apparently ChatGPT is already indexed as an author in PubMed, because people are already using it within just weeks of its announcement. So we had to be very clear: No, ChatGPT cannot be an author. Only humans can be authors. If authors use these tools, they have to tell us. That’s what we say for any tools, like statistical programs — you have to tell us if you use them. And you’re responsible for them. ChatGPT may be filling a niche but it is clearly not the expert in the field we expect authors to be that publish with us. The author takes responsibility for what’s published on the page, so if this tool is used, the author ultimately takes responsibility for it.
My last question is if you can give us any glimpses of what may be ahead, or new, for JAMA. What’s something new your subscribers may be seeing soon?
There are a lot of issues related to the conduct of science. We think our responsibility is to be a place where some of the controversies and big dilemmas in how science is currently being conducted can be discussed. We want to have those conversations in our journal and we want to have them in person. You’ll see us having more convenings, you’ll see us providing a forum for multiple points of view. Covid showed us how great our scientific discoveries can be in terms of translation to health but also how they’re not quite keeping pace. They don’t happen quite fast enough, they don’t happen to help me to understand an issue for the patient in front of me. You see a lot of introspection now about how science is funded, how it’s regulated, how it’s conducted, and we as a journal want to be a home for convening and having those discussions.