The Urgency of Now and the Responsibility to Do More—My Commitment for JAMA and the JAMA Network

This week I join JAMA and the JAMA Network as the 17th editor in chief.

Taking a leave from the University of California, San Francisco, where I have spent my entire academic life as a student, physician-scientist, and academic leader to become a full-time editor was not an obvious move. But these remarkable times demand more from each of us who cares deeply about biomedical science and advancing health.

Science, medicine, and public health are at extraordinary crossroads, crystalized by the pandemic. The contemporary investment in research has yielded unprecedented discoveries at an exceptional rate, establishing innovative tools and approaches that promise further insights to spur future progress. Faced with a novel virus devastating the planet, the scientific community moved with unparalleled speed to design effective diagnostic tests, vaccines, and therapeutics only to have their widespread adoption thwarted, in part, by confusion, poor communication, mistrust, politicization, and organized disinformation. The pandemic demonstrated local and global interconnectedness, but also laid bare how entrenched social and structural inequities translate to catastrophic inequities in health. The pandemic illustrated the way in which accessible high-quality medical care, functioning public health systems, and sensible policies must operate together to improve health—and often do not. Science, medicine, and public health have had brilliant triumphs, but have also been notably mired by inaction, lack of innovation, and failure to embrace much-needed transformative approaches. The urgency of now makes clear the compelling need to build on the successes forged by this crisis and engage in critical self-reflection to learn from shortfalls if the challenges of the ongoing pandemic and myriad health issues beyond COVID-19 are to be addressed.

Scientific journals must embrace their responsibility to help shape this discourse. By identifying and vetting the highest-quality and most important scientific content, ensuring clear communication of findings and their context, and disseminating information broadly and responsibly, the critical role of scientific publications has never been more important.

The true power of a scientific journal stems not from its scores on the proliferating comparative metrics, but rather from the trust that it engenders. Clinicians trust that they are gaining important knowledge, vetted by the review process, and as transparently free from bias and conflict of interest as possible. Authors and scientists trust that their work will be impartially reviewed, ideally improved, and promptly and widely disseminated. The public trusts that they are reading vital content and understanding the implications of new discoveries. Even when there is disagreement and controversy, all trust that the discourse is rooted in science, and that views will be aired fairly and openly.

Insularity and parochialism are threats that must be guarded against because they may inhibit the recognition of scientific content with potential to change practice and translate research into improvements in health. While working to counter these and other threats via editorial policies, it is paramount that the voices in the room where decisions are made represent diversity of thought, expertise, and backgrounds. The voices of those historically marginalized and excluded from science and medicine have also largely been absent in scientific and medical publishing, to the detriment of all. Who is in the room matters. Ensuring diversity is not simply an issue of fairness and equity; it accelerates advances in science; it produces better medical journalism; it is fundamental to the trust readers place in a journal to deliver the highest-quality content and most complete context to advance health.

I am committed to JAMA’s vision to be a trusted voice for science and medicine. My mission in leading JAMA and the JAMA Network is to ensure that we are worthy of that trust.

I draw on JAMA’s key objectives,¹ many initially outlined more than 35 years ago. Then, as now, JAMA’s goal is to promote the science and art of medicine and the betterment of the public health. Many of JAMA’s long-standing objectives resonate today, including to maintain the highest standards of editorial integrity and quality independent of any special interests; publish original, important, valid, peer-reviewed articles on a diverse range of medical topics; promote and address diversity, equity, and inclusion within the journal and in medical research, clinical care, health policy, and society; foster responsible and balanced debate on important issues that affect medicine, health, health care, and health policy; improve health and health care internationally by elevating the quality of medical care, disease prevention, and research; inform readers about the various aspects of medicine and public health, including the cultural, sociopolitical, ethical, legal, environmental, economic, structural, and historical; recognize that, in addition to these specific objectives, JAMA has a social responsibility to improve equity and the total human condition, promulgate truth in science and medicine, and promote the integrity of science.

Achieving those objectives, in the context of these challenging times, is an opportunity for JAMA that I embrace with bold intention, deep humility, and unwavering commitment. We have a responsibility to do even more.

We seek to publish the highest-quality and rigorously conducted science, which will shape thinking about human health, advance the practice of medicine, or inform public health. Clinical trials represent the most definitive evidence for new interventions and remain a critical focus area. However, much of what is important for medicine and public health is not amenable to study in traditional randomized clinical trials. With increasing access to data sources and improved analytic methods, reports based on new trial methodology, quasi-experimental designs, innovative observational approaches, and early translational investigations may all be important and of interest to JAMA audiences. Whether through Original Investigations or Research Letters, the lifeblood of JAMA is publishing outstanding, methodologically sound science. Importantly, we will embrace the principles of open science and are committed to adapting our publication framework to support transparency and equitable, open access to research.

The best scientific findings do not change ways of thinking, practice, or policies unless they are communicated effectively and placed in the context of other findings and explanatory factors. Whether explicating a causal pathway or the social forces that may shape a finding, authors and editors must ensure this context is conveyed effectively to the reader. More broadly, JAMA will continue to be a leader in the publication of Viewpoints, Editorials, and Special Communications that speak to the broader issues and controversies that shape science, medicine, and public health. Look for more concerted efforts, concentrated themes, and focused issues addressing major concerns at these crossroads. JAMA will be a home for such discourse.

JAMA is one of the most widely circulated general medical journals in the world, with more than 290 000 recipients of the print journal, more than 1.6 million recipients of electronic tables of contents and alerts, and over 45 million annual visits to the journal's website. And that’s just JAMA. In addition, the JAMA Network consists of JAMA Network Open and 11 specialty journals: JAMA Cardiology, JAMA Dermatology, JAMA Health Forum, JAMA Internal Medicine, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Otolaryngology–Head & Neck Surgery, JAMA Pediatrics, JAMA Psychiatry, and JAMA Surgery. Each of these journals is led by its own outstanding editorial team and each represents a leading journal in its field. We will continue to build synergies across the JAMA Network to reach the broadest possible audiences. We will seek out and amplify opportunities for authors and readers to engage with our content. We will use the JAMA Network digital, multimedia, and social media platforms to extend our reach and tailor content to meet each audience member’s needs more effectively.

For JAMA and the JAMA Network journals to fulfill their missions within the complex biomedical ecosystem, we need your input. Across the US and around the globe, JAMA and the JAMA Network serve a diverse array of audiences. Whether scientist, clinician, academician, trainee, author, policy maker, patient, or general reader, your views about our work are critical. If you are a scientist with an important finding that may change clinical or public health practice or an author with a viewpoint that promises to do the same, and you are unsure whether JAMA is right for your manuscript, drop us a line at jamams@jamanetwork.org.

We all have an important role in advancing science and health in this uniquely challenging moment. JAMA and the JAMA Network are committed to meeting this moment and our mission to advance the science and art of medicine and contribute to the betterment of public health.

Corresponding Author: Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, JAMA and the JAMA Network (Kirsten.Bibbins-Domingo@jamanetwork.org).

Conflict of Interest Disclosures: None reported.