Journals have long recognized that they are unlikely to flourish if they publish only scientific studies. Increasingly they publish reviews that update practitioners on new developments, educational material, news, reviews of books, articles that are more journalism than science, letters and obituaries. Slowly they have begun to look less like traditional scientific journals and more like popular magazines with shorter articles, brief summaries, and graphics.
They try to be useful tools to doctors in their practice, but they have had only limited success. Doctors suffer from what Muir Gray, a public health doctor and director of Britain's National Electronic Library of Health, calls `the information paradox': they are overwhelmed with material of limited relevance and quality but cannot find answers to the many questions that arise when they meet with patients and which thus go unanswered. Journals are not good at getting doctors to change and improve their practice. Words on paper rarely lead directly to change.
What journals can do is to make people think, set agendas, encourage debate, draw doctors' attention to new things that may be important, and even legitimize subjects. In short, they are very like newspapers, and Robbie Fox, the great editor of the Lancet in the 20th century, liked to call his journal a newspaper.
Should journals then abandon publishing science? In the end science might abandon them and be posted on publicly available websites rather than appear in journals; but it is unlikely that many journals will abandon science first (although I can think of at least one American journal of family practice that has done so). Most of a journal's kudos comes from the science it publishes; it is the science rather than the rest of the material that attracts worldwide media attention and causes subscribers (mostly institutions) to purchase the journals. Some of the scientific studies that journals publish are hugely important, and the science gives journals an authority and legitimacy that separates them from the (usually much more readable) `throwaways'.
Despite my criticisms of journals I still believe that a good journal can be a major asset to a medical community. It can move medicine forward, less by providing a clear direction of travel and more through highlighting the deficiencies of the present—and providing a hundred ideas on how to do better.