Gunther Eysenbach's random research rants

JMIR's Fast-Track Experiment (Innovations in Scholarly Publishing: Part 1)

2011-07-12T10:02:00.013-04:00

As (to our knowledge) the first journal in the world, the Journal of Medical Internet Research (JMIR) started in 2007 to offer a "paid fast-track" (FT) option, where authors pay an extra fee if they require an extra-speedy handling of their manuscript.
JMIR's fast-track package consists of two components:

a) we make an initial editorial decision within (currently) 3 weeks after submission
b) after acceptance, we publish the paper within 4 weeks

FT can be purchased at any time during manuscript handling process.
As we made part of the the source code available for OJS, some other journals have started to adopt similar policies, although the details of their policies vary widely.

We see several advantages of this model. First, authors often have deadlines to meet, such as a grant submission deadlines, end-of-grant deadlines (by which grant money needs to be spent), deadlines for promotion & tenure applications, PhD defense deadlines, etc. From our authors who have used the FT option we know that the FT track is widely appreciated, and almost 25% of all authors make use of it. Guaranteeing a rapid decision by the journal is a considerable advantage over the current system, where authors are subjected to unpredictable journal turnaround times.
Secondly, even for authors not in hurry or with insufficient funds who are not opting for the FT, the FT revenue stream helps to keep other fees down. All authors pay a lower Article Processing Fee than what we would have to charge without the FT option.

Thirdly, we think that our FT offering may create a competitive environment where journals become more accountable in regards to their turnaround times, and not only compete for the highest impact factor or the best authors, but on other metrics such as the shortest turnaround times. All this would - in our opinion - help to transform the often sluggish process of scholarly communication and accelerate scientific progress.

Obviously, speeding up processes must be done without sacrificing quality and integrity. Some of the principles we have implemented are

all reviewers have the same instructions, reminders and turn-around times (2 weeks) for all manuscripts - fast-tracked or not
reviewers are blinded, i.e. do not know whether or not a manuscript is fast-tracked
on the decision page, where editors see the reviewer comments and make a decision, the editor also does not see if a manuscript has been fast-tracked or not
fast-tracking at the decision-making level (promise a) is achieved by sending aggressive email reminders to the editor to assign more reviewers. Editors are asked to make sure that within the first week of submission, at least 2-3 reviewers have agreed to review the paper, so to achieve a rapid decision editors spend more time monitoring reviewer responses and assigning more reviewers if needed.

As other experiments of scholarly innovations which we are undertaking, the experiment is closely monitored, and (to enhance public trust) our peer-review statistics are fully transparent (these are real-time statistics, so they change on a daily basis. The following data cited below are based on the peer-review results as of 2011-07-12, a snapshot is available at WebCite).

To summarize what these data - based on 689 submissions (incl 156 FT submissions) and almost 1000 completed reviews - tell us:

Fast-tracking works (line 1.3). Fast-tracked articles are on average (median) published over 100 days earlier than non-fast-tracked articles (median time from submission to publication for FT articles 182 days, non-FT: 303 days). Note that these times still may appear long, but these figures include the time authors need to revise their manuscripts (which is on average 3 months per revision)
No evidence for lighter peer-review of fast-tracked articles (line 4.3a): While cynics have speculated that money-greedy publishers/editors may take shortcuts and favor fast-tracked articles and make decisions in the absence of a sufficient number of reviews, the data at JMIR speak a different language. In the past 4 years or so we sent a total of 519 manuscripts for peer-review, with FT articles receiving MORE peer-reviews (1.96 reviews per article) than non-FTed articles (1.88 reviews). Come to think of it, this is not so surprising, because editors work harder to assign a sufficient number of reviewers, assigning 5.29 (FT) versus 4.50 (non-FT) reviewers to each submission (line 4.1)
No evidence for preferential treatment of fast-tracked articles (line 3.1): There is also no evidence for an editorial bias - the acceptance rate of articles which have been sent out for peer-review are virtually the same for both tracks: 63% (FT) versus 61% (non-FT).
FT articles are not rated better by reviewers (line 4.7): If reviewer recommendations (which are made on a scale of A-E) are converted to a numerical scale 1-5, then the mean reviewer recommendation of FTed articles is 2.8 - exactly the same as "normal" articles (it should be stressed that reviewers are blinded regarding the FT status).
FT articles are more often sent out for peer-review (line 2): Articles which are not within the scope of the journal are not sent out for peer-review - 85.9% of FT articles and 72.3% of nFT articles were sent out for peer-review, indicating a higher proportion of articles which are "out of scope" among the "normal" submissions. Again, it is probably not surprising that FT'ed articles are more often within scope (if someone pays a FT fee he is more likely to make sure that the manuscript is within the scope of the journal, often through pre-submission inquiries). Also, at JMIR it is possible to request fast-tracking of an article after acceptance (to speed up the production process), which also biases these numbers (obviously, all accepted manuscripts were peer-reviewed). Some authors may also wait until the "within scope" decision has been made and peer-review has started before they fast-track the paper.
The quality of the peer-reviewers is the same (line 4.8a): After peer-review has been completed, the editor may rate the quality of the review on a 5-point scale. There are no differences here: The mean rating is 4.19 for FT'ed article reviews, and 4.10 for non-FTed. We recently also started to ask authors to rate the quality of reviews, but with only 4 ratings in the FT track the sample size is too small to draw any conclusions at this time.

These are preliminary data, but overall they confirm that it is possible to accelerate the publication process without compromising quality, introducing biases, or affecting the integrity of the process. Further evidence could be generated by directly comparing quality metrics (e.g. the number of citations) between FTed and nFTed articles (we don't have time for this, but if anybody is interested in this, we are happy to share the list of FTed articles).

As a next step we are planning to refine the system so that peer-reviewers who have submitted a review on time will receive credits which they can use for the FT fee if they submit something to JMIR or iJMR (we did experiment with paying reviewers directly but the overhead costs for administering these micropayments is too high). This will create a microeconomy with incentives for reviewers ("if I review your paper on time, I'll be guaranteed a more speedy decision-making for my paper when it's my turn to get reviewed") which we hope will accelerate knowledge dissemination and scientific progress.

Next (coming soon): Innovations in Scholarly Publishing Part 2: Preliminary Results of JMIR's Open Peer Review Experiment

Impact Factors of Medical Informatics Journals 2011

2011-06-30T08:47:00.004-04:00

(Toronto, June 29th, 2011) The new JMIR (Journal of Medical Internet Research) Impact Factor for 2010 (released in June 2011 by Thomson Reuters Journal Citation Reports) has further increased to an unprecedented 4.7 (5-year impact factor: 5.0). Never before in the history of the impact factor had a journal in the medical informatics category such a high impact factor. JMIR remains the leading journal in the health informatics category, clearly outranking other journals like the runner-up, the J Am Med Inform Assn (JAMIA) (IF 3.1, 5-yr IF 3.9), the Int J Med Inform (IF 2.2, 5-yr IF 2.2), the J Biomed Inform (IF 1.7, 5-yr IF 1.2), or Method Inform Med (IF 1.5, 5-yr IF 1.2).

JMIR also remains the #2 journal in the health sciences & health services research category, with the top journal in that discipline (Milbank Q) having almost the same impact factor as JMIR (IF 4.8). JMIR outranks journals such as Health Affairs (IF 3.8) or Med Care (IF 3.2).
JMIR also outranks established public health journals such as Am J Prev Med (IF 4.1) or the Am J Public Health (IF 3.9) - this is an interesting observation because JMIR has a clear "public health" angle due to the large number of studies evaluating web-based or mobile behavior change programs.
Finally, as an open access journal, we also take pride in the fact that our papers receive more citations than open access articles published in a "generic" open access outlet such as PLOS ONE (IF 4.4). JMIR's impact factor is also higher than all 35 BMC journals except the two BMC flagship journals BMC Med (IF 5.7) and BMC Biol (IF 5.2), which are ranked 12th and 8th in their disciplines. Except for two PLOS Biology journals (PLOS Biol and PLOS PLoS Computational Biology), JMIR remains the only open access journal taking the #1 spot in its discipline.

While everybody in the publishing industry recognizes the limitations of the impact factor as a metric for quality of a journal, these numbers (in addition to our other metrics such as views or tweets, published at http://www.jmir.org/stats/overview) provide an important validation of our editorial work, and of the work of the authors deciding to submit their best work to JMIR to achieve maximum exposure, visibility, and recognition.
We also know from emails and conversations with fellow scientists that JMIR has been and continues to be an inspiration for those seeking to establish new journals independently of large publishers. With the creation of iJMR and other journal-spin offs, JMIR will broaden its publishing activities in 2011 and beyond.
Thank you - once again - to all authors, reviewers and editors for helping us to maintain our status as the leading journal in our fields and one of the the leading open access publishers!

ABOUT THE JOURNAL OF MEDICAL INTERNET RESEARCH (http://www.jmir.org)
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The "Journal of Medical Internet Research" (JMIR; Medline-abbreviation: J Med Internet Res), founded in 1999, was the first international scientific peer-reviewed Open Access journal in eHealth and Health Informatics and has quickly established itself as the leading journals in this field.
The journal has now more than 50.000 readers per month, is subscribed by more than 45.000 TOC alert subscribers, and publishes about 50-60 high-quality papers per year. Leading ehealth research institutions and departments are institutional members of JMIR (http://www.jmir.org/membership/viewall), enabling their faculty and students to publish in JMIR free of charge, while other authors pay our article processing fee from their grants (similar to how they budget for conference presentations and travel).
JMIR focusses on patient/consumer-centered, participatory approaches, innovative methods, and applications with public health impact, as opposed to hospital information systems and clinical informatics. With a 2010 ISI impact factor of 4.7 and a 5-year impact factor of 5.0 JMIR has established itself as THE leading peer-reviewed journal in the field of "ICT in health". As of 2011, JMIR is listed #1 in the medical informatics category and #2 in the health services research category of Thomson/Reuters Journal Citation Reports (JCR 2010, released June 2011).
Due to its open access policy, the journal has a broad readership, including policy makers, health care practitioners, academic researchers (including medicine, social sciences, and engineering), and even patients/consumers.
JMIR will publish applied research in the areas of consumer health informatics, mobile communication, and public health informatics, in particular if mobile or web-based methods are employed. A rigorous evaluation preferably with clinical outcomes is usually a prerequisite for acceptance - technical papers with only formative evaluation or other papers not fitting the scope of JMIR should be submitted to iJMR (interactive Journal of Medical Research) instead.
As one of our unique features JMIR tries to publish in "Internet speed", achieving minimal editorial turnaround times of sometimes only a couple of days or weeks between submission and publication. Selected papers are published for open peer-review before formal acceptance.
The journal is freely available at http://www.jmir.org.

ABOUT THE IMPACT FACTOR
The Impact Factor, published annually by Thomson/Reuters in the Journal Citations Reports, is the most widely used metric for the influence and importance of a scholarly journal. The impact factor 2010 was calculated by counting the number of citations received in 2010, citing articles published in 2008 and 2009, divided by the number of articles published in that journal in 2008 -2009. In other words, an impact factor of 4.7 means that on average an article published in JMIR in 2008 or 2009 received 4.7 citations in 2010. The five-year impact factor takes articles published between the years 2004-2009 and is the average number of citations received in 2010. In other words, articles published in JMIR in 2004-2009 were cited on average 5.0 times in 2010.

A Call to Arms from Wikipedia Doctors

2011-02-02T08:16:00.003-05:00

A group of doctors, scientists and medical students who write Wikipedia's medical articles and are involved in the Wikiproject Medicine have issued a "call to arms", calling on their peers to join them in their efforts to provide consumer-friendly medical knowledge free to the world at large.

In a paper published on January 31s, 2011 in the peer-reviewed, openly accessible Journal of Medical Internet Research (JMIR, the leading journal in health services research and health informatics), they argue that the possibilities to use Wikipedia as a tool for worldwide health promotion are under-appreciated, citing its unique global reach and examples of how the Internet encyclopedia is used in humanitarian projects [Heilman et al. Wikipedia: A Key Tool for Global Public Health Promotion. J Med Internet Res 2011;13(1):e14].

The 19 authors are all members of Wikipedia's project that manages the health-related content. They note that both doctors and patients commonly seek health information online. Patients usually turn to search engines like Google for health-related queries, and previous research by these authors has shown that Wikipedia appears among those results in around 75% of cases.

Wikipedia's medical content broad and fairly accurate

Based on a review of existing studies of Wikipedia's medical content, the paper concludes that Wikipedia has articles on an incredibly wide range of medical topics with few factual errors, although most of Wikipedia's articles are only in the earliest stages of development and the readability needs to be improved.

"With more than 20,000 articles on health and more than 6,000 drug-related articles, there has never been more freely accessible health information on the Internet thanks to Wikipedia. But now we need more experts to expand these articles and to make them more accessible to the general public at the same time," says Dr. Michaël Laurent, the article's corresponding author.

Although critics have questioned Wikipedia's open editorial policy and examples of errors have been widely published, the authors point out that the encyclopedia has developed multiple strategies to prevent damage to its articles (including the use of vandalism fighting software, automated correction scripts, page protection, edit filters, blocking and banning).

Calling all doctors to contribute

Since WikiProject Medicine was founded by one of the authors (Dr. Jacob F. de Wolff) in April 2004, more than 200 editors (ranging from laypeople and students to doctors, nurses and professors) have registered at the virtual 'doctor's mess', where Wikipedia's medical content is discussed and coordinated. Over the years, the project has developed guidelines about writing good medical articles and finding reliable medical references. "Wikipedia lends itself very well to evidence-based medicine," the article notes.

The group suggests that physicians may contribute to Wikipedia for several reasons, including the intellectual challenge to summarize a medical topic for the general public and the satisfaction that comes from editing an important source of medical information, watching the articles grow and rise among Google results, often outperforming review articles in leading medical journals.

Citation:
Heilman JM, Kemmann E, Bonert M, Chatterjee A, Ragar B, Beards GM, Iberri DJ, Harvey M, Thomas B, Stomp W, Martone MF, Lodge DJ, Vondracek A, de Wolff JF, Liber C, Grover SC, Vickers TJ, Meskó B, Laurent MR
Wikipedia: A Key Tool for Global Public Health Promotion
J Med Internet Res 2011;13(1):e14
URL: http://www.jmir.org/2011/1/e14/
doi: 10.2196/jmir.1589
PMID: 21282098

Source: Journal of Medical Internet Research (http://www.jmir.org)

This is a JMIR press-release and can be freely redistributed under the Creative Commons by-nd 3.0 License. This means you can copy & paste the text above into any medium you like (if paper based, you need to preserve the hyperlinks by spelling out the URLs), as long as you give credit to the source, create no derivative works (which includes editing or changing the press release), and include these license conditions, i.e. this license text must be included.

Open Access Week: webinar about the Journal of Medical Internet Research

2010-10-19T09:08:00.009-04:00

To celebrate Open Access weeks, we have created a Webinar (slideshare presentation with audio track), chronicling the 12 year journey of the Journal of Medical Internet Research, one of the pioneers in this area. The talk focusses on the publishing innovations contributed by the JMIR team.
Enjoy!

Slideshare presentation

Open Access Publishing - The Journal of Medical Internet Research

View more webinars from eysen.

First PKP award for editors to Gunther Eysenbach, publisher of JMIR

2009-08-12T10:32:00.008-04:00

In my capacity as founding editor and publisher of the Journal of Medical Internet Research (JMIR), and open access advocate since over a decade, I am proud to have been honored with the first-ever Public Knowledge Project Community Contribution Award for editors.
The award was given to me (totally surprising - I didn't now anything about it!) at the 2nd PKP Scholarly Publishing Conference in Vancouver, July 2009, by John Willinsky, initiator of the PKP (Public Knowledge Project), for editorial/publishing excellence and the significant contributions I and the team at the epublishing and open access research group at the Centre for Global eHealth Innovation made to open science and open access publishing. Contributions of my group include not only major code development over the past 7 years, laying the foundation for many OJS plugins as well as the Lemon8 XML typesetting software, but also leadership, advocacy, innovation, and excellence in open science, reflected by the prominent standing of JMIR as one of the leading independent open access journals.
OJS originally suffered (and to a certain degree still suffers) greatly from the fact that it was developed without the real life input of publishers/editors, so when I decided to use OJS as a publishing platform in 2002, a tremendous amount of work was required to fix bugs and to customize the platform. Over the years, I invested around $350.000 in developer salaries to make this happen. Two of my former staff members (MJ Suhonos and Juan Alperin), who gathered their first experiences in publishing in my lab, developed publishing plugins and tools to support the new business processes I created, and fixed some of the more severe OJS usability issues. They are now both working for PKP.
It is good to see that my efforts as champion for openness in science & medicine (also reflected in my capacity as a founding member of the Open Access Scholarly Publishers Association and the services my lab to new journal startups, which include hosting, copyediting and article XML production) are recognized by others, especially if this recognition comes from someone whom I deeply admire (John Willinsky).
Big players in the open access field (which shall not be named) are in the news all the time, but what is often forgotten is that there are pioneering open access journals out there which were created long before these giants entered the scene. And none of the big players has bothered to share much of their code with the open access publishing community. The plaque he gave me will have a special place on my office wall, right next to my Tom Ferguson award.

Meanwhile, we continue to customize OJS and have developed some novel approaches which completely integrates the XML production process into the OJS platform (we are the only journal where this has been achieved). These changes go beyond a simple plugin structure, and unfortunately we do not have the funding or manpower to support documentation and sharing of these changes as open source. What we do offer is however to host journals on the modified platform and to support the article production process for new journals, especially those requiring NLM-XML markup (interested editors/publishers should contact me).

Open Access journal JMIR rises to top of its discipline

2009-06-20T07:32:00.002-04:00

I am still shaken and thrilled by yesterdays' big news: The Open Access publication Journal of Medical Internet Research (JMIR), which I created 10 years ago, has now established itself as THE leading peer-reviewed journal in the field of ehealth, or as I prefer to put it, for "health and health care in the Internet age". Yesterday, on June 19th, 2009, the Impact Factor rankings for 2008 were published by Thomson Reuters (Impact Factors are the most important metric for the influence of a journal, reflecting the average number of citations to recent articles). The Impact Factor for JMIR in 2008 is now an amazing 3.6 (up from 3.0 last year, and 2.9 the year before). This has to be seen against the background that medical informatics journals are typically not cited very well and have typical impact factors between 1-2.
Perhaps the biggest news due to its high symbolic value is that JMIR is now the top, number one ranked journal in its discipline, and has finally officially overtaken JAMIA, the official Journal of the American Medical Informatics Association (2008 IF 3.4), which has been on the #1 spot in this discipline for decades. For a small, independent, low-budget journal this is a major achievement and truly a David vs Goliath situation. AMIA is probably the most influential scientific society in the medical informatics field, and its journal JAMIA enjoys significant backing by the association. JAMIA is owned and published by Elsevier. I may be wrong on this (leave a comment!), but to my knowledge this is the first time in history that an independent Open Access journal takes the top spot in its discipline, overtaking the long-term top journal in a JCR (Journal Citation Reports) category. I am surprised by this myself - I would have never thought that JMIR could overtake the venerable JAMIA in terms of impact. I know that the Impact Factor has its problems as a metric, but Impact Factors continue to be a valuable measure of a journal’s quality for authors, librarians and societies, and the high impact of JMIR sends a clear message to traditional publishers as well as to societies in terms of what Open Access publishing means for impact.
JMIR is now ranked the top (#1) journal in the medical informatics category (out of 20 journals), and second (#2) in the health sciences & services category (out of 62 journals), by Impact Factor.

For further information see
http://www.jmir.org/announcement/view/24

I want to thank all readers, supporters, authors, reviewers, and editors for their support and/or editorial work they've put into the journal.

The new top position in the field means that we will be getting even more submissions, and that I will require even more help. I thank particularly those who have taken on "associate editor / section editor" responsibilities, actively guiding papers through the peer-review process (published JMIR papers acknowledge the section editor at the bottom of each article).

JMIR is continously seeking more academic section editors. Please contact me if know of any individuals who might be willing to take on editorial responsibilities. For those health informatics researchers at Medinfo2010 in South-Africa next year, we will be holding an editorial board meeting to discuss strategic issues.

For those prospective authors considering to submit a paper to JMIR due to its high impact, I urge you to make the Impact Factor not the sole and driving factor for submitting a paper to us. Our aim is to be selective in what we publish and - as a general rule - we will not consider highly technical, but only those with a considerable impact ("BMJ quality"). Our focus remains on topics related to patient empowerment through ICT (information and communication technologies) and web-based approaches, although mhealth and ubiquitous computing applications are also within scope. We also focus on patient/consumer-centered, participatory approaches, innovative methods, and applications with public health impact, as opposed to hospital information systems and traditional medical/clinical informatics. If your research falls into these categories, or if you plan a review or opinion paper in these fields, then we welcome your submission.

Best wishes

Gunther Eysenbach
Editor/Publisher, J Med Internet Res (JMIR)

"Swine Flu" vs "H1N1" terminology - tweets show that people do not adopt the new term

2009-05-21T11:33:00.000-04:00

In a previous post I already gave an example of the kind of research we are doing using the Infovigil system - an infodemiology/infoveillance system, which we are developing in cooperation with public health agencies *.
As described in this article, one of the applications of infodemiology (aside from identifying emerging epidemics) is to measure and track knowledge translation and dissemination. When the WHO as well as public health officials around the world dropped the terminology "swine flu", replacing it with "H1N1", on April 29th 2009, I was interested to see whether and how quickly this terminology would be adopted by the public - and ideal test case for a question which could be answered by infodemiological methods.

Figure: H1N1 term (red) versus Swine Flu/Swineflu (blue) terms in tweets (yellow: both). (c) Gunther Eysenbach, licensed under Creative Commons Attribution license (CC-by V2)

The figure above depicts the terminology used in tweets during the first 3 weeks in May, as a proportion of all tweets containing either "swineflu", "swine flu", or "h1n1" (including hashtags). On May 1st, less than 10% of the tweets contained only H1N1 (but not swineflu or "swine flu") (red), and 7% contained both concepts (H1N1 and [swineflu or "swine flu"]) (yellow).
As could be expected, the adoption of the term H1N1 gradually increased during the first week of May, and peaked on May 8th, when 24% of all tweets contained only H1N1 (and not swineflu or swine flu), while the term "swine flu" (or swineflu) alone was used in "only" 63% of the tweets. However, since then, the "swine flu" term experienced a sudden "revival", with the "swine flu" (or swineflu) term alone again used in 74-79% of the tweets, and "H1N1" hovering around 16-20%, without any clear trend of the term's use increasing.

We are still analyzing what happend around May 8th/9th to cause the trend to reverse (suggestions welcome). One working hypothesis is that interest in the epidemic (and the number of tweets) has declined significantly since around that date, so the nature and content of tweets has changed as well.

Comment: As a public health researcher, I am sympathetic of the reason for the name change and disappointed (but not surprised) by the publics' (in particular journalists') reluctance to adopt the name change. Studies have shown over and over again, that terminology matters: one of my favorite studies shows that changing the diagnosis "chronic bronchitis" to "smokers lung" actually encourages people to stop smoking (Brandt et al., 1997). The WHO had good reasons for suggesting a terminology change: The inherent threat in using the term "swine flu" is that people translate this into the wrong preventive behaviour (such as avoiding pork). If opinion leaders (in particular the media) would have adopted the name change, then - I assume - the public would have had an easier time to follow.
But I guess it is true what people say about change: Only as babies in our wet diapers we embrace change. It is the same reluctance to change which prevents new medical and scientific evidence to penetrate into medical practice and into the consciousness of the public in a timely manner (it takes years to change medical practice even if new research findings are out). And it is this reluctance to change which we hope to visualize with our line of infodemiology work which focuses on knowledge translation questions.

---

* Infovigil is NOT funded by Google and has no relationships to Google Flutrends - they gladly took our ideas but didn't collaborate.

Reports on Twitter Fueling H1N1/Swine Flu Fear and Misinformation Are Vastly Overstated

2009-05-20T09:18:00.000-04:00

Is Twitter fueling panic and misinformation? (Image Source: Posible caso de influenza , (C) Hello32020, licensed under CC-by license)

Recent media reports (e.g. on CNN and USA Today) suggest that microblogging sites such as Twitter are fueling an epidemic of misinformation, disseminating rumor and speculation about the H1N1 (Swine Flu) outbreak.
As infodemiology scholar these media reports struck me as largely anecdotal, not based on systematic evidence.
Using the infovigil system (which allows archiving and analysis of tweets and other sources on the Internet) we decided to address this issue more systematically.

Number of Tweets collected by the Infovigil system between May 1st and May 18th, 2009, containing the keywords or hashtags H1N1, swineflu, or Swine Flu (Image Source: Gunther Eysenbach, University of Toronto, licensed under Creative Commons Attribution license V2.0 CC-by)

My student Cynthia Chew and I just finished a preliminary content analysis of 400 randomly selected tweets (sent during the first weeks of the outbreak), and found that her data do not support the notion of twitter spreading misinformation. As she wrote in her abstract submitted to the Medicine 2.0'09 conference in September in Toronto, she found only 7/400 (1.75%) cases of misinformation in tweets.
News posts were the most common type of information shared (46%) followed by public health education (19.18%) and H1N1-related humour (18.25%). 36.75% of all posts quoted news articles verbatim and provided URLs to the source.
Take that, CNN and USA Today!

Gunther Eysenbach MD MPH
Senior Scientist, Centre for Global eHealth Innovation, Director, Consumer Health Informatics, Public Health Intelligence & Infoveillance Group

Patient empowerment and power distance, health care safety and plane crashes

2009-05-07T16:06:00.000-04:00

I just finished reading a fascinating book chapter "The ethnic theory of plane crashes" in Malcolm Gladwells book Outliers. Malcolms argument is that

The single most important variable in determining whether a plane crashes is not the plane, it's not the maintenance, it's not the weather, it's the culture the pilot comes from. Planes are flown safely when the pilot and co-pilot are in open and honest communication. And in cultures where it is difficult for a junior person to speak openly to a superior, you have lots of plane crashes.
(Source: CNN Interview with Gladwell)

As summarized by Rob Verger:

Gladwell explores two plane crashes—one Colombian (Avianca Flight 52) and another, South Korean (Korean Air Flight 801)—and how the culture of the pilots perhaps contributed to each disaster. He focuses on how well the pilots communicated with each other and with air traffic control. Poor communication in these examples, he argues, has to do with something called a culture’s Power Distance Index (P.D.I.)—the term and concept come from psychologist Geert Hofstede—which is a measurement of “how much a particular culture values and respects authority,” as Gladwell defines it. Countries with a high P.D.I. generally value being more deferential towards authority, and thus not contradicting a superior (the U.S. and New Zealand both have a low P.D.I.). Gladwell argues that since both Colombia and South Korea rank towards the top of the P.D.I. list, the subordinate members of their cockpit crews were unable or unwilling to speak up as assertively as they should have about safety concerns.

Gladwell retells the story of Korean Air, which in the 1990s was plagued by a series of plane crashes. Investigators discovered that when Koreans spoke to each other in Korean, they "were trapped in roles dictated by the heavy weight of their country's cultural legacy." That meant that they were hesitant to challenge a superior directly. According to Gladwell, a number of plane crashes are the direct consequence of "power distance", resulting in miscommunication and eventually disaster.

As a health care researcher and patient advocate I was intrigued by the concept of power distance and the notion of measuring relationships between culture and safety.
And of course, being a professor in health policy and ehealth, I started thinking about the relationship between health care culture and quality/safety of care.

I would argue that in health care, the relationship between patient and health care professional is sometimes akin to the relationship between pilot and copilot. Patients need to speak up and need to be engaged to utter concerns or preferences to avoid disaster. Power distance, which is "the extent to which the less powerful members of organizations and institutions accept and expect that power is distributed unequally" is a barrier often impeding patient-doctor commmunication.

I also hypothesized that power distance is an inverse predictor for patient empowerment: The more consumers accept that there is and that there should be a "power distance" between patients and doctors, the less advocacy in terms of patient rights and access to information will take place, and public policy will be slower to adopt an empowered patient model.

To test this hypothesis, I correlated data (total scores) from the Euro Patient Empowerment Index, which scores patient rights, information access and financial incentives on a health policy level, with Hofstede's Power Distance Index - and found a surprisingly high inverse correlation between the two metrics.
Countries with a high Power Distance Index such as Poland also tend to have low Patient Empowerment scores, while countries such as Denmark, where there is less "fear of authority", also score high on the patient empowerment metric.

What does this all mean for health care policy? Well, if you believe Gladwell's argument that power distance is a predictor for aviation disasters, then it is very feasible to make the analogous argument in health care: that high power distance and low patient empowerment is often a cause for miscommunication with disastrous outcomes in health care.
And obviously there is a relationship to my other research area, ehealth, in that the Internet and the virtues of Medicine 2.0 (participation and openness, collaboration and disintermediation/apomediation) are powerful antidotes to reduce the power distance in health care between patients and doctors, but also between health care professionals (e.g. junior and senior doctors).

I am intrigued by these relationships between culture, policy, and health care quality, and I am trying to get my head around how to do further research in this area.

To avoid "ecological fallacies", such studies presumably must be undertaken at the individual level. So perhaps what we need to develop next is a patient empowerment index that can be administered at the individual rather than policy level, and which can be used to study relationships between empowerment and outcomes.

Medicine 2.0'09 Abstract Submission Now Open (and: Awards!)

2009-04-15T14:40:00.000-04:00

Today, the Medicine 2.0'09 conference opened its abstract submission system for presentation proposals for this years' conference (Sept 17-18th. 2009, Toronto). The deadline is May 15th, 2009.

Also announced were a few attractive Medicine 2.0 awards for best paper presentations, one sponsored by the International Medical Informatics Association (IMIA), one sponsored by the Journal of Medical Internet Research (JMIR).

The annual Medicine 2.0'09 conference is all about social networking and Web 2.0 applications in medicine health, health care, as well as in biomedical research. Other than some commercially dominated "Health 2.0" tradeshows, this conference distinguishes itself by 1) having an academic focus, with an open call for presentations, published proceedings and peer-reviewed abstracts (although there is also a non-peer reviewed practice and business track), and 2) being the only conference in this area which has a global perspective and international audience (last year there were participants from 18 countries).

The program in 2008 was outstanding, with internationally renowned speakers, a philosophy of "openess", and a very nice atmosphere for networking.

This years' program promises to be even better, so I'll see you in Toronto in September...

How to cite twitter, how to cite tweets, how to archive tweets

2009-04-05T11:12:00.001-04:00

As twitter and microblogging is gaining momentum as a social phenomenon, a number of researchers start wondering how to cite tweets (for example here) and how to cite a whole thread (series of tweets).
A related issue is how to digitally preserve and archive tweets. For example, using twitter search, one can currently only search a few months back, older tweets are not retrievable. And while it is difficult to imagine that twitter won't be around for a while, it is not certain that the site still exists in 5, 10 or 20 years, making it impossible for future scholars to access the same information the author accessed.
A third related issue is dynamically changing content on twitter. For example, it doesn't make much sense to cite a search URL like http://search.twitter.com/search?q=twitter, because obviously the content is changing all the time.

For all these reasons, the WebCite tool comes in handy (http://www.webcitation.org) [3]. WebCite, which is endorsed by hundreds of scholarly journals, is a member of the International Internet Preservation Consortium (other members include for example the Internet Archive/Wayback machine) and works with libraries to make scholarly important digital material (including cited webpages, websites, online datasets etc) permanently accessible and "citable".

Here is how I use the WebCite tool to cite and archive tweets:

1. If I want to search all tweets by a given user, or tweets matching a hashtag or keyword, I use the search interface at http://search.twitter.com/ (or advanced: http://search.twitter.com/advanced) to generate a query searching for the username, a given hashtag etc, for example http://search.twitter.com/search?q=eysenbach

If I want to cite a specific tweet, I simply enter the entire tweet into the search interface, for example "http://search.twitter.com/search?q=Wondering+about+copyright+and+twitter.+Who+owns+intellectual+property+%2F+ideas+posted+on+twitter%3F+".
This is a workaround, as archiving the direct URL of the post (http://twitter.com/eysenbach/statuses/1457158115) currently seems to fail (http://www.webcitation.org/5foQZ3stR) (WebCite is working on this).

2. Copy and paste the search URL ( http://search.twitter.com/search?q=eysenbach) into the archive form of WebCite under "URL to Archive [url]:" and enter your email adress under "Your (citing author) E-mail Address [email]:", so that WebCite can email you a success/failure notice.

If you use WebCite regularly to cite other webpages etc., add the "WebCite this" bookmarklet to your browser. You can then archive any URL by just clicking the bookmarklet on your browser without having to navigate to the archive form of WebCite.

3. You're done! Cite the tweet or tweet thread as follows:

Eysenbach G (03-04-2009). wondering about how to archive my tweets (and friends' tweets) locally - any solutions out there? Retrieved from twitter.com, archived at http://www.webcitation.org/5foXLx2sm

or

[Multiple authors]. How to cite tweets. Search result retrieved on 2009-04-05 12:08pm from http://search.twitter.com/search?q=how%20to%20cite%20tweets, archived at http://www.webcitation.org/5foMuVHgy

As a side note, forget the APA or NLM styles [2] on how to cite blogs and websites. These citation styles leave out the most important aspect of citing a webpage or blog (which can change every minute or - in the case of twitter - every second), which is to archive it and to cite a permanent, archived snapshot - at least if the intention is that the reader sees the same as the author when he cited the tweet or series of tweets. In addition to the original URL, always cite the WebCite URL which links to a stable snapshot of the cited page.

For example, a URL like http://search.twitter.com/search?q=twitter is showing a different result every second. Only by "freezing" and archiving the result, (http://www.webcitation.org/5foXx28BB) the URL can and should be cited.

Limitations
Currently, the WebCite team is working on a few fixes, to make archiving and citing of tweets easier.

A current limitation is that the "show conversation" links in search results do not work if the search results are archived by WebCite (see e.g. http://www.webcitation.org/5foMuVHgy), presumably because javascript is used to retrieve that additional information.

Secondly, archiving the direct URL of a microblog (http://twitter.com/eysenbach/statuses/1457158115) and webciting the twitter homepage of a user works insofar that WebCite creates an internal copy of that page, but it doesn't diplay very well in the WebCite frame (appears for a few seconds and then disappears: See e.g. http://www.webcitation.org/5foQZ3stR or http://www.webcitation.org/5foR9anu2. (any hints on why this is - my guess is some javascript magic on these pages-, and how it can be fixed, are welcome). Thus, use the workaround of using the twitter search interface to archive tweets from a specific user or a specific hashtag, as described above.

Thirdly, the twitter search interface currently only allows the display of max 100 microblog entries (tweets) on one page, so that one WebCite snapshot has to be taken per search results page.

Fourthly, there is an urgent need for a tool allowing researchers to prospectively monitor and archive feeds from twitter, which is also something WebCite is working on (there are relations to the Infovigil [3] project, which allows advanced analytics such as trendanalysis, geographical coding, and links to polls).

Copyright
Ok, this question always comes up.. Using and archiving webpages should be covered under fair use clauses if the intent is scholarly communication. Twitter itself raises some interesting copyright issues, including the question if tweets reach the standard for copyrightability.

------
References
1. Eysenbach G, Trudel M. Going, Going, Still There: Using the WebCite Service to Permanently Archive Cited Web Pages. J Med Internet Res 2005;7(5):e60 URL: http://www.jmir.org/2005/5/e60
2. Patrias, K. Citing medicine: the NLM style guide for authors, editors, and publishers [Internet]. 2nd ed. Wendling, DL, technical editor. Bethesda (MD): National Library of Medicine (US); 2007 [updated 2009 Jan 14; cited Year Month Day]. Available from: http://www.nlm.nih.gov/citingmedicine
3. Eysenbach G. Infodemiology and Infoveillance: Framework for an Emerging Set of Public Health Informatics Methods to Analyze Search, Communication and Publication Behavior on the Internet. J Med Internet Res 2009;11(1):e11 URL: http://www.jmir.org/2009/1/e11

Article Processing Fees and Open Access journals

2008-11-24T14:50:00.000-05:00

Stephen [WebCite] has just blogged about the Libertas Academica table on Article Processing Charges [WebCite] (which by the way seems to be swiped -without attribution- from the Biomed Central comparison table [WebCite]).

What I am missing in both tables is an overview of what journals are actually offering for these costs. For example, PLoS One* has no copyediting process, and also seems to skip the final proofreading step common at most other journals (galleys are not sent to the author for final approval).
As a result, some authors decry the quality of their published work. For example, John Logsdon [WebCite] writes

There was no opportunity given for making corrections to proofs. I have already identified an issue with one of the tables that would have been corrected in proof had there been an opportunity.

On the same page, Banoo Malik offers an insightful comment:

I contacted the production staff and they mistakenly gave it the citation year of "2007" not 2008. Thus, my first primary-authored paper will likely NEVER appear in anyone's eTOCs,
(...)
Obviously you get what you pay for. Cheap production costs yielded some production oversights. I can appreciate how many hours and effort a copy editor and production staff spend on these seemingly small details now since I followed up on a few points myself. [WebCite]

On the same page, Andrew Staroscik writes:

I am unhappy with parts of the BMC process. I agree that the pros outweighed the cons but I also had an issue with proofing. The BMC process did not have a copy editing step! There are typos in the published version of our paper that I and the other authors did not catch until it was tool late.

Is having a competent copy editor look over the proofs really a particularly costly step in the process? [WebCite]

The answer to the last question - at least from my perspective as publisher of JMIR - is a clear "yes". JMIR charges a $1500 Article Processing Fee, but spends most of this budget - hundreds of dollars - for every article to clean it up before publication, to standardize the reporting, and to improve language issues. Bringing an article into the final form, including checking all the references, crosslinking them to DOIs, PMIDs, PMCIDs etc. is - even though a semi-automatic process - a very timeconsuming and expensive undertaking.

This is what authors often don't realize when looking at APF comparison tables such as those published above: There are considerable differences between journals on how much time and costs they spend on the actual production process, which justify different article processing fees.

The notion that the "ONLY major cost in running a journal is the time spent by the editorial team and reviewers" [WebCite] is - at least for how I run my journal - not accurate.

In fact, JMIR is spending most of the article processing charges on external contractors - copyeditors, XML typesetters etc. There are several copyediting and proofreading steps in the production process, which not all journals seem to employ. I invite authors to critically assess what they get for the money instead of just looking at the article processing fee. JMIR staff and external contractors spend on average 10-20 hours to bring a manuscript into its final form.

And open access journals not charging any Article Processing Fees are almost guaranteed to skip these steps. Many won't even have XML versions of the articles (i.e. no submission to PubMed Central), because creating them is very expensive.

So I would encourage academic authors considering to submit articles to an open access journal to not only ask how much the article processing fee is, but also what they get for their money.

---
Correction notice: Edited 25/11/2008. I am taking back (and have removed) my original remark on "superficial" [WebCite] peer-review. More correct and value-neutral would have been to say that some journals have a leaner ("hassle free) [WebCite] peer-review process than others (for example, editors may decide to accept an article without sending it out to external reviewers).

eHealth (web-based behavior change programs) in the Toronto Star

2008-11-17T15:57:00.000-05:00

Today, the Toronto Star published an article about Web-based behavior change programs [Pigg, Susan: Monitoring your vices online. Toronto Star, 17.11.2008, URL:http://www.thestar.com/article/537988. Accessed: 2008-11-17. (Archived by WebCite(R) at http://www.webcitation.org/5cOtvqnhO)] - with a picture of me in front of my whiteboard in my office. I talked to the reporter about the pros and cons of online-ehealth programs, such as those which we are currently publishing in the JMIR Theme Issue on Web-Assisted Tobacco Interventions (the Toronto Star article has a broader scope though). I mentioned the problem of attrition - many users are starting to use these programs enthusiatically, but stop using it after a while. But there are ways to tackle the attrition problem: Social networking probably make sites more sticky and engaging, and create peer-pressure to return. In addition, personal health records (and PHR platforms like Google Health and Microsoft Healthvault), sensors, Ubiquitous/pervasive computing, smart appliances and smart home-care devices will make it easier for users to aggregate and manage automatically tracked data (rather than having to enter information in online diaries etc). Of course, this raises certain privacy issues...

As you pour that glass of wine or two when you get home tonight, you might want to think about the price you're paying for the daily ritual of taking the edge off.

That drink – which, admit it, is usually two or three as you ease into the weekend – costs you about $2,000 a year. It's adding up to at least 100 extra calories a day and, if you're an average-sized, 50-year-old woman, about 15 pounds of unflattering weight over 12 months.

In the course of a year, you will have downed some 520 drinks and been under the influence of alcohol 1,161 hours. That means your throat is often inflamed, your liver and pancreas are under stress and you are boosting your chances of developing some cancers.

That's not your doctor talking. That's checkyourdrinking.net.

If you think you may have a problem, rest assured there are thousands of others just like you. They're in cyberspace as well, doing online self-assessments and then spending hours in social networking sites debating with like-minded people. Their concerns? Is there a better way to cope with stress? Do their dark days now rate as full-fledged depression? Is their weight off the scales?

There has been a virtual explosion the last few years in so-called eHealth sites, which help people tackle everything from insomnia to anxiety attacks and gambling addictions. But, increasingly, they are being used by companies – usually as part of employee assistance programs – to boost productivity by reducing absenteeism, sick days and disability claims.

"None of these programs is meant to replace a physician or offer (medical) diagnoses," says Estelle Morrison, director of program development at Ceridian Canada, which runs employee assistance programs on behalf of many major Canadian companies. "They are meant to educate people and make them more self-aware and knowledgeable so they can go to the right people and get the help they need.

"We now see employers understanding that if they don't start to provide some very important support to their employees, they will be in quite a mess in the next few years because of aging baby boomers who are struggling with health issues, in terms of employee absenteeism, in terms of labour shortages, in terms of (the health effects of) people working 24/7.

"These are issues that are impacting the mental health, the productivity and the availability of staff – and employers are now seeing the bottom-line cost of that."

In the U.S., companies are offering "incentives" – gift cards, running shoes, health-club discounts, cash awards of up to $1,000 – for employees who undertake "health risk assessment" surveys aimed at pinpointing and minimizing their risky habits. In Canada, Morrison says, cash incentives are more seen as "rewarding" bad behaviour, so "we've had a lot of iPods."

The assessments usually include 50 to 75 questions ranging from your cultural background to whether you wear seat belts.

"They're being very, very aggressive in the United States about getting these kinds of systems in place," says Dr. David Goldbloom, a senior medical adviser for Toronto's Centre for Addiction and Mental Health.

Goldbloom says he was surprised to see the number and sophistication of "behavioural health" programs during a recent health-care conference in Arizona. "There were tonnes of examples of companies that are working very hard to make this more a part of their workplace, but also competing with each other: who's got the healthier workplace?"

Toronto-based V-CC Systems Inc. launched its online behavioural change programs in Canada in 2000 and now offers its services to many companies. It also has partnerships with agencies such as the Canadian Cancer Society, which uses its online smoking-cessation programs, says Rachel Fournier, the company's director of business development.

V-CC is one of the few eHealth sites that offer some free behaviour-change surveys and programs around drinking, obesity, anxiety, smoking and depression, as well as access to its online forums. (Far more comprehensive programs are available through company assistance programs for employees.)

What makes the programs so popular, say experts, is that they are anonymous and available 24 hours a day in the privacy of your home. With traditional assistance programs that offer counselling, there is always the fear the information will leak back to your boss.

Rick H., a recovering alcoholic and drug addict, uses the V-CC site most days, offering personal perspective and advice online. "I think it's very helpful to people who are starting off and trying to find a path. It gives them some tools to get them started, but I don't think it's for maintaining long-term sobriety. They tend to hang around a month and then move on.

"I like to think that some of them make it, but I know, from being a member of Alcoholics Anonymous for two years, that only about 5 per cent make it to five years sober on the first try.

"But there's always value if somebody has hope."

What started as online self-assessments and expanded into online self-help groups is evolving in a new generation of eHealth programs. These are so tailored to individual circumstances that they could significantly reduce at least some serious outcomes, such as, say, drinking or poor diet escalating into costly diabetes and cardiovascular problems or depression – which costs an average per case of $10,000 and 40 lost days at work – spiralling out of control.

"I think it's very important that we continue to do research and evaluate the impact of these programs," says Dr. David Ahern, a U.S. physician who is doing just that kind of research on behalf of the Boston-based Health e-Technologies Initiative.

"But I am much more of an optimist about the benefits of these programs than the downside. I think they have tremendous potential to help improve health and the quality of health care."

The downsides, says Canada eHealth expert Dr. Gunther Eysenbach, include getting people to stick to the programs, especially if they have to keep tedious daily online logs of their habits and behaviour. There are also the privacy risks of cyberspace, he notes.

While the smoking programs have proven among the most successful – some research shows about a 10 to 12 per cent quit rate – weight loss is trickier, says Eysenbach.

"With weight loss, there's just an intrinsic paradox that you make people sit down at a computer to lose weight when you should actually be sending them out onto the street to do some exercise."

A more active intervention is starting to happen, with programs that can now be used on mobile devices and "smart devices" that, in time, Eysenbach believes, will make it much easier for people to keep track of behaviour that poses a risk to their health.

He predicts it won't be long before your car will keep track of how much you have driven and whether you should, for the sake of your heart, start riding your bike. Or your fridge will be telling you it's time to stop snacking.

Or put down that drink.

Also mentioned - in a sidebar to the article - is JMIR:

Dr. Gunther Eysenbach runs the Toronto-based Journal of Medical Internet Research and has spent 10 years monitoring and studying the value of online health initiatives and behavioural change programs. See jmir.org.

Open Access journal JMIR funded by SSHRC's Aid to Scholarly Journals competition - finally!

2008-11-17T11:47:00.000-05:00

The Social Sciences and Humanities Research Council (SSHRC) in Canada has just announced that the Journal of Medical Internet Research (JMIR) (which I publish) will receive a $90.000 grant over the next 3 years. In the decision letter the agency writes that the adjudication committee "recognized the quality of the journal and saw that it was making an impact on the field." It "judged the editor-in-chief to be highly competent, the reviewers to have been well-chosen and the publication plan presented to be entirely sound and reasonable."
The SSHRC is funding 142 journals over the next 3 years under their Aid to Scholarly Journals 2008 competition, selected among 186 funding proposals.
In 2007, JMIR has already won a SSHRC grant for Open Access journals.

The editorial board and publisher is thrilled about this decision. Only 4 years ago, at the last SSHRC competition, JMIR was discouraged to submit a proposal, because it was an Open Access journal - 4 years ago, SSHRC did not consider to fund journals with no "subscribers" (the number of paying subscribers was seen as a quality criterion for an academic journal).
The policy change at SSHRC - to fund Open Access journals - is partly a result of intense lobbying of JMIR and others - see for example the submission by Gunther Eysenbach in response to the SSHRC-CFHSS Consultation on Open Access to Publicly Funded Research (2005) (Archived by WebCite® at http://www.webcitation.org/5cP2FNrRb)

Google Uses Searches to Track Flu’s Spread (and forgets to say where this idea came from)

2008-11-11T20:50:00.000-05:00

See also: Robert Lemos. Sick Searchers Help Track Flu. MIT Technology Review, Nov 12 [Archived in WebCite]
----
I am currently in a mild state of shock. A couple of years ago - when Google.org was just created and Larry Brilliant was appointed CEO of Google.org, I was trying to collaborate with them regarding my research on the correlation of searches on Google and Flu symptoms (published in 2006 here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1839505). My hope was that a visionary guy like Larry would be open to a collaboration to explore my idea, the correlation between Internet searches and disease outbreaks (most notably influenza).
Larry Brilliant explained in his 2006 TED presentation (after which he was made executive director of Google.org) that his TED wish was an early detection system of disease outbreaks through Internet monitoring of published reports. The "idea" to analyze and aggregate media reports was not original - it was directly "inspired" by Ron St John's GPHIN (another project made in Canada) - but at least he gave GPHIN credit. Monitoring and aggregating what people publish (new items, Internet postings etc) is what I called "supply-based" infodemiology / infoveillance. However, what Larry Brilliant was not thinking about at that time, and what was (and is not) a part of GPHIN or other infoveillance system was what I call "demand-based infodemiology" (infoveillance), i.e. automatically analyzing what people are searching for on the Internet. At the time Larry became CEO of Google.org I was already working (and publishing / speaking) about this.
I was hoping that Google.org would perhaps be open to fund this project, or to share data.
What I did not expect is that they just go ahead and do what I proposed themselves, without ever getting back to me!
Today the NYT reported that Google.org has -- mmh, let's say "adopted" my idea, without giving any credits to its origin.
In the past 12 hours, at least half a dozen people who know about my infodemiology work have emailed me and asked "Hey, isn't this what you were doing, why aren't you on that paper?".
The NYT even goes so far to (wrongly) report that "Google Flu Trends appears to be the first public project that uses the powerful database of a search engine to track the emergence of a disease.". Wrong - apparently this reporter didn't do his homework or checked the published literature. In fact, I started doing this line of research about 4-5 years ago - in 2003, and talked about this at the CDC and on various conferences (e.g. at AMIA, in 2006 - where my paper "Infodemiology: Tracking Flu-Related Searches on the Web for Syndromic Surveillance" won the Distinguished Paper Award, and in 2007, on a joint panel organized by John Brownstein from Healthmap.
Healthmap by the way just got a few millions from Google.org.
The google.org team led by Dr Brilliant (according to the NYT article) even managed to get a paper accepted in Nature (while I haven't been as lucky, see below). Their paper
"Detecting influenza epidemics using search engine query data.
Jeremy Ginsberg ,Matthew H. Mohebbi, Rajan S. Patel, Lynnette Brammer, Mark S. Smolinski and Larry Brilliant is here.
Google.org obviously has every right to use and publish their data, and perhaps it is a case of "great minds think alike" (though I have not seen any presentation or publication from them which precedes mine), but I wonder how outside researchers who submit proposals and suggestions to Google.org can be certain that they don't just steal the ideas? Google.org has not the structure and level of accountability as traditional funding agencies or charities - in fact, it is set up as a company. As an academic, my currency is reputation and getting credit where credit is due. It would have been so easy in this case!

-------------
The following is my slidedeck of my "infodemiology" and "infoveillancve" experiments, which I have been conducting since 2004. The slides were presented at various AMIA meetings, at the CDC, at a NCI/NSF workshop, and in other places. For the record: The terms infodemiology and infoveillance were created by me!

Eysenbach: Infodemiology and Infoveillance

View SlideShare presentation or Upload your own. (tags: medicine health)

Here is a presubmission inquiry letter I sent to Nature Medicine in October 2005 (the editor said this is not something they would consider publishing. Apparently, after 3 years and with authors from Google.org and the CDC on the paper, the situation has changed!):

Research Letter

Using Google for Syndromic Surveillance: Web Searches for Flu Symptoms as Predictor for Influenza Outbreaks

Editor,

We are considering submission of a short paper (500-800 words, with 1 figure) entitled

Web Searches for Flu Symptoms as Predictor for Influenza Outbreaks

An increasing proportion of people in industrialized countries are using the Internet to seek health information (1), often before they visit a health professional. An interesting question is whether tracking health information seeking behaviour of populations over time can be used for public health purposes, particularly syndromic surveillance, which has been defined by the CDC as “surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response”. While most syndromic surveillance systems rely on data from clinical encounters with health professionals, monitoring for example sick-leave prescriptions, house calls, hospital- or pharmacy-based data (2), we explored whether an automated analysis of trends in Internet searches can be useful to predict outbreaks such as influenza epidemics. We analyzed data from the Canadian flu season 2004/2005 over a period of 33 weeks from week 41/2004 (Oct 3-9) to week 20/2005 (May 15-21), comparing Fluwatch data on the number of influenza lab tests for Influenza A or B conducted in sentinel laboratories (“lab tests”), the number of lab tests testing positive (“cases”), and the number of cases of influenza like illness (ILI) reported by sentinel physicians with clicks in Google on an sponsored link triggered by influenza-related keywords. In our analysis, search engine clicks were a better predictor for flu cases than ILI reported by sentinel physicians. These data suggest that for diseases where consumers are likely to consult the Internet first before they visit a physician, tracking Internet search behaviour may be a valuable method complementing traditional methods of syndromic surveillance.

Response

Decision on presubmission inquiry NMED-PI29222

From: medicine@natureny.com
To: geysenba@uhnres.utoronto.ca
Date: Oct 31 2005 - 2:09pm

31st Oct 2005

Dear Dr. Eysenbach,

Thank you for asking us to consider your proposed article "Web Searches for Flu Symptoms as Predictor for Influenza Outbreaks" (NMED-PI29222). We have given the paper our careful consideration but sadly have decided that submission to Nature Medicine would not be appropriate.

We receive a great many presubmission inquiries and given the very limited space in our journal we are only able to invite formal submission of a few of these. Thus, the competition is fierce. In choosing which to invite we consider the likely broad appeal of papers, the level of advance they offer over previously published work and whether or not they adequately address subjects that will interest and be accessible to both scientists and clinicians within the biomedical research community. In this case we were not persuaded that your proposed article would compete well with the others that we have received. In making this decision we do not intend a criticism of the work -- indeed we are sure that others in your field will find it of significant value -- but merely question its appropriateness for Nature Medicine.

Nevertheless, thank you very much for giving us the opportunity to consider your work. I am sorry that we cannot be more positive and hope you are soon able to interest an alternative journal in your work.

Sincerely,

Clare Thomas, PhD
Associate Editor
Nature Medicine

This email has been sent through the NPG Manuscript Tracking System NY-610A-NPG& MTS

My paper was also turned down at the BMJ, CMAJ, JAMA, Lancet, and Science. In all but one case (CMAJ) the editors did not even send it out for peer-review. Here is the Science rejection letter.

From: Debbie Dennison [ddennison@science-int.co.uk]
Sent: November 4, 2005 7:14 AM
To: geysenba@uhnres.utoronto.ca
Cc: cash@science-int.co.uk
Subject: Decision on your Science manuscript 1122097 Eysenbach

4 November 2005

Dr. Gunther Eysenbach
Centre for Global eHealth
Fraser Elliott Bldg, 4th fl
University Health Network
190 Elizabeth St
Toronto ON M5G2K5
CANADA

Ref: 1122097

Dear Dr. Eysenbach:

Thank you for submitting your manuscript "Tracking Web Searches for
Syndromic Surveillance" to Science. Because your manuscript was not given a
high priority rating during the initial screening process, we will not be
able to send it out for in-depth review. Although your analysis is
interesting, we feel that the scope and focus of your paper make it more
appropriate for a more specialized journal. We are therefore notifying you
so that you can seek publication elsewhere.

We now receive many more interesting papers than we can publish. We
therefore send for in-depth review only those papers most likely to be
ultimately published in Science. Papers are selected on the basis of
discipline, novelty, and general significance, in addition to the usual
criteria for publication in specialized journals. Therefore, our decision
is not necessarily a reflection of the quality of your research but rather
of our stringent space limitations.

We wish you every success when you submit the paper elsewhere.

Sincerely,

Caroline Ash, Ph.D.
Senior Editor

Debbie Dennison
Editorial Assistant
Science International
Bateman House
82-88 Hills Road
Cambridge
CB2 1LQ

Phone: +44 (0)1223 326500
Fax: +44 (0)1223 326501

Reference:

1. G. Eysenbach. Infodemiology: Tracking Flu-Related Searches on the Web for Syndromic Surveillance. AMIA Annu Symp Proc. 2006; 2006: 244–248 : http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1839505

Founding the Open Access Scholarly Publishers Association

2008-10-14T10:00:00.000-04:00

Today is Open Access Day (Accessed: 2008-10-14. (Archived by WebCite® at http://www.webcitation.org/5bZ5360OL). After many months of discussions and work we used this symbolic date to launch the Open Access Scholarly Publishers Association (OASPA). I (being publisher of the Journal of Medical Internet Research) am involved in founding this important organization (Archived by WebCite® at http://www.webcitation.org/5bZ5Qwdxu), and serving on its interim board. There has been some heated debates on how the bylaws should be structured, in particular vis-a-vis some concerns that one publisher group would "overwhelm" and outvote another publisher group, given that the agenda and priorities of "scholar publishers" (the subgroup I am representing) may not always be aligned with those of commercial/professional OA publishers.
OASPA has some important missions. One is to set standards and keeping the standard of OA publishing high (e.g. by creating and enforcing a code of conduct, which includes for example standards against spamming). Another is advocacy work for gold-OA publishing. A third one is education - helping newcomers in the business to set up and maintain successful open access journals - something the epublishing and open access research at the Centre for Global eHealth Innovation - which I direct - has been doing for many years now.

Announcing The Launch Of The Open Access Scholarly Publishers Association, Oaspa

Posted at 10:05AM Tuesday 14 Oct 2008
Press Contact:

Caroline Sutton

Tel/skype: +46 (0)18 495 1126

Cell: +47 90 69 05 06

Caroline.Sutton@co-action.net

ANNOUNCING THE LAUNCH OF THE OPEN ACCESS SCHOLARLY PUBLISHERS ASSOCIATION, OASPA

14 October 2008, London. The Open Access Scholarly Publishers Association, OASPA, announces its official launch today in conjunction with an OA Day celebration hosted by the Wellcome Trust in London. The mission of OASPA is to support and represent the interests of Open Access (OA) journals publishers globally in all scientific, technical, and scholarly disciplines through an exchange of information, setting of industry standards, advancing business and publishing models, advocating for gold OA journals publishing, education and the promotion of innovation.

From having first emerged as a new publishing model over a decade ago, OA publishing has become an embedded feature of the scholarly publishing landscape: The Directory of Open Access Journals (DOAJ) lists over 3500 peer-reviewed journals; a growing number of professional organizations offer OA publications; university libraries increasingly support OA publishing services; funding organizations support and encourage OA publishing; and a long tail of independent editorial teams and societies now publish their titles OA. Professional OA publishers such as BioMed Central and the Public Library of Science (PLoS) have been in business for over five years, while some scientist/scholar publishers (editorial teams operating independently of a professional publisher) have published their OA journals for a decade or more. Moreover, a number of traditional publishing houses are now engaging in Open Access activities, the recent acquisition of BioMed Central by Springer and the SAGE-Hindawi partnership being two cases in point. By bringing together those who share an interest in developing appropriate business models, tools and standards to support OA journals publishing, it is hoped that success in these areas can be achieved more quickly to the benefit of not only OASPA members, but more importantly, for the scholarly community that OA publishers serve.

Membership in OASPA is open to both scholar publishers and professional publishing organizations, including university presses and for profit and non-profit organizations. Members are expected to demonstrate a genuine interest in OA journals publishing by having signed either the Berlin or Budapest Declarations and must publish at least one full OA journal. Other individuals and organizations who support OA journals publishing or who are interested in exploring opportunities are also welcome. Membership criteria and an application form can be found on the OASPA website, www.oaspa.org.

The founding members of OASPA represent a broad spectrum of OA publishers and include: BioMed Central, Co-Action Publishing, Copernicus, Hindawi Publishing Corporation, Journal of Medical Internet Research (Gunther Eysenbach), Medical Education Online (David Solomon), the Public Library of Science (PLoS), SAGE, SPARC Europe and Utrecht University Library (Igitur). Representatives from each of these publishers will form an interim board until a first General Meeting is held during 2009.

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Open Access Scholarly Publishers' Association, OASPA, is launched today 14 October 2008 in response to long-time informal discussions among Open Access publishers, and aims to represent the interests of OA journals publishers globally. For more information about the organization, visit the OASPA website at: www.oaspa.org.

The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending over £600 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing.

Open Access (OA) scholarly publication refers to the dissemination of peer-reviewed manuscripts containing original research or scholarship immediately upon publication, at no charge to user groups, without requiring registration or other restrictions to access.

OA publications also allow users to "copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship...."

Medical Blogging: Impact and Ethics

2008-09-24T15:26:00.001-04:00

Yesterday, Ivor Kovic and colleagues published the paper "Examining the Medical Blogosphere: An Online Survey of Medical Bloggers" in the Medicine 2.0 Theme Issue of the Journal of Medical Internet Research.
What I found most amazing about the results of his survey among medical bloggers is that a whopping 66% of those bloggers have received media coverage in mainstream media. Clearly, medical blogging is an "important vehicle to influence medical and health policy".

The potential impact of blogs on mainstream media and - eventually - policy has not escaped the attention of Public Relations professionals, who, in many instances, target bloggers as opinion leaders first. Bloggers - and especially medical bloggers - have therefore, in my opinion, a special responsibility for fact-checking and following other journalistic "best practices".

In the light of this I reflected on the presentation of Kevin Clauson (with Joan Dzenowagis from the World Health Organization) on Risk 2.0: The future of connected health at the Medicine 2.0 congress in Toronto, a few weeks ago.

Kevin Clauson at Medicine 2.0, Sept 5th 2008

Participants at Medicine 2.0 voting for questions posed by the speaker

Clauson used an interactive device to poll the congress audience. He asked the audience a few questions, among them whether they thought that it would be ethical for a blogger to post a blog entry that is "influenced by (but omitted mentioning of) a public relations professional". What I found surprising here was that 25% of the participants actually thought that this was not a problem! (I think it is!)

25% of the participants thought a blog "influenced by (but omitted mentioning of) a public relations professional" is ok

Clauson also cited results from the Healthcare blogger survey which say that 29% have been contacted by a PR professional, and 52% of those have posted at least one entry based on the info provided by the PR professional (the degree of disclosure is not known and would make an interesting research project).

Clauson's slide citing the Healthcare blogger survey

Also interesting was the fact that 56% of the Medicine 2.0 audience felt that, when it comes to advertising, blogs should be held to the same (ethical) standard as biomedical journals, and 21% even thought the standard should be higher. On the other hand, 23% thought the standards should be lower.

Voting results on "should blogs be held to the same (ethical) standard as biomedical journals?"

I think these results clearly show that some consensus building towards ethical standards for medical blogs is required, as well as some research on the quality and adherence to best practices.

The paper by Ivor Kovic and colleagues on "Examining the Medical Blogosphere: An Online Survey of Medical Bloggers" is an important first step in that direction.

Further information
Media Coverage on Kevin Clauson's and Joan Dzenowagis' Risk 2.0 panel at Medicine 2.0:

Digital Healthcare & Productivity (http://www.digitalhcp.com/2008/09/09/health20risk.html)

http://www.ihealthbeat.org/articles/2008/9/15/Health-20-Technology-Brings-New-Risks-to-Health-Care-Facilities.aspx?topicID=55

http://www.markle.org/weekly_digest/weeklydigest_vol.7_issue34.pdf

Patient involvement through YouTube at the Medicine 2.0 conference

2008-09-19T11:03:00.001-04:00

One of the most inspiring presentations at the Medicine 2.0'08 conference was a presentation by Luis Fernandez Luque, which included a YouTube video by a patient, Lauren Parrot, specifically recorded for the conference.

I think involving patients via YouTube in this conference was a phantastic idea. The video from laurenvparrot , which was played in the plenary, was very inspiring and touching.

I am wondering how we can harness this idea for Medicine 2.0'09, perhaps in a more systematic way. Perhaps we can pose some specific questions for patients and invite YouTube submissions, which will be presented/exhibited at the conference? This would enable patient-involvement without creating traveling costs etc.

Perhaps we can also find a sponsor for a "Patient 2.0" award...

If somebody has ideas for specific questions / discussion points for patients/consumers, please post them here or on the Medicine 2.0 Social Network discussion board.

Pictures from FlickR showing Luis Fernandez Luque presenting the YouTube video from Lauren Parrot, specifically recorded for the Medicine 2.0 conference.

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Originally uploaded by eysenbach

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Originally uploaded by eysenbach

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Originally uploaded by eysenbach

Date for Medicine 2.0'09 set

2008-09-19T11:03:00.000-04:00

After the immensely successful Medicine 2.0'08 conference on Sept 4/5th, 2008, we have now set the date for the next Medicine 2.0'09 conference: Sept 17-18, 2009 (same venue, i.e. the MaRS Centre in Toronto).
Please make a note in your calendar. See also Important Dates (http://www.medicine20congress.com/importantdates.php) for a tentative schedule of submission deadlines etc. for next year. Hope to see you again in Toronto!

Please help us to promote next years' conference. At the bottom of the Sponsors page (and at the bottom of this blog post) there are revised banners for next years' conference. Please post them on your blog, websites, and in your emails, linking back to http://www.medicine20congress.com - thank you!

Medicine 2.0 Photos on Flickr

2008-09-06T18:39:00.000-04:00

Just published: Over 800 photos from the first international Medicine 2.0 congress, at http://www.flickr.com/photos/30211781@N04/sets/72157607120617918/

All pictures are (c) G. Eysenbach, licensed under Creative Commons Attribution-Noncommercial-ShareAlike, so feel free to use them.

Thanks to all participants and especially the speakers for making the congress such a resounding success. With almost 200 participants from 19 countries, the congress was sold out. The feedback from the evaluation forms was overwhelmingly positive and there seems to be a real enthusiasm to do another congress next year (in fact, with the exception of two respondents, who were "unsure", ALL participants answered the question on whether there should be another Medicine 2.0 congress with "yes")... The congress brought together a broad range of innovators, researchers, opinion leaders, bloggers, business leaders, and others.

If you missed Medicine 2.0.08, make sure to join the Medicine 2.0 social network on crowdvine, and preregister here for Medicine 2.0.09 (do not preregister again if you already preregistered for Medicine 2.0.08).

Medicine 2.0 Toronto Day 1

2008-09-05T03:25:00.001-04:00

Medicine 2.0 Toronto Day 1
Originally uploaded by eysenbach

The Medicine 2.0 conference is in full swing, and it seems like participants are greatly enjoying the talks and the conference. I just posted a first set of photos to Flickr. Unfortunately, I am too busy to blog about the talks myself, but there are plenty of other bloggers among the participants.

Apomediation - Word of the day

2008-08-30T09:51:00.000-04:00

Kent Anderson (Accessed: 2008-08-30. Archived by WebCite® at http://www.webcitation.org/5aScYgcU5) and Martyn Daniels (Accessed: 2008-08-30. Archived by WebCite® at http://www.webcitation.org/5aScc366m) are both intrigued by the term Apomediation, which I first introduced in a book chapter [1] and recently elaborated on in an editorial for the Journal of Medical Internet Research [2]. I especially like Kent Anderson's blog because it accurately characterizes what is meant by apomediation. A few talks at the Medicine 2.0 congress next week in Toronto are also mentioning apomediation in their abstracts, and I look forward hearing other perspectives on the concept.

References
1. Eysenbach G. Credibility of health information and digital media: new perspectives and implications for youth. In: Metzger MJ, Flanagin AJ, editors. Digital Media, Youth, and Credibility. The John D and Catherine T MacArthur Foundation Series on Digital Media and Learning. Cambridge, MA: MIT Press; 2008. URL: http://www.mitpressjournals.org/doi/pdf/10.1162/dmal.9780262562324.123
2. Eysenbach G. Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. J Med Internet Res 2008;10(3):e22
URL: http://www.jmir.org/2008/3/e22/

Social networking for doctors: CMA launches Asklepios

2008-08-21T12:49:00.000-04:00

The Canadian Medical Association (CMA) will be presenting Asklepios at an opening talk at the Medicine 2.0 conference in Toronto, on Sept 4th. Asklepios is described as a social networking site for Canadian physicians, medical students and residents in Canada, "which will be a very significant development for enabling the use of web 2.0 technologies by Canadian doctors (...) Asklepios is an online community that allows physicians to make new contacts, get advice from colleagues, and collaborate with physicians all over the country.". The talk at Medicine 2.0 presents an early first look at Asklepios.

Medicine 2.0 Final Program

2008-08-20T09:00:00.000-04:00

Excitement for the Medicine 2.0 conference on September 4/5th in Toronto (only a bit more than 2 weeks away!) continues to build, and the program schedule looks exciting indeed - very international and more academic than other health 2.0 conferences, as John Sharp noted. I look forward to it!

Note that there is also a social network of people interested in Medicine 2.0 emerging, which is open to those who cannot attend this year.

Medical Blogging - don't do it?

2008-08-20T07:18:00.000-04:00

The CMAJ has published a provocative and thought-provoking piece on medical blogging [1]. I like the article, but not the title. Do it - but responsibly. I think / hope that some of these issues will be discussed at the Medicine 2.0 conference in Toronto. There will be a medical bloggers panel at the conference

The idea of developing guidelines is interesting, though a Medical Bloggers Code already exists [2].

Reference

1. Mark Otto Baerlocher, MD and Allan S. Detsky, MD.
Online medical blogging: don't do it!
CMAJ 2008; 179: 292 doi:10.1503/cmaj.080757.

2. Healthcare Blogger Code of Ethics. http://medbloggercode.com/the-code/. Accessed: 2008-08-20. (Archived by WebCite® at http://www.webcitation.org/5aDEkONrK)