As we enter the new millennium, peer-reviewed publications
face a number of important issues. These include the rising cost
and decreased rate of subscriptions for traditional print journals.
Importantly, the development of the Internet has created additional
challenges and potential. The Internet can markedly improve the
efficiency and content of scientific presentations. Papers can be
published more quickly and can include a variety of supplementary
material, including videos and original data. Links can be created
to other sites, enhancing the presentation and developing the contextual
importance of the work. However, there are a number of challenges
to be faced in the transition to Internet publishing. Among these
challenges are the public perceptions and expectations regarding
the transfer of information on the Internet. There is the perception
that information should be free. However, there are costs associated
with the peer-review process and with the infrastructure of computer
and customer support that are necessary in electronic publishing.
Currently, revenue to support journals is derived from subscription
charges and advertising. While these will continue to be the major
sources of revenue in Internet publishing, the paradigm for obtaining
these revenues will change. Wide accessibility to electronic libraries
from virtually any site eliminates the need for individual subscriptions.
Publishers are also currently confronting issues regarding the interplay
of peer-reviewed articles and advertisements. Advertising
revenue is enhanced when placed in more obvious positions within
a journal, but the integrity of the peer-review process depends
upon avoidance of a conflict of interest that may be posed by intermixing
scientific information and advertising. The American Medical Association
has created guidelines for Internet advertising which dissociates
advertisements from scientific content. Another important issue
is the privacy and confidentiality of the viewer.
Current journals face the threat posed by non-traditional,
non-peer-reviewed Internet publications. In these publications,
authors may prepare and post manuscripts at low cost. However, the
value added by the peer-review process creates optimism that this
form of publication will continue in the electronic medium and will
be an important mechanism for verifying validity amidst an overwhelming
amount of medical information.
Table 1: American Medical Association Guidelines for Electronic
Publishing
I. Principles for Content:
A. The ownership of the Web sites including affiliations, significant
investors, and strategic alliances should be clearly indicated.
Ownership of copyright must be clearly indicated on all items.
B. Information about restrictions on access to content, required
registration, password protection, mechanism of payment, and preservation
of privacy and confidentiality should be provided.
C. Funding or sponsorship for any content should be clearly indicated
and comply with the principles for advertising and sponsorship as
outlined in Section II.
D. Guidelines for editorial content are provided covering the
mechanisms of review, date of posting, revision, updating, timeliness,
and source of editorial content.
E. Standards for intra-site linking, navigation, exploration
of content, and downloading files are provided.
II. Principles for advertising and sponsorship
These principles were revised from "Principles Governing
Advertising in Publications of the American Medical Association"1. General principles for maintaining
the highest ethical standards in advertising and for establishing
the eligibility of advertisers on AMA web sites included those listed
below.
A. The appearance of an advertisement on an AMA web site infers
no endorsement by the AMA.
B. An advertisement on an AMA web site shall not be referred
to in collateral advertising.
C. Advertisements must not interfere with the mission or objectives
of the AMA or of its publications.
D. Decisions to sell advertising space are to be made completely
independent of specific scientific content; for example, advertising
sales representatives are to have no prior knowledge of specific
content before it is published.
E. Placement of advertising adjacent to content on the same topic
is prohibited. For example, banner advertisements must not appear
next to the title of a related article.
F. Viewers will not be required to view advertising materials
in the process of reading scientific content. Viewers will not be
sent to commercial web sites unless they choose to do so by clicking
on an advertisement.
G. The AMA reserves at its sole discretion the right to decline
any advertising or to discontinue previous advertising.
III. Principles for Privacy and Confidentiality
A brief summary of the AMA commitment to maintain web site visitors’ rights
to privacy and confidentiality includes the following.
A. The privacy policy of the web site should be published and
easily accessible to the user, and the web site must adhere to the
privacy principles that are posted.
B. Third parties that post or link to advertisements on the Journal’s
web site must adhere to the Journal’s web site privacy
policies.
C. Personal information, including e-mail addresses,
must not be collected unless voluntarily provided by the web site
visitor who is informed about the potential use of such information.
This must be explicit and clear.
D. Information about a site visitor’s access and navigation
of the web site may be used by the site owner to improve the site
but cannot be shared with other parties without the site visitor’s
express permission.
E. The AMA will not collect and will not allow third parties
to collect personal medical information from users without the express,
fully-informed consent of the site visitor.
F. Market research conducted by the web site or its agent should
be clearly identified as such.
G. Guidelines to ensure confidentiality of patients’ private
medical information as used in AMA publications and web sites are
covered in detail and do not differ in any great measure from those
used for many years for its hardcopy publications.