The Debut of Viewpoints and Other New Developments at JAMA

Journals contribute to the discourse about the enterprise of medicine, including clinical care, education, research, and policy. With this issue of JAMA, we are pleased to introduce a new feature—Viewpoints—the opinions of leading scholars. Viewpoints, which are replacing Commentaries, will be featured at the beginning of the journal, at the top of the table of contents, so they will be hard to miss.

Over the past few months, we have been in contact with numerous thought leaders—individuals who have written insightfully, thoughtfully, and provocatively about various aspects of medicine. These distinguished writers in turn suggested other individuals whom they thought had important views about health, health care, and health care delivery. As a result, many new Contributing Writers have been added, and many previous contributors to JAMA have been retained (Box). The goal is to publish thought-provoking, timely Viewpoints in each issue of JAMA, with some articles in response to a specific contemporary issue, others that reflect the Viewpoint writer's thoughts about a topic, and some that will be solicited from this group and published promptly when an important problem arises.

This issue of JAMA includes 4 articles from JAMA Contributing Writers that provide insights about several key topics in medicine and health policy. John P. A. Ioannidis, MD, DSc, and colleagues (Vinay Prasad, MD, and Adam Cifu, MD) point out that change occurs in medicine continually, reflecting new evidence, and a certain amount of reversal of established medical practices is inevitable, but the rate of abandonment of ineffective practices is slow.¹ Ezekiel J. Emanuel, MD, PhD, discusses the need to control the growth in US health care expenditures and identifies commonly targeted areas that represent false cost controls and highlights other major areas that may achieve real cost savings.² Robert H. Brook, MD, ScD, discusses the new era in US health care being ushered in with implementation of the Affordable Care Act, and delineates key metrics to measure and monitor to determine both anticipated and unanticipated effects of the new law on the health of the US population.³ Elliott S. Fisher, MD, MPH, and colleagues (Jonathan Skinner, PhD, and James Weinstein, DO, MS) suggest a “withhold” approach to slowing the growth in Medicare spending that may achieve savings while allowing motivated clinicians and health care organizations to recover the proposed financial cuts and thus maintain or even increase their reimbursement.⁴

In addition to articles from the JAMA Contributing Writers, we also encourage other authors to continue to submit manuscripts on virtually any topic relevant to medicine, health care, or health care policy for consideration for publication in the Viewpoints section. Details about writing and preparing Viewpoints manuscripts are available in JAMA 's Instructions for Authors.⁵

Other changes and new developments have come to JAMA and more are planned. We seek the best content through ongoing and regular contact with leading researchers around the world. Last year, we attended many important research meetings in the United States and Europe and will continue to do so in 2012. The print table of contents has been redesigned. Much of the key content—Research articles, Viewpoints, Editorials, Clinician's Corner, and Review articles will now appear on a single page. New article types—such as the JAMA Clinical Challenge—were introduced last year⁶ and more are planned. Clinician's Corner will continue in an expanded mode. We anticipate that each week there will be a review article, for example, Clinical Review, The Rational Clinical Examination, Clinical Crossroads, Grand Rounds, or Care of the Aging Patient, as well as a brief clinical article or tutorial. The JAMA Clinical Challenge will become a mainstay of Clinician's Corner. Other brief article types are under development, including tutorials about research methods and statistics that are geared for clinicians. The news@JAMA blog (available at http://newsatjama.jama.com) debuted early last year. Please sign up for this service, so each afternoon you will receive a brief news story about an important health care issue that broke in the last 24 hours. Shortly, we will be introducing our electronic table of contents and abstracts in various languages—our goal is to reach a far broader audience that will allow readers to scan our content before deciding which articles to read in their entirety.

Medicine is a complex balance of art and science, narrative and evidence, and uncertainty and certainty. Even in an evidence-based world, narratives make an important contribution to health. Our long-running feature A Piece of My Mind will find more prominence in JAMA, immediately following Viewpoints. In addition, another familiar feature of JAMA —the cover and the fine art that has graced it for the past 50 years—is undergoing some tweaking. For instance, a medical illustration appeared on the cover of the November 16, 2011, cardiovascular disease theme issue,⁷ and another illustration appears on the cover of this issue. As mentioned in the description about the cover of the November 16 issue, the use of a medical illustration on the cover is a return to the type of work that appeared on numerous covers in the 1970s and 1980s. We have rediscovered a rich tradition of the past.

Technology is contributing to many of our new developments, and we are using it to assist in improving communication. The number of podcasts has doubled, a weekly video interview with an author of a research article was introduced in August, weekly author audio interviews are now available, a smartphone application is coming soon, and quick response (QR) codes were introduced to help readers gain access to some of JAMA 's multimedia content, including author video and author interviews.

Two other major changes are forthcoming—development of a new Web site for JAMA is under way and a print redesign will follow. Why these changes? Our goal is to serve the interests of our broad readership—clinicians, researchers, patients, and other stakeholders. We seek the best content and want to use technology to present it in creative and engaging formats. We look forward to hearing from you about these new developments and new initiatives at JAMA.