24 February 1999 Rev. 20 March 2000
1,000 words

Lundberg editor-in-chief of Medscape;
"opinion leaders" cover medical meetings,
peer review "on the spot"

NEW YORK--Medscape has hired George Lundberg as Editor-in-Chief.

Lundberg chose Medscape (of 15 job offers) for the opportunity to provide medical information on the Internet to practicing physicians and to the public. "We can offer speed to publication without sacrificing quality," he said. "We can attract peer review."

"I believe Medscape will be the brand name people will trust for Internet information," said Lundberg, at a press conference at the New York Academy of Sciences on 24 February 1999.

Instead of having journalists cover presentations at medical meetings, Medscape sends doctors who are "opinion leaders," to write reports, said Lundberg. "We want the best physicians to peer review on the spot, and report to the Medscape audience the next day." This information would not otherwise have been submitted to medical journals for publication for 6 months or more, he said.

Medscape will deliver "clinically useful information to physicians in their day-to-day practice," said Lundberg, "and for patients in their interaction with physicians."

Medscape will not compete with the "big 4" (JAMA, the NEJM, The Lancet and the British Medical Journal), because it will be clinically oriented. Medscape is not publishing primary results of medical research, although, said Lundberg, "I believe it will happen."

"Articles do not change opinion," said Lundberg. "Opinion leaders change opinion." So by giving physicians assessments by opinion leaders on the Internet, "they can change physician behavior much faster."

Ingelfinger rule

Medscape's reporting will not conflict with the Ingelfinger rule, "as long as these meetings are open," said Lundberg, in response to a question by Janice Hopkins Tanne (who has been covering the Lundberg story for the BMJ).

"The Ingelfinger rule is not supposed to be applied to regular presentations" where scientists present their work openly to their colleagues. "We're not writing about the whole paper, the methods and results, the tables." The average doctor isn't interested in that anyway. The "print" journals are becoming archival, and places for researchers to talk to other researchers.

Lundberg would argue that it would be against the "public interest" to deny Medscape access to open medical meetings.

Guarantees from Medscape

Lundberg joined Medscape because (1) It was the first medical site on the Internet (2) It has the largest audience (3) It has always followed the highest ethical standards (4) The potential audience of physicians, other medical professionals and patients (5) The small group of top officers with whom "I can work with and communicate" (6) "The excellent assemblage of the right people at the right time to share medical information."

Paul Sheils, JD, president and CEO of Medscape, developed the Wall Street Journal Interactive Edition. EVP Jeffrey Drezner, MD, PhD, a psychiatrist and psychoanalyst, joined Medscape when Medscape acquired an HIV and oncology Internet information company he founded. Peter Frishauf, chairman of the executive committee, covered student protests for UPI and the New York Times during "the war-torn 1960s." Frishauf graduated Columbia J-school and is a member of NASW. Lundberg, a pathologist, was a Lieutenant Colonel in the U.S. Army during the Vietnam war, a war, he often says, "I didn't like very much." (Dermatologist E. Ratcliffe Anderson, MD, the AMA EVP who fired Lundberg, was an jet fighter pilot and Lieutenant General in the Air Force during the Vietnam war.)

Editorial integrity and firing

In response to a question from Mark Bloom of Physicians' Weekly, Lundberg said that he was guaranteed absolute editorial integrity by Sheils, "as part of my contract" and a "trust relationship." (PW has an article, "Off with his Head," on the Lundberg firing, and several stories about Lundberg and Anderson in its searchable database).

Regarding ethics of medical information on the Internet, Lundberg cited his editorials, "Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet, Caveant Lector et Viewor--Let the Reader and Viewer Beware, 16 April 1997, and Policies for Posting Biomedical Journal Information on the Internet, 11 June 1997, and also coverage in the BMJ.

[Note: These links no longer work. When Lundberg was editor, these articles were available free on the Internet, along with several other important stories and regular features from JAMA, but soon after he left, the material older than 1999 was removed, and beginning 1 April 2000, JAMA's full-text articles will only be avaiable to paid subscribers.]

On his firing from JAMA, "I cannot and shall not comment" said Lundberg. "My great legacy was the quality of the staff," and I have reasonable confidence that this will continue." He remains a member of the AMA and pays his dues, "which is a lot of money," but "I have no official relationship with the Journal."

A press release and background information is on Medscape's web site. The press conference is cybercast, and can be heard on the web for at least 90 days.

Esther Dyson: Chunky and timely

Esther Dyson, a Medscape board member, was there. I asked her how Medscape fits into the trends in medical information on the Internet.

Medscape is "getting more personalized," said Dyson. It was "very dry." It will have more "opinions that are labeled as opinion and backed up by fact." There are a lot of "quirky" one-man shows on the Internet. "Personality with substance is what we look for. The trash on the Internet is still going to be there."

The information that is best-suited to the Internet, said Dyson, is "chunky" (in small pieces) and timely. People will not read a long article on the Internet; they will download it, she said. She distributes her own $700/year newsletter, Release 1.0, in print, because it contains long essays, and because it's not timely. (But some content, including abstracts, selected issues and a calendar of events, is free on the web.)

--Norman Bauman