‘We need more voices in the room’

What in your career and personal life attracted you to the editor-in-chief position?

I’m a general internist, and I’ve been a professor at the University of California, San Francisco in the department of medicine and the department of epidemiology and biostatistics. I’ve been doing that most of my professional life.

I have long sought to be published in JAMA, but really hadn’t had any experience working on the other side as an editor. But I have come to appreciate the importance of how we communicate about our science, and how doing that well can have an influence on how we practice medicine, how we design health policy and how we influence public health. It’s an extraordinary time to think about communication, and I feel really honored to have this role.

You replace Dr. Howard Bauchner, who stepped down in 2021 after JAMA aired a podcast and posted a tweet questioning the existence of structural racism in medicine. How do you plan to address what many say is structural racism embedded within scientific journals?

Every institution in our society, and certainly all our institutions in science and medicine, have started to reckon with the fact that these deeply ingrained biases affect the conduct of science, affect the care we provide to our patients, affect a lot of things.

The issues that JAMA faced are not specific to JAMA. These are true across scientific publishing. They are things we struggle with in academic institutions, and certainly in the conduct of healthcare.

The opportunity to think with real deliberation about how we structure our editorial boards, who works for us, who are part of our reviewers, who we ask for opinion pieces from, who sits on our editorial boards, is really critical. Who’s in the room matters. Who’s making a decision matters. What we want to be doing is making sure that we always attract the best science, always have the right voices, that reflect the breadth of views on important issues in science and medicine.

Are there any changes you’ve made that highlight new or different voices that you’re exceptionally proud of?

We host a big Peer Review Congress every four years, bringing together scientific journals from around the world. One of the most exciting talks there was how we collect data about the demographics of who makes up editorial boards and peer reviewers, so that we can ensure over time that we’re really reaching our goals to be an inclusive and equitable environment in scientific publishing. We look forward to continuing to work on that.

Across JAMA and the JAMA Network, we have hired deputy editors in all our journals who have a specific focus on and expertise in areas of equity, diversity and inclusion. It’s great to

see them coming together to think about how to continue to shape our journal.

How can journals work to build trust with their audience amid misinformation among patients and consumers?

We’re proud of what we publish in JAMA. Across the network, we publish explainer videos to try to reach lay audiences. But [targeting] the strains of sources of misinformation, and more targeted sources of deliberate disinformation, really is challenging.

We’re constantly being bombarded with information from places that we trust, but also from a lot of other places. It’s critical to sort through it to understand, “Well, how should I, as a patient, how should

I, as a clinician, make a decision?” Especially because there are so many sources of misinformation, and then a few strains of very deliberate focuses of disinformation.

In the pandemic, these issues that have always been there became magnified, and oftentimes more highly polarized.

Our job as a journal is to make sure that we have high integrity in our process for deciding what science to publish, but then to also think about all the ways we can disseminate our findings and influence as broad an audience as possible.

One thing I’ve learned over the years is that you’re never just communicating to the group you think is your core audience. You’re always communicating to a much broader audience. Keeping that in mind is critical.

You’ll see us continuing to communicate to a broad audience, including patients, a lay audience, policymakers and the general public, but you’ll see us doing it in a way that recognizes there are other, oftentimes competing sources, and sometimes deliberate sources of disinformation. We’ll probably be amplifying our voice a little bit louder than we have in the past.

When publishing scientific research to the highest degree of integrity, how do you measure the impact of a health equity initiative?

My primary way of being in the world is as a scientist.

We do have places that have been doing this for a while, that have thought about the metrics, that have thought about the measurements over time and that recognize this work has to be done in partnerships with the communities and patients that are most affected in order to have the greatest impact.

We don’t just want to adopt the latest health equity initiative. We want to learn from groups and organizations that have been doing this for a while. We want to work in partnership with others in the communities that have been most affected by the issues related to inequities in health.

We want to be deliberate in our measurement to understand what is working, and how we can tweak things and design things better.

As a journal that publishes rigorous science that is deeply rooted in health equity, we do want to be publishing those initiatives so that the broader healthcare community can understand what initiatives work. These issues are urgent, but they do need to be done well, and learning from how others are doing them is really important.

In your first editorial for the JAMA Network, you mentioned the need to guard against threats of insularity and parochialism. What did you mean by that?

We each have our own expertise, and we have our own experience. But all of us have to guard against thinking that experience represents the entire universe of patient experience, or of a scientific approach to a problem, or the way one designs a healthcare intervention.

I am a firm believer that we need more voices in the room, particularly to address the most challenging issues that face medicine, that face science, that face health in general. We need to really understand people who have different experiences from our own, in order to think about the design of the best intervention, or when evaluating a scientific article.

We have to approach everything with a little bit of humility. When we’re designing systems, or we’re designing big journals, we want to make sure that we have many voices at the table to really understand how to do this best. ■

“You’re never just communicating to the group you think is your core audience. You’re always communicating to a much broader audience.”