In Summer 2008, Google launched Knol, immediately branded as Google’s answer to Wikipedia. This article focus on how Knol – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it.
Enter the issue of money, probably the most controversial aspect of Knol. Authors can, at their discretion, choose to allow Google to post ads on their Knols (using Google’s AdSense service). If they do, the authors receive a share of the revenue stream. How much? Nobody outside the Googleplex knows for sure, but the overall revenue will be determined by search popularity and position. So, the thinking goes, experts have an incentive to write terrific Knols and keep them updated in order to maximize their ad revenue.
The Blogosphere is again atwitter with discussion of Knol (for example, see here, here, and here) – much of the discussion surrounding whether Knol is a Wikipedia Killer. Wikipedia, run by a foundation with authors writing presumably for the Good of Mankind (authors and editors are not compensated), is generally characterized as the White Hat in these comparisons. Some observers, though, note that certain Wikipedia entries show clear (but untraceable) corporate influences or other biases, biases that would presumably be more transparent on Knol because of the defined authorship. Most of the reviews of Knol have been pretty positive, and the general sense is that there is probably room for both Knol and Wikipedia to do well. The Internet is a big place.
The challenge to medical journals
With that as background, let’s examine how Knol – and other forms of electronic self-publishing such as blogs – may disrupt the traditional world of medical publication .
The disruptive impact of the Internet on the publishing businesses is well appreciated. Newspapers are dying on the vine, venerable textbook publishers are reeling under the competitive pressure of new web-based resources, and most journals have scrambled to make their content available online. But, even as they accommodated the changing preferences of readers, traditional print journals and textbooks (in health care, at least) have not yet been rocked by competition for content. I believe that this is about to change.
Until recently, if I or another author had a research study or a thought piece we wished to disseminate widely, our only avenue was a traditional medical journal. The act of submission required that we relinquish ownership of the intellectual content to the journal’s publisher. For instance, here’s JAMA’s copyright waiver:
“In consideration of the action of the American Medical Association (AMA) in reviewing and editing this submission… I hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the AMA, in the event that such work is published by the AMA. …”
That authors voluntarily signed away their intellectual content is remarkable. Think about it: many researchers spend hundreds, even thousands, of hours creating a “product,” and then hand it to a third party without compensation. (Of course, substantial amounts of research have been funded by tax dollars, with its implied obligation to pursue publication.) In exchange, journals agree to perform peer-review, which – in the case of major journals like the New England Journal and JAMA, with acceptance rates similar to Princeton’s – is likely to end in rejection after a 1-3 month review process. After a few spin cycles (submission, review, rejection, submission elsewhere, review, revision, re-submission…), most articles are accepted – somewhere – and published 4-12 months after that .
Major journals have been thrilled by this arrangement, which led to two salutary economic outcomes. First, individuals and libraries paid good money to subscribe, largely to read and offer this highly vetted content. Second, advertisers, desperate to reach the journals’ large and important audiences, paid premium ad rates. This virtuous cycle (from the publisher’s standpoint) hinged on the willingness of authors to submit content without seeking remuneration.
Why did authors play ball? Because publication in a prominent journal was, and remains, the coin of the academic realm – the ticket to promotion, grants, consulting agreements, and recognition. In other words, authors voluntarily handed over their intellectual property as a loss leader, largely to establish their “brand.” (I don’t discount the importance of altruism in many researchers’ decision-making, but doubt that it, in isolation, would have generated the historical dynamic). So all academics learned to play on this particular field, since it hosted the only game in town.
The JourKnol Alternative
But Knol allows authors to post text, pictures, videos, and more, all without breaking a technological sweat or employing a teenager. The author simply creates the content, loads it in, and clicks “Publish” – no peer review, no rejection, no delay, and no relinquishing copyright. And, from the moment they publish their Knol, authors can at least partly realize the monetary value of their content through the advertisement option. Knol can well be a web-enabled biomedical knowledge platform.
But won’t traditional journal publishing remain the coin of the academic realm, notwithstanding these new dissemination pathways, because of the perceived value of peer review? For now, sure, but we may also witness the democratization of peer review, since readers can comment on and rate Knols. And, rather than looking at a journal’s “Impact Factor” as a proxy for the impact of an article, this blog tracks and reports the number of views of each entry; Knol might ultimately do the same, but for now I can estimate how widely read and linked a Knol is by where it comes up in a Google Search. There is under development an alternative value for measuring the Knol impact factor 
In other words, traditional journals’ enviable position as the sole arbiters of the quality and impact of an author’s work may be challenged by web-derived measures of the impact of individual “articles,” such as number of hits, number of links, and reader ratings and comments.
Are you skeptical? And you should be. Having an article peer reviewed by 3 experts is different than having 17 Joe Six-packs (or, if I really crave positive feedback, family members) give it a thumbs up on Knol. Udi Manber, Google’s Director of Search Engineering and the brains behind Knol says “Yeah, not all reviews are equal. But we could also rank the reviewers.” How? Lots of ways. For example, reviewers could be ranked by their number of published articles, multiplied by the impact factor of the journals their articles were published in, all determined by an instant PubMed search. Or by the number of visits to their Knols. The head begins to spin with the possibilities.
The point is this: peer review, that most sacred of academic rituals, might ultimately be replaced by real-time rankings by experts and, if you buy the Wisdom of Crowds thing, the masses. Manuscripts might be improved not by month-long editor-mediated back-and-forths between anonymous peer reviewers and authors, but by Wiki-like suggestions directly from readers to authors. And the impact of a work might be determined not by whether it was published in a widely read and cited journal, but by whether the piece itself was widely read, cited, and linked .
Is this progress? May be yes, may be no. Traditional system has generally served us well, and has set a high bar for the quality of published content (at least in the major journals). But, as in other areas in which the Internet is democratizing and transforming commercial relationships (online brokerages or travel sites, for example), Knols and blogs are demonstrating that the technology now exists to “dis-intermediate” the publishing of medical research. With that, traditional journals may need to compete – and not only against other journals – for both readers and authors. Journals may find that they need to begin to compensate authors for their articles, allow authors to retain copyright, or employ other previously unthinkable strategies to remain the preferred choice for authors’ best work. Changing a well stablished system is one of the most difficult plans:
But how about tomorrow and next year? Like all aspects of the Internet, if faculty, universities, and journals want to preserve the magic of the prior system of peer-reviewed publishing, they will need to adapt and lead in this new world, not just hope that they can hold onto their prior business model in the face of these staggering technological changes. Now in Knol there are an alternative options for publishing in books and journal open access free of charge. For instance JourKnols combining the pros of Knol and academic publishing. (Open Journal of Medicine, The Collaborative Books Project: Healthcare and Medicine Series)  .