BMC Medicine: a decade of open access medical research

On 24 November 2003, BMC Medicine published its first article. Ten years and over 900 articles later we look back at some of the most notable milestones for the journal and discuss advances and innovations in medicine over the last decade. Our editorial board members, Leslie Biesecker, Thomas Powles, Chris Del Mar, Robert Snow and David Moher, also comment on the changes they expect to see in their fields over the coming years.

Just a few months after the Human Genome Project was declared complete [1] BMC Medicine was launched as an open access [2,3], open peer review journal (i.e. where signed peer review reports are published with the article) [4,5], with the aim of making high impact clinical peer-reviewed research of general interest, accessible to everyone from the basic scientist to the practicing clinician. The journal, initially under the direction of Pritpal Tamber and then Melissa Norton as Editor-in-Chief, was launched amidst a raging debate about the viability of open access publishing [6]. But open access survived and evolved [7,8], and BMC Medicine now ranks 8 th out of 155 journals in the 2012 general and internal medical journals category of the Journal Citation Reports [9].
While mainly focused on primary research in its early days, the journal responded to the needs and demands of its readers and contributors by providing, for example, a platform for discussing controversies in medical practice [10][11][12][13][14][15] and embracing social networking technology to promote open scientific discussion and debate [16][17][18][19]. Although proud of its Impact Factor (IF) of 6.68, BMC Medicine recognizes that the IF is a restrictive metric that does not fully reflect the influence of individual articles post-publication. The journal therefore provides informative article metrics which are immediately available on published articlesa feature which has proven to be popular with many of our authors [20].
Of course, innovations in publishing and technical advances notwithstanding, BMC Medicine owes its success to the scientific contributions made by its authors, reviewers and expert editorial board members. To celebrate its 10 th anniversary, we recently reviewed some of our most successful articles in terms of accesses [21], citations [22] and 'impact' in news and social media [23], and also summarized author and reviewer experiences [24] and explored our author demographics [25]. As a general medical journal with a very broad scope, it is not possible for us to cover all the main advances in medicine featured in the journal over the last decade, but in this editorial we present a selection of our favorite recent content, together with predictions by our editorial board members on possible future directions for their respective fields of research.
Translational medicine: how far have we come with stem cells, biomarkers and 'Omics' research?
Stem cell research and therapy has advanced rapidly in the last decade, and clinical trials for a wide range of diseases are already underway [26,27]. In 2012, the journal published an intriguing study by Zhao and colleagues, who used Stem Cell Educator therapy to safely reverse Type 1 diabetes. The researchers used stem cells from cord blood to 're-educate' T cells in patients with Type 1 diabetes, thereby restoring pancreatic function and reducing the need for insulin [28]. These compelling results highlight how stem cell therapies may become part of mainstream treatment for many diseases.
Within the last 10 years, major advances have also been made in biomarker research and 'Omics' studies in a preclinical setting. Advances in whole genome sequencing have allowed the identification of genes involved in a large number of diseases, and biomarkers that indicate disease severity or susceptibility to treatment are increasingly being characterized [29][30][31][32]. As Leslie Biesecker points out (Box 1), clinical exome and genome sequencing are already being used in the clinic for diagnostic and prognostic purposes. However, Biesecker also indicates that these new technologies are not without problems and alludes to the role the journal plays in ensuring the latest research is appropriately validated and disseminated.
Despite the discovery of many biomarkers for cancer in particular, so far very few have been used within the clinical setting [33], which is partly due to a lack of consistency and clarity in the reporting of prognostic tumor markers. This prompted the development of the Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK) checklist [34], which was updated in 2012 by Altman and colleagues [35] and more recently, the development of criteria to address the lack of scientific rigor when evaluating preclinical evidence to support translation of omics-based predictors to clinical trials [36,37].
The continued identification of new genes and biomarkers specific to disease subtypes and individual patients is essential for translation into personalized medicine, in terms of estimating both disease risk and response to therapy. As highlighted above, the field which has seen the most progress in this area is clinical oncology, and Thomas Powles explains what further changes are required to achieve effective personalized cancer therapies (Box 2).

Evidence-based medicine: education, communication and collaboration
There has been increasing international focus on public health initiatives, development of healthcare policies and evidence-based guidelines to improve medical practice [38,39]. This is embedded in effective education strategies, which is evident from a continuing medical education intervention aimed at strengthening links between evidence-based and values-based medicine in healthcare personnel [40]. Researchers found this intervention led to improved values, such as openness to change, which are essential for improving medical care.  A collaborative international approach is required to achieve these goals.
Chris Del Mar (Box 3) recommends that going forward a more collaborative approach to decision-making between clinicians, patients and policy makers needs to be developed, and highlights the importance of transparency and communication.
There is also increasing focus on involving researchers based in low-to-middle income countries as principal investigators in local research projects. This is especially important as local knowledge helps to ask the 'right' questions in health research, ensures the best available evidence is accumulated and that all ethical aspects have been considered [41][42][43]. This is vital to guide healthcare policies and identify new tools and strategies; the consequences of not doing so is evident from a recent bibliometric analysis of childhood immunization research output from Africa. Since the onset of the Expanded Program on Immunization in 1974, vaccine research productivity in Africa has skewed toward those funded privately, with minimal research input from African authors, suggesting a need for better communication among all stakeholders [44]. Robert Snow points out (Box 4), conditions for research are now improving in Africa, and it is important that local researchers and governments work closely to drive the research output from these regions forward.

Enhancing research with reporting guidelines
Without clear guidelines for conducting and analyzing medical research, there is a limit to how far medicine can progress, and the last few years have seen many important improvements in reporting standards. In 2010, BMC Medicine co-published the updated CONSORT (CONsolidated Standards of Reporting Trials) statement by Schulz and colleagues [45]. This statement guides authors on the reporting of two-parallel design randomized controlled trials by using a checklist and flow diagram based on the latest methodological evidence. More recently, in response to the particular challenges in reporting economic evaluations of health interventions, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was published [46]. This statement consolidates existing guidelines with the aim of providing more 'user-friendly' guidance for researchers and editors.
As research methods become more sophisticated, so too do the methods via which literature analysis can be conducted. The 'RAMESES' (Realist and Meta-review Evidence Synthesis: Evolving Standards) statement [47,48] was published to provide researchers, institutes and journals with guidance on how to conduct these new forms of literature analysis, and adherence to the guidelines will lead to quality assurance and uniform reporting of studies.

Chris Del Mar
Bond University Gold Coast, Australia Medicine will enter a new phase of concern about decreasing gains for increasing harms -including not just cost but also over-diagnosis and over-treatment. The medical profession has not been able hitherto to demonstrate an ability to make such cost-benefit decisions sensibly alone, and therefore there will be increasing input from society; increased demand for shared decision-making with the patient; and more directives from government. One important element of quality will soon be considered to be the extent to which the clinician has explicitly, clearly and carefully communicated the evidence in such a way that every patient is in a position to express a preference for the range of management options available. Evidence-based medicine will no longer be some hidden activity that clinicians may (or may not) engage in: it will become the currency expected for patient-clinician communication. Ensuring consistency is a challenging task, and David Moher explains (Box 5) that journals and editors play a key role in providing peer reviewers and authors with the tools and guidance to ensure that medical research is appropriately reported.
We hope you have enjoyed our selection of just some of the most exciting content from BMC Medicine, and hope this has prompted you to seek out favorites of your own.
As an open access general medical journal, we aim to promote better informed clinical decisions and improved therapies. We will continue to publish content that has the potential to improve clinical practice, research and reporting. We especially encourage debate on health related issues not just within the clinical community, but also for the general public who should be, after all, the primary beneficiaries of the research.