In this episode of The Future of Medicine, we welcome Kirsten Bibbins-Domingo, PhD, MD, MAS, physician, epidemiologist, and Editor-in-Chief of JAMA, whose work sits at the center of how today’s most influential medical research is evaluated, communicated, and translated into practice.
Dr. Bibbins-Domingo takes us inside the high-stakes world of scientific publishing, exploring how editors weigh evidence, interpret peer review, and decide when research is strong enough to move the field forward. She explains why “no scientific study is perfect,” and what that reality means for clinicians, researchers, and the public.
In this conversation, Dr. Bibbins-Domingo reflects on her journey from basic science to population health and editorial leadership. She discusses how journals are adapting in an era of information overload and AI, why context and communication matter more than ever, and how scientific editors think about balancing rigor, risk, and real-world impact.
Looking ahead, Dr. Bibbins-Domingo shares her perspective on the future of medical publishing, and why reaching people where they are will be essential to maintaining trust in science and advancing patient care.
As part of our ongoing series from Stanford’s Department of Medicine, bringing together leaders shaping the future of healthcare, this episode offers a thoughtful, behind-the-scenes look at how medical evidence moves from manuscript to medicine.
The Intro
“No scientific study is perfect, and our job is not to make the study perfect.”
Dr. Kirsten Bibbins-Domingo is a physician, epidemiologist, and editor-in-chief of the Journal of the American Medical Association.
“We have to be better at reaching people.”
A longtime leader in health equity and prevention, her work has shaped how we think about the social and structural forces that drive health outcomes today.
"You should learn the place that you're in."
In our conversation, she talks about the changing role of medical journals, amplifying diverse voices in science, and what it means to lead at the intersection of medicine and society.
Welcome to Stanford Department of Medicine's inside look at The Future of Medicine.
The Transcript
Dr. Euan Ashley: Kirsten, welcome to Stanford.
Dr. Kirsten Bibbins-Domingo: Thank you so much. It's great to be here.
Dr. Ashley: Yeah, it's so nice to have you and joining us on the future of medicine. That's, yes, what we like to focus on here. And I can't think of anyone who can give us a better angle on that than you, since you see so much of what is hoping to be the future of medicine come across your desk. But before we get to your current role, I would love to hear a little bit about your background. I love people's stories, and I understand that you grew up in a military family and you were born in Germany. Is that right?
Dr. Bibbins-Domingo: Yes, that's right. Tell me a little bit about that and how it's shaped where you are today. Sure. So that's exactly right. You did your homework. So yeah, my mother is actually German, and I was born in Germany, and my father was in the military, and we—so it means my childhood was one of growing up all over.
Dr. Ashley: Right? You moved from place to place.
Dr. Bibbins-Domingo: Exactly. And my mother was one of these people who always believed that you should learn the place that you're in. And so she learned Spanish and took us around when we were in South America. And so I think the way that shapes my childhood and my probably outlook now is I probably am very open to a lot of different ways to think about things. I'm very comfortable thinking sort of in a global environment, and I think I always look for sort of those commonalities. I try to move into a new situation and then try to look for the thing, how it relates to something else. So those are probably things that I realize now, in retrospect, probably stem from my childhood.
Dr. Ashley: Yeah. Yeah. You're comfortable in different environments or changing environments. So you mentioned Europe and South America. So I mean they're obviously very different, but you moved around a number of different places.
Dr. Bibbins-Domingo: Yes, we moved around all through the US, but yes, Europe and South and Central America were probably the most during my childhood. And then even now, my family—my mother, all of her relatives—were still in Germany. So we were very tied to going back to Germany. My husband is from Africa. My brother-in-law is from South America. So we have a very global family.
Dr. Ashley: Global family. Yeah. Yeah. Well, I think there's probably never been a more important time for us to understand better the world in a global way.
Dr. Bibbins-Domingo: I agree.
Dr. Ashley: And obviously your work touched on that. I didn't know this about you. One of the things I learned when I was reading was that your PhD is in kind of molecular biochemistry or molecular biology.
Dr. Bibbins-Domingo: Yes. So here's the story there. So when I was an undergrad at Princeton, I don't have doctors in my family. So when I was in undergrad at Princeton, the first few weeks of school, everyone was like, “Are you premed? Are you premed?” And I didn't really know what premed was, and I didn't really like them who were asking me. So my knee-jerk reaction was, “No, I'm definitely not premed if that's what you are.”
Dr. Ashley: I don't understand your question, but probably no is the answer.
Dr. Bibbins-Domingo: Right. Right. But I loved being in the lab, and I was in a great lab at Princeton. And I knew at UCSF there were many people who had left Princeton and started departments at UCSF. And so it was always my dream to go to UCSF, and I was really fortunate to be in Harold Varmus's lab during my PhD.
Dr. Ashley: Yeah. And a somewhat accomplished individual himself.
Dr. Bibbins-Domingo: Yes. Exactly. Exactly. And I loved it, and I really did love being in the lab. But I realized that you start to know over time, as I'm sure you have come to know, what types of questions suit you best, what really becomes more motivating. And for me, the application of the discoveries is more motivating, even though I love the rigor of the basic fundamental sciences. So towards the end of my PhD, I told Harold that I wanted to go to medical school, and then I decided to go to medical school.
Dr. Ashley: You found an answer to that question.
Dr. Bibbins-Domingo: Exactly. Yeah, exactly.
Dr. Ashley: One of the things—and then you—so maybe two, a couple of things there then. So UCSF had been something that was in your future. You'd had that in your sights from an early stage. How did that come about?
Dr. Bibbins-Domingo: Yeah, you know, several people—Bruce Alberts, Keith Yamamoto—had left Princeton to come and found the departments at UCSF. I mean, there's a tie there. And so I knew about UCSF, and I loved it when I came to visit. And then UCSF has been my home forever. I like to say that I have the best basic science training at UCSF, and then I went to medical school, and then I became a primary care doctor at UCSF. So as you know, I did internal medicine residency, primary care, and then I learned to do population sciences and clinical sciences. And so it is—I know there's that Stanford-UCSF rivalry a little bit—but for me, I love UCSF because it's very few places that you can have the best of all of those aspects of training and work. And so it's been wonderful. And I'm still a faculty member at UCSF. I'm on leave while I have this job at JAMA, but I still come back. I still show up in resident clinic a few times a month, and I have a small research group still at UCSF. Wonderful.
Dr. Ashley: And for the record, we love UCSF, too. Okay, good.
Dr. Bibbins-Domingo: And we love Stanford.
Dr. Ashley: No, it's a great, very gentle, friendly competition, but there are many ways we're so much more similar and lots of grants and other connections that bring us together and working together. And together we're so much more than the sum.
Dr. Bibbins-Domingo: I agree. And I have to say, having now the perspective at JAMA and seeing sort of the national, global perspective, you realize there is something really special about UCSF and Stanford and this area and what it means for both sciences and for innovation and especially as it relates to biomedicine.
Dr. Ashley: No, that's amazing, and I definitely want to get to that in just a moment. You mentioned this move from the more basic science to large-scale population science and epidemiology. I think you had a master's in advanced studies in clinical research. One of the things—and I play a little bit, I try, in both those worlds—but one of the things with the world of molecular biology, it's very easy to perturb systems and measure kind of a single thing or even measure multiple things, whereas with populations it's very hard to intervene at a population level. And so in the end, you, I think, were very attracted to the idea of population health or understanding populations. Can you put that in perspective for me? You'd said that felt more attractive to you than the lab work.
Dr. Bibbins-Domingo: It probably started with more interest in the application for the patient in clinic, right? So that's what it was for me first. It was like, well, how do I understand this molecular pathway and what it means for what I'm going to do for a patient? So the context was really the individual patient first. I mean, my drive to go to medical school was really about patient care, was taking care of patients. It's why it's been the hardest thing for me to completely let go of. But as a generalist, it puts you squarely in the prevention space. And I think it's hard to think about prevention from just the doctor's office. You have to think a little bit upstream, a little bit more. I mean, I've always had a little more focus on more marginalized populations. I practice at San Francisco General Hospital. And so there you start to really see how it's not just what's happening—the decision you make with the patient in the visit—but what happens when they go home and what other things are happening in the neighborhood. And so that's why you start thinking pretty quickly population-wide. So I would say that's the pathway, the sequence for me.
Dr. Ashley: The challenges, I think, are different. That's the deal.
Dr. Bibbins-Domingo: Absolutely. Absolutely. And we need more. And I have to say, the reason people often ask whether I regret my earlier training or whether—you know—and for me, the thing that stays with me is that I'm broadly curious about lots of types of science, which is definitely a nice feature to have as an editor. You're right. It's such an exciting time for discovery sciences and for the techniques in all these fields of science. And then being able to pull it all together, I think, for improving care for patients and for the health of the population, I think is what's really interesting right now.
Dr. Ashley: Yeah. No, I completely agree. And well, you've touched on this already, so I partly know the answer to this question, but let's start before we get into your current role and what it is—what drew you to it first? Because you were pretty happy and pretty successful.
Dr. Bibbins-Domingo: Yes.
Dr. Ashley: In your former role.
Dr. Bibbins-Domingo: Yes. Yeah, exactly. So I had a career at UCSF as a physician-scientist. I founded a research center at UCSF, and I became the chair of epidemiology and biostatistics.
Dr. Ashley: These are not small achievements.
Dr. Bibbins-Domingo: No. And I loved them, and I do love UCSF. I was a vice dean for population health and health equity at UCSF, and I had never been an editor. So I had never been an editor of any type—not a sort of editor, baby editor, guest editor.
Dr. Ashley: So you woke up one morning, you're like, the thing I need to be is an editor.
Dr. Bibbins-Domingo: Well, what I realized—I did like the leadership roles that I had. During COVID, I really appreciated the ability to—I worked a lot with the state department of public health and our city department of public health and across the UCs with how we can inform. And so it was a really interesting time to think of, well, what would it take to actually do this? And to be frank, I was looking for a leadership opportunity. I was appreciating the importance of science communication, which I always had. And I frankly—nobody likes to hear this—but I frankly applied for this job on a whim. And I thought it's not going to harm me because they're not going to like me and I'm not going to like them. And so, why not?
Dr. Ashley: Yeah. Yeah. And as it turns out, they liked you.
Dr. Bibbins-Domingo: And I sort of liked them. Well, I like the idea of what could it mean to really think about what journals do, because journals are this key institution that is essential for the dissemination of the science that we do. And we can't translate the science into better health without journals having some role in that. And then what could we think about how to do that better? How do we do it in a way that's responsive to the needs of authors and of readers? And so it was just an intriguing opportunity.
Dr. Ashley: Well, I think there's another really interesting thing about decision-making there, because especially as scientists—and doctors—but we're very analytical about.
Dr. Bibbins-Domingo: Absolutely.
Dr. Ashley: If we have a fault, we're probably too analytical. Absolutely. And I think there's another version of leadership or decision-making where you go with your gut a bit more. And I wonder if some of that was like, instead of overanalyzing it, just send in the application.
Dr. Bibbins-Domingo: Well, I do think there's a little of that. And I think probably as scientists we are analytical for sure, but I think the best people also have that intuition and that gut and sense of direction and willingness to take some risk, right? You can't overanalyze everything. And I was analytical. I made sure UCSF gave me a leave so I could come running back. I had to figure out, is JAMA positioned well? I think having had prior leadership roles, I probably understood myself as a leader as well—that I think I'm pretty good in a situation where I think I can bring something to the organization to make it better. I'm not good as a fixer-upper or cleaner-upper. But JAMA was in a very good position. It is a strong brand of a network of 13 journals. But I also thought that the perspective you bring as an author and as a reader are important perspectives to what you can bring to a journal to sort of think about what it means to be for the future. And so I figured I did have something, and if it didn't work out, I could go back.
Dr. Ashley: It seems like it turned out you did have rather big something. But I mean, the Journal of the American Medical Association is one of the most prestigious medical journals in the world, read all around the world. As you said, it's a stable of many more journals, not just the flagship journal. And so that amazing opportunity—but give us a sense of what this job is like. I mean, what do you actually do? What do your days look like?
Dr. Bibbins-Domingo: Good question, because that was my first thing, because of course I had never been an editor. And I'm a full-time editor, right? So I have to say my first few weeks on the job, it became clear to me that much of doing this job reminded me of when you're the attending on the wards, right? So lots is happening on the wards. There's a lot of work that has to get done to take care of patients. And as the attending, you are not doing every single thing. You're not repleting the K. You're definitely not doing— Exactly. Right. There's a lot of other things going on. Some things are automatic. There's a big team behind you. But ultimately, your decision, the tone you set for the team, and the decision you might make for a given patient—yours is the name on the bottom, right? And that's how I felt with this. So we have a nice team in Chicago. We have about 115 people in editorial and about 120 people in publishing. We're independently published. We don't have a commercial publisher. All my publishers sit right next door to me. And we have a team, and there's a whole process for every single thing—how a paper comes in, how it's triaged, how it goes out to associate editors, how we make decisions. And then ultimately I have to make sure all those processes work the way they're supposed to. And then ultimately the decisions at the end of the day—certainly at JAMA—the decision for a paper to move forward is a lot about me listening to the input from all the editors, what they want to do, and then I'm the final—Yes. —and then all the problems, of course, come to me. I have a weekly meeting called the problems meeting.
Dr. Ashley: We do. Okay. Okay. Well, we can imagine what that is. We definitely need to get into that. But I assume you have a weekly editors' meeting then, which is where the editors are making their pitches and updating you on where the—
Dr. Bibbins-Domingo: Exactly. So one of my favorite things is we have an editors' meeting twice a week. And you imagine our associate editors are not full-time editors—they're academics around the world. Some of our deputy editors are in-house and full-time, but many of them are not. That's one of the things COVID taught us—that you didn't have to always be in person, even if you were spending most of your time with the journal. So we now have manuscript meeting that is a very intense meeting. I imagine people—it's not just the person who is presenting a paper. We have lots of people who come to this meeting, lots of editors. They will tell us ahead of time you're going to present this paper. That means the editor has already gotten the peer reviews back. Okay, the editor has posted that paper on our internal site, and so if you can't make that meeting, other editors have read the paper and have given comments. And then we have the discussion. And so it's much like if you've sat on study section—which some people have that experience—where the handling editor will present the paper, and if they've brought it to the meeting, it's already passed many hurdles. And that handling editor is sort of the advocate for that paper. It's like, I'm bringing this paper in because, you know, despite reviewer number two, this is a really important paper.
Dr. Ashley: That happens, does it? Reviewer number two sometimes gets bypassed.
Dr. Bibbins-Domingo: Well, yeah. I mean, I think the fortunate thing we have in our journal, which unfortunately not every journal has the luxury of, is that we're a very hands-on, high-touch journal. And so the peer-review process is essential, but so is the discussion with the editors. And so we're not—it’s not just that we average three reviews and give you a score and then that's not how it works. And so the discussions are pretty intense. You have to imagine, as a general journal, these are critical care docs and primary care docs, and the cardiologists are like, what about—and we have, probably because I was a former chair of epi-biostats, we have a group of five statisticians, not people who are there to say why didn't they do analysis X, but people who are more there to say, because no study is perfect, they're there to say there's no fatal flaw here. So if you think this is important and we can discuss the limitations, go ahead. So they're there to give us that final seal. We could go ahead with these caveats if the content experts say, no, this is really important for the field.
Dr. Ashley: Yeah. Yeah. No, that's great. Well—and I think just to stick inside that room for a moment—so it's a few-hours meeting, it sounds like, and people, individual editors, are presenting individual papers in sort of a short form, and then there's a longer-form discussion that sometimes gets a bit heated, maybe.
Dr. Bibbins-Domingo: Yeah. Well, it gets heated. We're very cordial, but it gets definitely animated. People are engaged. People are engaged. And I'm really pleased that we've gotten to that point—that even though we're a hybrid meeting, there's a high level of engagement. There are a lot of people who've thought about this. And in the end, you know, the journals—our journal, the journals my peer competitor journals, New England, Lancet—you know, the reality is we only publish the number of papers we publish. And so every decision is about, is this paper going to get that spot?
Dr. Ashley: Right. That seems like it. And remind us—I mean, what is the percentage right now in terms of the acceptance?
Dr. Bibbins-Domingo: Yeah. If I say it, I never make any good friends. So it's like 4%. Four percent.
Dr. Ashley: Yeah.
Dr. Bibbins-Domingo: Eric Rubin, who's the editor-in-chief of New England—his advice he gave me when I first started, he said, you know, being an editor-in-chief is a great way to make friends until you reject their paper. So it means that the process is not always great for any given author. I think we're fortunate. We have 12 other journals in our network, most of them in the top five in their field or at the number one and two position. We have a great transfer mechanism. Each of those journals has academic editors-in-chief. Each of those journals makes their own decisions. But the transfer mechanism is a real benefit, I think, for authors. And then I would say the other thing I've been very keen to do is to make sure that we are amplifying the top things that might sit in a subspecialty journal, but we amplify them with all the machinery in Chicago. And so we're a small enough family of journals that the editors-in-chief—they talk to me, I talk to them. If an author says, you know, I really have this great primary outcome for this trial, but there's this other patient-centered outcome we also want to report, we'll coordinate across the two journals. And so those things, I think, are the advantage we have as a network and we think is a benefit for authors.
Dr. Ashley: Yeah, I think it—I mean, speaking as an author—and we've all been rejected. I'm sure you have as well.
Dr. Bibbins-Domingo: Yes, I have.
Dr. Ashley: I mean, one of the reasons we want to be in those journals is because they are prestigious, and they're prestigious because it's only a small percentage of papers that make it in. So this is the flywheel that we're all living through. But I think what authors appreciate—and they get this from JAMA, I know—is rapid turnaround and decisions that have some context to them. Because I think there are some other journals where that's maybe not the case. Yes. I think we all know that there's nothing worse than waiting months and months and then getting no and not really hearing why.
Dr. Bibbins-Domingo: Exactly. Right. And I think—I think, you know, I'm going to talk about this in grand rounds, so I'm putting a plug for my grand rounds—but we really have an explosion of journals right now. And I think the experience for authors can be very different across the journals. And I have this really very positive experience about my first paper in JAMA, where it was a paper that was rejected initially, and then I had an editor who sat down with me—I was really early in my career—and my mentor and said, here's why we're not going to take—we can't take this paper. And then we realized what we had to do to get the paper to be something that would be in JAMA ultimately. And I think that's my hope, is that everyone sort of has that experience or learns how journals work to have that experience, because I think that can be very positive, even though there's a lot of grind.
Dr. Ashley: Completely agree. Yeah, I've had some really good experiences with professional editors, sometimes on review papers, but other times on primary data papers, where they've said, you know, this is what we would need. And equally, I think it's good when you see that there's an understanding that reviewers are going to say different things and that it isn't the perfect paper, but that there's an editor who's saying these are the things we would need.
Dr. Bibbins-Domingo: Yeah. And that's what I've been very clear with my editors on. And I think we have now a very shared understanding of that—that our job as editors is to make the decisions, to use all these inputs, and then to tell the author, not to say, okay, you know, there's a million things you have to do here, but to say these are the most important things. Because in the end, no scientific study is perfect, and our job is not to make the study perfect. Yes. It is to actually take that core element of it that makes it important and interesting and something that somebody else would want to read, either to do the next experiment or to translate it into something that might improve care for patients. It's important to get it out there. And so we have to know when we're at the point of diminishing returns. And then we spend a lot of time—the other thing we spend a lot of time doing—is saying, you know, a paper that you publish, we want to know the methods are solid. We want to know the methods—you’re reporting them so that some other scientist can read them. But because we're a journal that also publishes for a clinical audience, we put a lot of stuff around that paper to translate what is in that paper for a clinical or a broader audience.
Dr. Ashley: Even broader lay audience.
Dr. Bibbins-Domingo: A lay audience, exactly. Right. So we're going to publish papers with editorials. Most likely our papers oftentimes have multiple editorials. We have a great multimedia team—you have a great team here. I mean, we have a great multimedia team that does podcasts and videos. We do explainers. My core belief that I've come to after being in this job now for a little bit of time is that I think journals like ours have to do the core work we've always done as good as we've ever done it, because there's a role for our journals in this whole process. But then we have to do a much better job at trying to reach people where they are, right, like you're doing here—to, you know, because none of us sit—I don't know what you—but none of us sit with the paper version cover to cover. No one does that. Even if you like to do that, very few people—that is their sole experience with a journal anymore. And so we have to be better at reaching people where they need to be, in the forms that it needs to be in—not just to reach them, to penetrate all the information overload we're all in, but also to give the context around scientific findings that are complex, that are not neat and tidy, that might have different implications in different groups and things like that.
Dr. Ashley: But it's a great point, because publishing has changed so much. I mean, some people now will feed the article into a language model and it'll create an automatic podcast of two fictional people discussing it, and that's how they ingest an article. But again, from the position you have as the editor-in-chief at JAMA, these tidal waves of change through society, but also publishing, are coming. How do you think about dealing with those and adapting?
Dr. Bibbins-Domingo: Yeah, I mean, we're in a fortunate environment that we control everything in-house, and so we have the luxury to think about how to do this well. I do think much in the way that AI is challenging lots that we do clinically or how we consume media, it also forces us to say, well, what is the value that we bring as an editorial team? It's not just producing a podcast, because as you say, you can just do that. Yes, it can happen automatically.
Dr. Ashley: It can happen automatically. This is a real conversation. What is it? Yes, it is. We are real people.
Dr. Bibbins-Domingo: Yeah. Thanks for that reminder. But even in peer review, you can feed a paper in and ask it to give a critique of a paper. So why would I call you to ask you to tell me why this paper is good? And that's because there are things that you're going to tell me that no language model is going to be able to tell me. And that's where we have to focus on—where are we adding value to this process? You can put a paper on a preprint server today. So why wouldn't you just do that? Why would you go through this whole process of submitting?
Dr. Ashley: How do you think about that? That's—preprints are sort of another one of those tidal waves, really, aren't they?
Dr. Bibbins-Domingo: Yeah. You know, I think traditional journals like ours were probably suspicious of preprint servers, probably hostile to them. This is all before I was an editor. During COVID, I had the experience of having a first author specialist who said, we're going to put this on the preprint server. And I was like, okay, why are we doing that? And he said, because the state is debating how we're going to roll out vaccines, and our paper needs to be out there. People need to be talking about this now. And I was like, okay. And that ended up being a very influential publication. Because there's something about the preprint servers that gets us talking about a paper now, and that is important. I do think the value—so I like preprint servers. We are not against—
Dr. Ashley: You don't run your own, though.
Dr. Bibbins-Domingo: We don't run our own. We don't run our own. But we do have—with medRxiv—you can have a streamlined submission to JAMA Network Open from there. So we have that type of partnership. So I like preprint servers. We will take papers that have been on preprint servers. I think we play a different role in the ecosystem, right? And so when I talk to the editor-in-chief of bioRxiv, sometimes science needs to be out there right away. Sometimes it needs to be for scientists to debate and discuss. I think the clinical journals like ours, especially the top-tier clinical journals, they're the journals that are usually giving you that final seal of approval, like this is what it is. And so my colleagues who write guidelines or who say we're trying to adopt this new way of caring for a patient in our clinical setting—they're like nobody's going to do that until it's in this journal. And so I think we each have a role to play in the process. I've talked to editors of the larger open-access journals, and they're like, yeah, sometimes we just need to get more things out. And that's the role they play, whereas ours is a little—we play a different niche in the whole ecosystem. And I think you probably need all of those. Whether you need as many journals as we currently have, I'm not sure, but I think the different ways of communicating is something we do need.
Dr. Ashley: Yeah, yeah. I think that very well said. And I think there's an imprimatur that comes from especially, as you say, these top medical journals that lead to the idea that once it's there, it really means something certainly a little bit different than a preprint server.I think everybody understands that. Yes. But it also makes, I think, your decision as an editor quite hard, because something could be very valid in as much as it's presented to you, but maybe not quite ready for that stamp or not quite ready for that profile. That seems like a tough decision that would fall at your feet quite a lot.
Dr. Bibbins-Domingo: I totally agree with you, and we wrestle with that quite a bit. Especially, you know, I like this series as the future of medicine. This is such an exciting time for discovery, right? We're learning so much more about mechanisms of disease. We're thinking so much more about how data can give us new insights. And that's exciting. It's so great. I don't want us to be a journal where—a journal has still got to be different than a textbook, right? It can't be so—we know for sure that this is the way to go—because if it's that sure, the textbooks are publishing faster. And so somewhere in there has got to be—and I in particular have this. It's probably because I started as a basic scientist, and so I appreciate a lot of what's happening now. I think since I've been editor-in-chief, you've seen our journal—we probably take a few more risks on early translational things. We always put around them more explanation. So we don't dismiss the fact that our core audience are mostly clinicians, and so we have to do more explaining what something means. So I'm willing to take risk on science that's not perfect if I understand—if an author is very clear in telling me where this is going. They clearly have done a set of studies that help us to see why this is the next thing to move the field forward. So yeah, the old adage for that—I think a lot of the top-tier journals say—is that we publish either the first in the field or the last final word—the first word or the final say. I think that is generally true. I think the challenge for journals is to figure out how to take some risk on something that's not perfect, may not pan out, but is really interesting and points the way for how we might think about things.
Dr. Ashley: That's a really nice way of putting it. I mean, I think again most of us look to these top few journals as journals where often publications will be practice-changing.
Dr. Bibbins-Domingo: Yes.
Dr. Ashley: But if that's the goal, then I think there will be a lot of really interesting, potentially practice-changing work that doesn't make it in.
Dr. Bibbins-Domingo: That's exactly right. That's exactly right. And we're experimenting with different ways to figure out how to do that. But I totally agree, and I do feel like that's the responsibility. I feel like I would like more people to have a window into where the field is going. Do you know what I mean? And I think as editors it is not a failure of the whole scientific process for that observation to then turn out in a few years not to be true. We obviously want to avoid fraud and bad behavior and not publishing that. But the process of science is that we're constantly learning.
Dr. Ashley: And when we have to change our view according to the new data, that is the essence of science. And communicating that to the public is also important. That's the way science—So, well, before I let you go, I just wanted—since you have this amazing view on the future of medicine—give us a sense of some of the things that you're most excited about or the ways that you see medicine changing over the next few years.
Dr. Bibbins-Domingo: Yeah. I think the discovery—I think the reason why it's exciting right now, as you know, is that we understand so many more mechanisms. We have so many more tools. And the tools that we have can be applied across the whole spectrum of scientific inquiry. And that means there's so much we can do right now. And I think that's—I mean, it is really exciting. And one of my jobs is I handle the editorials for the commentaries. And so it's wonderful to publish the science, and it's wonderful then to work with the people who appreciate how important a discovery is—or how it's going to change what they do in clinic—and who can articulate that. And so every week I can see that. And so that's an exciting time. I do think it's a time that—we are living in this environment—you talked a little bit about we publish and then the media picks it up and whatever—but we're living in a time where there are lots of ways people get information. It's not just, oh, it was published in JAMA, so therefore—we're—you know, there are lots of journals. There's lots of ways to amplify things. There are lots of people who amplify in different ways. And I think that means we who are thinking about evidence, who believe in the standards for developing evidence, have to understand the communication of evidence within this environment. And I think we have to take seriously how to play in that environment where there's lots of information, there are lots of people telling you, well, it probably works this way. And I think we have to get better at doing that too.
Dr. Ashley: So is that information system one of the biggest challenges but opportunities then for the next few years?
Dr. Bibbins-Domingo: One hundred percent. It is our opportunity, because physicians, clinicians generally, scientists are still amongst the most trusted. And I think if we were good at communicating what we do, why we're excited about it, why it's an interesting time to practice, why these things that are on the horizon will make it better for patients in the future—I think if we're better at communicating that, then we will have a little bit more control over our own message and our destiny.
Dr. Ashley: I know. Destiny. That is a wonderful point in which to end it here at Stanford on the Future of Medicine. Thank you.
Dr. Bibbins-Domingo: Wonderful. Thank you very much.