How Medscape Became a Leader in Online Medical Information

Founded in 1995, Medscape surpassed the milestone of 1 million members from around the world. However, most of these members were not US-based physicians. This was wonderful for global medical education but hazardous for the owners of Medscape because the early business plan depended on advertising and sponsorship aimed at US-based physicians.

Enacting, publishing, and following a Code of Ethics for Medscape was a critical early step in building trust in the company's honesty and integrity. Medscape had to convince the audience of the reliability of content presented through a strange new medium — the internet — that was itself awash in untrustworthy and often flagrantly false information. Medscape's world-class editorial board comprised recognized leaders from many fields and countries who served as guarantors of validity, a vital next step in gaining the trust of readers.

Physicians had learned from medical school and residency onward to trust only what they read in established medical journals and not to trust what they read in newspapers and magazines, heard on the radio, or saw on television. So, how would those physician-readers view an internet site for medical information?

An Exclusively Electronic Medical Journal

Coming from an academic, practice, and medical journal background to Medscape, I had the same hesitation about online publishing. Early work to integrate online publishing with conventional print medical journals (JAMA, Annals of Internal Medicine, The BMJ) laid the groundwork for trust in this new medium, but those efforts were aimed at supplementing, rather than replacing, existing modes of distribution.

So, I got the idea that Medscape should launch an exclusively electronic, peer-reviewed, primary source, general medical journal that looked, acted, and functioned exactly like a regular print publication but was better, faster, and cheaper. Paul Sheils, the Medscape CEO, rapidly approved the idea and we commenced building it. I called it Medscape General Medicine (MedGenMed) because I expected it to be a general (not specialist) medical journal with some articles of interest to all physicians.

Christina Myers became the only editorial assistant, and Bill Silberg hired Nancy Puckett, an established medical publishing professional, as our part-time managing editor. Medscape already had excellent publishing professionals on staff who were highly skilled in the production modes of the internet, and they were extraordinarily helpful in getting MedGenMed started.

A Decade of Success

We determined that MedGenMed would not be a quarterly, monthly, or weekly publication but would publish when an article was ready, facilitating rapid throughput. We could beat any other peer-reviewed medical journal in the world to rapid publication, and we broadcast that capability to a world of authors to woo them away from a medical journal world still stuck with old and slow editorial and publishing processes.

MedGenMed was never behind a paywall; it was free to authors and readers. Our founding editorial board members functioned as the first peer reviewers, but we rapidly expanded this resource to include the same reviewer pool that all the major medical journals utilized. Our initial publication was on April 9, 1999, less than 2 months from when I joined Medscape as editor-in-chief.

It was immediately obvious to readers that MedGenMed was a real medical journal, and except for the online format, identical to the print journals they were accustomed to reading. After 1 year, MedGenMed was even listed on MEDLINE, a gold standard of trust at the turn of the century. The third foundation pillar had been driven — one more reason for young Medscape to succeed.

The complete 10-year history of the renamed Medscape Journal of Medicine can be found on Medscape, MEDLINE/PubMed, or PubMed Central.

(Dear reader, I beg your indulgence for my ultimate triple-referencing, fail-safe redundancy. Early authors feared that by not being on paper, their articles might be lost to antiquity. They, of course, failed to realize that most medical journals are printed on acid-rich paper with less than assured shelf lives.)

George Lundberg, MD, is sheltering in place without access to his usual video studio. He is contributing editor at Cancer Commons and a clinical professor of pathology at Northwestern University. Previously, he served as editor-in-chief of JAMA (including 10 specialty journals), American Medical News, and Medscape.

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