Faust Files: A Sit-Down With JAMA’s Incoming Editor-in-Chief

In this video, Jeremy Faust, MD, of Brigham and Women’s Hospital in Boston, and Kirsten Bibbins-Domingo, MD, PhD, of the University of California San Francisco School of Medicine, discuss diversity, equity, and inclusion in medicine, the role of an editor-in-chief, and how to make JAMA a good earpiece for those in the field.

The following is a transcript of their remarks:

Faust: Hello. Jeremy Faust, editor-in-chief of MedPage Today. Thank you for joining us.

We are going to be joined today by Dr. Kirsten Bibbins-Domingo. Dr. Bibbins-Domingo is the incoming editor-in-chief of the Journal of the American Medical Association, JAMA, and the JAMA Network. She’s a professor of medicine and the chair of the Department of Epidemiology and Biostatistics at the University of California San Francisco School of Medicine, and she was the inaugural Vice Dean for Population Health and Health Equity at UCSF School of Medicine. She brings all that to what is really one of the most powerful positions in academic and all of medicine.

Dr. Kirsten Bibbins-Domingo, welcome and thank you for joining us on MedPage Today.

Bibbins-Domingo: Thanks for having me.

Faust: My first question is just to talk about this moment of taking command. You’re now going to be in command of kind of the flagship of a big fleet. Where do you want to take us? What are your one or two big goals? Where do you see us headed?

Bibbins-Domingo: Well, the reason that this job interested me is that I think we’re really in an extraordinary time for science and medicine, especially as we come out of this pandemic.

We’re at a time when we’re really at the height of the heights of science and the way in which science can improve health – think in the pandemic about vaccines and therapeutics. Really, we can’t imagine a time like this, having these so quickly after a new pathogen.

We’re also at a time when there’s a lot of mistrust about science, we don’t really know where to find the right information all the time, advancements in science don’t translate to improvements in health. There are a lot of other things that shape health and medicine in the U.S. and globally. I think the opportunity with JAMA and the JAMA Network is really to publish the best science that’s out there, make sure it reaches the broadest possible audience, but also to always put our scientific discoveries in the context of these broader questions so that we can really have the conversations, have the debates about how our science translates into improvements for health across the population and for health across all in the population.

Faust: Trust is a big thing, and big huge medical organizations can be a little opaque. I don’t think everyone really quite understands that JAMA is a project of the American Medical Association but is not necessarily the mouthpiece, it is not the mouthpiece. If anything, I almost think of JAMA as the earpiece, a way for us, the community, to feed into the AMA and say, “Look, here’s what researchers and clinician scientists and advocates and experts are thinking. We want you to see this at the highest level.”

So with that framework, with JAMA as the earpiece of the field, what do you want the American Medical Association to know at this time? What should we be telling them?

Bibbins-Domingo: Oh, I love that. I think I’m going to use the “earpiece.”

So you are absolutely right. JAMA is independent, editorially independent, fiercely so, from the American Medical Association. I do view JAMA as the place to have these discussions that are really shaping modern medicine. So I don’t think we are speaking to the AMA, but we are speaking to those things that are important for us in clinical practice and that are important as we think about public health. I think JAMA has always been that place that is giving voice to all of the various current issues and current debates, and I think when we think across the JAMA Network – and we’re doing this in all of the subspecialty journals as well – we really have the opportunity to both hear and to give voice to the important issues that shape the care of our patients.

I like your analogy of the earpiece. And I think that that is what we hope to be.

Faust: And do you think there’s one particular message that hasn’t landed that needs to land at this time?

Bibbins-Domingo: I think for the flagship journal, that the opportunity is to, again, publish the very best science. We have to always be leading with that, but also put it into context.

When I think about the things that shape both how I care for my patients as well as what other things shape the health of my patients, I do think of the deep inequities. I think about the trust that patients have in the clinical care they receive as well as the messages that they have. Think about all of the things that we’re talking about with trust in the pandemic and the messaging right there. I think about the globalization of medicine and of science. I think about forces even like climate change that actually will have increasingly important implications for how we think about health of communities. I think about the cost of healthcare and the fact that we, you know, are spending so much and are not achieving the population health outcomes.

Those are some of the things that in some ways sit external to medicine but certainly shape the way we interact with patients, the way science actually translates into health, and the way we think about the broader population health issues.

Faust: So you kind of touched on the idea of reaching everybody and the work reaching everybody. This kind of gets to diversity, equity, and inclusion [DEI], both in terms of the journal and representation, but also just the audience and who we’re trying to reach and who we’re trying to help.

You’ve done a lot of work, scholarly research and advocacy, in those areas. What are some important steps going forward in the DEI space that you intend to steward at the journal?

Bibbins-Domingo: Right. So, as you know, Jeremy, you and I are physician scientists. We’re doing research in addition to caring for patients. I think of myself as somebody who is interested in prevention – in studying what preventive interventions work. I’m particularly focused on cardiovascular disease interventions, both clinical and public health.

What I’m interested in is, when we have a new discovery, does that translate into improvements in population health? Does it improve the health of everyone in the population? Who’s not benefiting from a particular new advance? Why are they not benefiting? What are the barriers? And then, how could we redesign to make sure that a new intervention is going to benefit everyone?

So I think of myself as a cardiovascular disease prevention researcher, but everything has an equity slant, because I want to know what it is that prevents us from getting from point A to point B.

I actually think that more of us should think about ourselves in that way. To think about – when there is a new discovery, when we have a new advance, when there is something new that we’re faced with in the pandemic, and we are not translating to improvements in health – why is that not the case? Those are the types of things I think that will help us to be better scientists. It will help us to think about how to translate our findings into improvements.

So for me, the health equity issues are not separate issues. They’re not issues that I exclusively deal with or [only for] people who are focused on certain populations. It is something that I think all of us have to be thinking about as we’re doing our science, because that is the only hope we have to translate science then into improvements in health for the broadest number of people possible.

Faust: As I’m hearing you talk about this, I think about your role as editor-in-chief and what sort of mechanisms you have at your disposal. I can kind of off the top of my head think of two distinct ones, and there are probably others, but one is certainly just priorities, right? Like, what are we going to put in the journal? 98% of the submissions aren’t going to reach the quality check, then you have to decide between really great things and it’s just a matter of priorities. So that’s number one. And I wonder how you’re going to think about how to set those priorities or what those priorities will be.

Then the second piece is actually really nitty-gritty. In the physician scientist space, we’re just not going to publish certain kinds of studies because we think that these are games that researchers, unfortunately, with conflicts of interest may be playing, and that leads to some downstream benefits that really are very narrow and for a certain subset of people.

Do you see yourself getting in the weeds on that one? Or do you think your role is a little bit more big picture? Like, “Here are the things that we as a journal are actually kind of focused on right now.”

Bibbins-Domingo: It’s a good question. And, you know, just reminding you that I’ve not yet taken this job, so I will still be learning about how we are actually doing this.

JAMA and the JAMA Network has this real wonderful luxury that there is the flagship JAMA journal and then there is a journal that has been publishing, in my view, quite extraordinary science called JAMA Network Open. That gives us the opportunity both to think about what the flagship journal is publishing – the highest quality, the most important science, as well as the viewpoints, the types of ways we can put science in context.

And that doesn’t mean giving up on really other outstanding pieces of science because, in all of our subspecialty journals but particularly in JAMA Network Open, I think you’re starting to see the breadth of the really great science that’s out there. I think over time, we will see how to not only what flavor or types of science – I just want it to be the best science, frankly – that will be in the journals. But I think more important is always being able to put the science in context.

There are so many new interventions, things that come out of a clinical trial, things that come out of a new pragmatic trial, for example, that really will be shaped by many other things. And I would hope to give voice to not only the publication of the great science, but in the ways that we transmit it to the broadest possible audience, as well as in the things that are built out around it. That are really able to give readers and listeners an understanding of the types of things that a new scientific discovery will prompt in the future.

The second thing you talked about is related to conflicts and, I think, also about methods of really making sure that when we say we have the best science, that a reader, a listener can feel confident that that is the case. And that is about scrutinizing conflicts. It is about ensuring the most rigorous science, and I do think that that is also important.

One of the roles I’ve had before was as the chair of the U.S. Preventive Services Task Force. I think that was in this field of prevention, I never quite understood how much money was in prevention, how much politics is in prevention. I learned that on the job, and that’s where I learned so much about thinking about how we think about conflicts of interest.

I’ve most recently been chairing a Department of Epidemiology and Biostatistics, which has made me deeply appreciate people who understand methods and who understand how we know what we know when we have new findings.

I think those are going to be important. I think if you’re going to be JAMA and the JAMA Network that people can trust, those things still have to be core to what you’re doing. So, I think they will play an important role.

Faust: I know you haven’t started yet, so this is a hypothetical question, but I’m actually a little bit interested just in your life balance and what you’ll be doing and what your day-to-day will be with this obviously all-encompassing job. Does this position allow you to do anything else? Will you still be able to see patients and stay involved in research? Or is it just like, okay, I am now the captain of this ship and that requires my full attention.

Bibbins-Domingo: I was really fortunate that UCSF gave me a leave of absence, so I will still be a faculty member at UCSF.

I do think I will continue to see patients, mostly working in a clinic with trainees. I think seeing patients has always been an important part of what I’ve done, even as I’ve continued to mostly have a career as a researcher, because I think it is the way we stay grounded in what we’re doing. It is the way still that the best scientific questions from my own career have come out of caring for patients. That was absolutely true during the pandemic. I think it’s important to stay grounded in that way.

I’m fortunate to work collaboratively with a lot of research groups, and I think that those collaborations will continue. I look forward to having those continue, not with me as the leader, the PI [primary investigator] of a grant, but as a part of a collaborative team. I know that that will be important.

And again, you know, the scientific enterprise is a complex one. There are many, many parts of this enterprise: the people who fund, the people who conduct research, the people who are caring for patients who read research and translate it into improvements, the scientific publication part of this. I think all of that has a role to play in how science and medicine and public health continue to advance and improve. I’m really excited to learn this part of that enterprise. But I think it is also important for me to be parts of those things that are really caring for patients and seeing how we’re actually doing the studies themselves.

Faust: Dr. Kirsten Bibbins-Domingo, incoming editor-in-chief of JAMA and the JAMA Network. Your success is our success. I wish you all of it. Thank you for joining us here on MedPage Today, and we will look forward to seeing where our field heads really in a great many ways under your leadership for years to come.

Bibbins-Domingo: Thanks so much, Jeremy.