It’s not every day that the president of the United States publishes an article in an academic journal.
But on Monday an article by "Barack Obama, JD," titled "United States Health Care Reform: Progress to Date and Next Steps," was published online in The Journal of the American Medical Association. The article appears with the label of "special communication."
In the article, Mr. Obama examines the Affordable Care Act, or "Obamacare," and makes recommendations for health-care policy reform for the next president. Among them: for the government to introduce an insurance plan, or "public option," in areas of the United States that lack competition, and for policy makers to push down prescription-drug costs.
Mr. Obama is the only author listed on the article, but under "additional contributions" he credits several staff members in the Executive Office of the President with helping prepare the manuscript. The article was published with four accompanying editorials critiquing the findings of Mr. Obama’s article.
The Chronicle spoke with Howard C. Bauchner, the journal’s editor in chief, about how, exactly, you edit and peer-review the president of the United States. The conversation has been edited for length and clarity.
Q. What was it like when the administration approached JAMA and was like, "Hey, we want to publish this in your journal?"
A. Well, we paused. It’s the first time certainly since I’ve been here that a sitting president has called — he’s been the only sitting president since I’ve been here, about five years — and said he’d like to write something for JAMA. For us, in some ways, it was similar to how we get queries for all special communications. Occasionally we’ll reach out to people if we have a specific idea, but I probably get a query a week about a group or someone who would like to write a special communication. In that regard, it was quite similar to other queries. The difference is obviously it’s the president of the United States.
What ensued after they reached out was, What was it that they thought the president would like to write about? So we discussed that. In this case, we needed to remind the people who contacted us our special communications are data-driven pieces. They’re not just long thought pieces with no data. We needed to ensure that there would be a commitment to having data, facts, information in the piece. That was the first point of discussion.
The second was that it needed to talk about the challenges ahead, not just the accomplishments, because I think there have been many groups, many individuals, many people who have said this is not yet a completed act or law, that changes are necessary. We really wanted to be sure that the president was willing to write about many of the remaining challenges with the ACA. They indicated that he was committed to that. I needed to remind them of what our process of editorial review was and that there’s copy editing that goes on with every author, and there certainly would be editing that would go on with this author.
Q. Tell me more about what the editing process was like.
A. This paper was handled much like all other special communications. It underwent peer review with critiques and criticisms and was sent back to the president requesting changes, very specific and very general changes in the document. Our peer review is confidential, so I don’t want to detail what those requests were.
But I can tell you I was quite pleased that the president was enormously responsive to our requests. I am also willing to acknowledge that JAMA has a very clear, strong sense of the type of language we use, but I think we did allow the president a bit more flexibility because of who he is. For example, you’ll notice that he uses a personal pronoun on a number of occasions, "I." He also has one or two vignettes in it of citizens in the United States whom he interacted with or who contacted him about the Affordable Care Act. Those are unusual for us at JAMA, but we thought, given what he was writing about and who he was, he deserved a bit more flexibility than some of our other authors.
Q. So the article is peer-reviewed?
A. There are different types of peer review. This paper definitely underwent peer review, and obviously we don’t fact-check every fact. But on the other hand, both the executive editor, Phil Fontanarosa, and I read many, many articles, so we’re generally familiar with much of the data that will be in special communications.
Q. What has the traffic and reception been like on the article and the editorials?
A. Traffic on the editorials has been modest. Traffic on the piece is remarkable. It changes regularly now. As of 5 a.m. [Tuesday] morning, because we only update once a day, it has 24,000 views, meaning that people have come to the website and looked at it in the HTML version or the PDF version. That will get updated early tomorrow morning, so I would expect the number to be much higher.
The other way we look at the attention the paper is getting in the short run, not the long run — the long run would be citation in other literature. [We look at] something we use called the altmetric score. The altmetric score is currently 3,519, which is probably the first- or second-highest score we’ve ever had for a paper. It’s getting a lot of attention. According to the altmetric score — you can see it on our website — it’s been in 54 news outlets, 80 blogs, 4,714 Twitters, one peer-review site, five Facebook pages, one Wikipedia page, and two Google+ users, and it will continue to go higher.
It’s getting quite a bit of attention.