Paradoxes, fresh starts, and the fortnightly BMJ

A new year is meant to bring new hope, and perhaps this one does too, but it’s hard to be thrilled by health services overwhelmed by winter pressures (doi:10.1136/bmj.q2871),1 transatlantic rabble rousing, and insoluble global crises and conflicts. What a new year can certainly bring is a fresh start, with new energy and effort to direct ourselves away from a destructive future, to focus on improving people’s health and wellbeing.

Yet with each era the task grows more complex. In Samuel Taylor Coleridge’s Rime of the Ancient Mariner, sailors marooned on a ship drifting near the equator are tortured by “water, water, every where, nor any drop to drink.” Medicine at that time, the end of the 18th century, was replete with untested hypotheses on illness and disease, reliable information was scarce, and therapies were few.

That changed—first gradually, then rapidly—with advances in medical science, printing and distribution, and the internet. More than 20 years ago John Muir Gray drew on Coleridge to describe the information paradox, whereby clinicians are overloaded with information but can’t find what they need when they most need it (doi:10.1136/bmj.319.7223.1476).2 Our attempts to fix the information paradox have spawned evidence based guidelines, expert summaries, and decision support tools. The march of information overload, however, remains relentless.

One solution to the information paradox was more innovation, the panacea to save us all. Innovation was embraced with gusto, and today we might describe ourselves as living in a world of innovation overload: it’s hard to know which innovation will truly help. Innovation and evaluation are reluctant bedfellows.

No matter—we now have artificial intelligence (AI), the new messiah on the block. AI offers hope in the way that better information and smarter innovation once did and still do. In theory, AI can provide the information we need with innovation built in. But it comes with the same downside, our lust for overindulgence. We’re already drowning in an all consuming overload where the AI that adds value is hard to identify: the AI paradox.

In this context it might seem a paradox that we retain The BMJ’s weekly print edition. We believe that the rationale for print is sound, although with the current issue we move to fortnightly print publication (doi:10.1136/bmj.q2701).3 This decision, taken after long and thorough consideration, has received an overwhelmingly positive response from readers who replied to our survey and request for feedback.

The move to fortnightly print allows us to retain the currency of the print edition through journalism and comment, creates more space for clinical educational content, research, and obituaries in print, helps print readers with information overload, reduces our carbon footprint, and places The BMJ on a more stable financial footing. Another benefit is that we can offer readers a better digital experience, including on social media, where we do need to innovate—even with AI, in moderation—and where the battle for trusted information is most intense. With the new frequency and format in place, you will see an ongoing evolution of The BMJ in its print and digital versions.

Where this all ends is hard to know. But in this world of paradoxes unresolved, of social media power, manipulation, and irresponsibility, too many have lost sight of what matters. The task we face as journals, clinicians, policy makers, and researchers in medicine and healthcare is to hold firm to information that’s trusted, to support innovation that’s properly evaluated, and to work with AI that truly adds value. Our duty to improve the health and wellbeing of people and the planet demands that we do all of this, and we must therefore bring new energy and effort to the fresh start that 2025 offers.