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Durante il Novecento, numerose case editrici hanno svolto un ruolo importante per la crescita culturale dell'Italia, una funzione formativa molto simile a quella che ha caratterizzato l'attività di molti editori di paesi come Francia, Inghilterra, Germania, Stati Uniti. Quasi sempre l'attività editoriale era legata al contributo di intellettuali che svolgevano un ruolo politico-culturale attraverso l'impegno professionale: narratori, giornalisti, poeti. Questa funzione esplicitamente pedagogica dell'editoria è stata messa in crisi verso la fine del secolo scorso dall'esaurirsi della stagione politicamente più coinvolgente e conflittuale e, allo stesso tempo, dall'emergere di nuovi modelli di gestione che affidavano la conduzione aziendale a dirigenti più attenti ai risultati economici che al prestigio culturale. Con l'inizio del nuovo millennio, l'editoria italiana e internazionale ha iniziato a essere dominata da multinazionali proprietarie dei marchi storici dell'editoria e spesso gestite in maniera impersonale. L'editoria scientifica è forse quella che meglio ha saputo adattarsi alla gestione manageriale e, forse non a caso, è la più attraversata dal cambiamento: una delle questioni più discusse riguarda la qualità dei contenuti e gli strumenti per la sua valutazione precedente (peer review) e successiva alla pubblicazione (gli indici bibliometrici hanno assunto un potere determinante per la progressione delle carriere dei professionisti sanitari). Anche i modelli di accesso alle riviste sono molto cambiati, nonostante l'open access in grande ascesa rischi di discriminare i ricercatori delle nazioni a basso reddito. In un contesto culturale, sociale e politico molto cambiato rispetto al secolo scorso, anche l'attività, le scelte e le decisioni delle case editrici meno esposte o schierate politicamente possono avere un valore culturale non trascurabile contribuendo così a formare punti di vista sul mondo. E non è detto che - proprio grazie al lavoro degli editori - queste prospettive sul futuro non possano tornare a ispirarsi ai valori che hanno orientato la cultura del Novecento.

Authorship is increasingly discussed in international journals: in fact, the authorship and position of authors influence professional careers, the acquisition of funding, and individual and institutional reputation. International associations of editors of academic journals call for vigilance in cases of misconduct: ghostwriting and guest or gift authorship are frequent and penalise especially younger researchers and women. However, authorship is a concept in the making, strongly influenced not only by the social and ethical context, but also by technology. Today, artificial intelligence is an important aid for the editorial boards of academic journals. But it is likely to become a support for authors in the future as well, given the success of automatic writing software.

Ten years after the death of Alessandro Liberati, the authors wonder how much the principles that guided the action of the founder of the Italian Cochrane Centre are still relevant. The guiding star of Liberati's professional life was the fight for useful research aimed at solving problems relevant to patients and their families. Consistently with the work of other researchers such as Sir Iain Chalmers and Paul Glasziou - they have recently offered important contribution on these issues - Alessandro Liberati worked hard to guarantee open, accessible, and transparent research to citizens, health decision makers and health professionals. Unfortunately, his final call to design a new research governance remained unanswered. Research is still too focused on individual therapeutic interventions rather than on overall care strategies. Studies are still too often unpublished or only partially published. Research is still influenced by conflicts of interest and peer review is often biased. Much work remains to be done, to ensure that publicly funded research is guided by the real needs of citizens and patients.

One year after the beginning of the health and social emergency, the health system shows its strengths and weaknesses. Among these, inadequacy of facilities, deficiencies of continuity between hospital and territory, inconsistent information and lack of bidirectional communication between institutions and citizens, uncertainties of data about therapies and the emphasis given to the role of opinion leaders. To get out of the pandemic, a change of perspective is needed: governments must not just support industrial investments but must they must encourage better and community-useful research and communication.

Health communication must be based on open and multi-dimensional dialogue involving all stakeholders: public and private institutions, health professionals, industries, associations and, above all, citizens. Currently, communication suffers many problems related to bad research (unethical research, falsification of data, conflict of interest, incomplete reporting, spin and plagiarism) and to the limits of an academic system that does rewards quantity more than quality. A turnaround is needed, based on five major changes: establishing rules that can actually be followed; improve the quality of scientific information; accept and encourage open confrontation; allow citizens to be able to express and assert their needs; transform uncertainty from limit to value. The "Liberati's principles" must be reaffirmed: an honest communication must make the results of the research accessible to those who have to make decisions that affect their health; researchers must engage in studies that promise benefits to citizens and are not just useful to one's career or industry; before opening up new research fronts it is necessary to exhaust the potential of research already started; the definition of research priorities must be a transparent and shared process; the best evidence is the most relevant for citizens and patients. These principles and all ethical issues related should be part of educational programs for all health operators and researchers.

The complexity of health systems often implies a condition of conflict of interests for many of the players involved: health professionals, managers of the NHS, pharmaceutical, medical devices or food industries, publishers and communication agencies, conference event organizers. Conflict of interests is a condition of risk, not a sentence of guilt: for this reason, conflict of interests should be managed through information and training of health personnel. Scientific societies play an important role being active in updating their members (conferences, meetings, e-learning and residential training courses) and influencing healthcare with the production of clinical practice guidelines. Professional associations must be active to foster the integrity of their members and to minimize the risk of conflict of interests, also to avoid wasting resources, making the health system fairer and more sustainable.

Despite advances in technology development for precision medicine, obstacles remain as barriers to progress and change. In this context simple questions arise: what is the level of understanding of precision medicine among healthcare professionals? We tried to address this question with a survey whose objective was to explore the perception and understanding of precision medicine.A questionnaire was administered to a sample made of oncologists, clinical and hospital pharmacists, pharmacologists and infectiologists in the context of five different Italian national congresses. Participation in the survey was voluntary and anonymous.The questionnaire was filled-in by a total number of 1113 professionals out of 3670 registered participants in the congresses. About half of respondents stated they were not sufficiently informed about precision medicine, and infectiologists were the ones who felt less informed. Most respondents agreed with the basic principles and definitions of precision medicine and believed this new approach is going to require deep changes in healthcare.Our findings show that healthcare professionals have partial knowledge on this topic and that there is a significant association between respondents' knowledge and their clinical specialty. However, despite some misconceptions about precision medicine, a genuine interest and familiarity with its basic principles seems to emerge.

An old Italian proverb states that lies have short legs. In other words, in the end you get found out. This is exactly what happened to an Italian researcher who acted as a referee for a manuscript submitted in 2015 to Annals of Internal Medicine. After a negative report (which presumably led to the rejection of the submission) he submitted a manuscript which was essentially the same. But he and his accomplices got found out and paraded in front of the world in an earth-shatteringly polite "Dear Plagiarist" letter by the first robbed author: Dr Michael Dansinger. Dr Dansiger's letter is a model of polite logic and an ethical masterpiece, the fake article got retracted and the thief's institution contacted. No reply so far, a depressingly familiar theme in contemporary research. We wonder why we carry on with a system which is completely broken. Commercial interests, reporting bias, secrecy, ethically dubious studies and inertia are the ingredients of contemporary research and publication practices. Editorial peer review, a scholarly practice originating in a more genteel era, is clearly unable to do much other than lend a very thin veneer of credibility to this pandemic of junk which is threatening healthcare budgets and the ethics of the next generation of researchers. We need a complete reform of the system which could give back some credibility to the "e" of evidence-based medicine. Complete lawful transparency, public reimbursement of interventions only on the basis of independently generated evidence and research ethics as a part of an international curriculum for budding researchers are urgently needed. These should be linked to publishers' complete disclosure of their sources of income and custodial sentences for those who abuse positions of trust. Meanwhile, stay away from anything implausible and non-replicable (as they probably are).

Scientific journals play an increasingly important role in the dissemination of research results, but also in the adoption of pharmaceutical innovation and technology in medicine. Healthcare decision makers are strongly influenced by the academic literature and for this reason medical journals should retain their independence and autonomy, preventing conflicts of interest. In a recently published editorial, the editor of the New England Journal of Medicine seems to be pleased with the results achieved. On the contrary, according to the editor of a respected specialized cardiovascular journal, Harlan Krumholz, journals are facing a number of important challenges. Medical journals are too expensive, too limited, too unreliable, too focused on wrong metrics, too powerful, too parochial, too static, and too dependent on a distorted model of business. In conclusion, medical journals do not seem to be the most appropriate educational tool in a scientific context that assigns value to transparency and sharing.

Conflicts of interest affect the scientific communication and information: their effects on the physician's prescribing behavior have been frequently studied and clearly documented. Recently, the New England Journal of Medicine published a series of papers questioning the radical positions on this topic, asking to reconsider the most intransigent approach, so that it may be possible a productive collaboration between academic medicine and pharmaceutical industry, in the interest of the patient. The papers published in the New England Journal of Medicine confirm the difficulties experienced by the biomedical journals: the support of the industry is essential and most of the authors and referees has ties with pharmaceutical or biotech companies. The debate among the various stakeholders is vital but should be open and transparent, with the aim to restore credibility to all the parties concerned: academic medicine, pharmaceutical industry and scientific publishers.

Country profiles from the watchdog Transparency International show a high level of citizen reported corruption in Italy.1 The problem is associated with the activity of criminal organisations, such as the Mafia, N’drangheta, and Camorra, which originated in the south of the country but are now active across the whole nation. As in other countries, healthcare is particularly …

"Making predictions is always very difficult, especially about the future". Niels Bohr's quote is very appropriate when looking into the future of libraries. If the Web is now the richest library in the world, it is also the most friendly and therefore the most convenient. The evolution of libraries in the coming years - both traditional and online - will probably depend on their ability to meet the information needs of users: improved ease of use and better reliability of the information. These are objectives that require money and - given the general reduction in budgets - it is not obvious that the results will be achieved. However, there are many promising experiences at the international level that show that the world of libraries is populated by projects and creativity. Traditional or digital, libraries will increasingly present themselves more as a sharing tool than as a repository of information: it is the sharing that translates data into knowledge. In the healthcare field, the integration of online libraries with the epidemiological information systems could favor the fulfillment of unconscious information needs of health personnel; libraries will therefore be a key tool for an integrated answer to the challenge of continuing education in medicine. The Internet is no longer a library but an information ecosystem where the data are transformed into knowledge by sharing and discussion.

This paper considers the impact of the new information environment on the scientific communication. Reading behavior changes: today, we browse, scan, watch, receive an impression of something. The new reading habits are not simply determined by the new tools; they are rather influenced by the need to produce and share data and information, using personalized and mobile devices. Also the content formats change: researchers, clinicians, and nurses produce texts, figures, tables, photos, videos, tweets, blog posts and they share them to readers that have to collect, appraise, recombine and - most importantly - contextualize the information. This "continuous partial production" is consistent with a "continuous partial utilization" of data; this is a risk, but it is also an opportunity. On the one side, we risk a self-referential, individualized learning process; on the other side, we can enjoy the extraordinary chance to build a "shared learning environment", able to give a comprehensive solution to the challenges experienced by the health systems. Medical journals survive as valuable media to organize data and information; the new social web tools should support the traditional publishing patterns, to enhance the sharing of information, to help the appraisal of data, and to move forward new communities of learners.

E-learning is widely used in continuing medical education but three main problems still face health decision makers: the substantial heterogeneity among the characteristics of the web-based educational projects; the concerns about the e-learning effectiveness; the variety of outcomes used to evaluate the effectiveness. Systematic reviews suggest e-learning has effectiveness similar to traditional educational methods.The attention should now be given to how and when can we use e-learning to improve the health workers' performance and better healthcare.

There is a rising interest for clinical cases in medicine. Actually, they don't necessarily conflict with the evidence-based medicine approach; rather, as several authors made clear, EBM-oriented case reports and clinical trials could be complementary. Cases and case series could even represent the first line of evidence and they are extremely valuable in discovering new pathologies and monitoring unexpected drug effects. They also play a relevant role in continuing medical education. The new section of Recenti Progressi in Medicina is edited by a prominent Italian research Institute (Istituto di Fisiologia Clinica, CNR). It focuses on a single case, guiding the physicians' decision-making from differential diagnosis to the treatment options.

Physicians cannot practice good quality health care without updating their knowledge; reading is a key component of the continuing medical education, so their reading habits have been frequently studied in the past years. The information needs of doctors usually arise during the consultation and they are commonly related to the therapeutic and diagnostic strategy. Seeking answers to these questions from primary sources, such as medical journals, is time consuming and often discouraging. The just-in-time approach should be integrated by a "proactive monitoring for newly emerging evidence". Creating such a proactive system is not an easy task: time management, triage, teamwork, take home messages and tools are the critical steps to a successful lifelong learning. The aim of this paper is to help doctors to understand the better management of clinical knowledge, and to explain how to keep up professionally with the medical literature.

EBM is 15 years old. At present the main challenge seems to be to overcome the problems that prevent EBM from being widely adopted by physicians, nurses, and health managers. Several methods for teaching and learning EBM have been evaluated and an open debate on their efficacy is underway. EBM teaching must be considered as a preliminary step to the continuing medical education process and a prerequisite of continuing professional development aimed to making learning relational, ethical, and managerial skills easier. The Continuing Medical Education Office of the Autonomous Province of Bozen, Italy, started an educational programme aimed at disseminating the evidence-based approach in healthcare. Hospital doctors, general practitioners, nurses, psychologists and health managers must gain, apply, integrate, and share evidence-based knowledge in order to improve patient health. This paper reports the encouraging preliminary results of the Project, and explains the relevance of sharing and accessing a virtual medical library, integrated by consistent e-learning courses and by a series of educational meetings among a small number of participants. It also describes the next steps for completing the educational project.

We have been invited to join the BMJ pico pilot study1 but can’t decide. Some of us are dubious about doing more work on a paper which has already been rewritten four times; others fear that publishing just an abstract in the print journal will diminish our work’s visibility.1 We wondered about the motives behind further reducing the paper research content while retaining the full electronic version of papers. Our first reaction was surprise as one …