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Medical Care

Past, Present, and Future

Tierney, William M. MD; Weinberger, Morris PhD; Ayanian, John MD; Burnam, Audrey PhD; Escarce, José J. MD, PhD; Hays, Ron D. PhD; Horner, Ronnie D. PhD; McHorney, Colleen A. PhD; Oddone, Eugene Z. MD; Romano, Patrick MD; Powe, Neil R. MD, MPH, MBA; Stearns, Sally PhD

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In the January issue of Medical Care, we take the opportunity to report on the status of the journal. This is the final installment of this annual editorial that the current group of editors will write. When we accepted the editorship of Medical Care in 1997, we agreed to serve for 5 years. We believed then, and believe even more strongly today, that a journal such as this is healthiest if the editorship changes hands on a regular basis. This provides the best chance of maintaining enthusiasm and creativity while advancing the journal in a changing world of peer-reviewed science.

The world of peer-reviewed journals has never been more dynamic. The Internet and electronic publishing are beginning to exert their effects in major ways, the results of which can only be imagined today. Although there has been much discussion of the electronic medium in publishing circles for many years, one can trace the current flurry of activity to the proposal made by Harold Varmus, then Director of the National Institutes of Health, to create E-Biomed. E-Biomed was planned to be an electronic compilation of medical scientific articles that would be freely available over the Internet to anyone wanting to read them. 1 The resulting furor ignited a reexamination of the nature of scientific publication, intellectual property rights, and copyright ownership. Many in the medical librarian and medical informatics disciplines welcomed E-Biomed as a long-overdue migration of scientific communication away from publishing houses and into the Internet’s freely accessible environment. 2,3 Others saw E-Biomed as a mechanism that would undermine the evaluation (and improvement) of science through the traditional peer-review process. 4,5

Following the initial furor, the concept of E-Biomed has evolved to PubMed Central, an extension of the current PubMed in the National Library of Medicine, which would be a repository of full-text articles appearing in traditional peer-reviewed journals. 2,6 At the same time, other efforts to increase Internet access to the medical literature have continued. For example, the British Medical Journal has made its full-text contents available for free to anyone with Internet access (, while Stanford University Libraries have created High Wire Press (, another electronic, Internet-accessible repository of full-text scientific articles. Moreover, for years, Ovid Technologies has made full-text articles from more than 100 peer-reviewed medical journals available to those willing to pay for the service.

Finally, not wanting to be left behind in the rush to electronic publishing, many major publishing houses have moved toward making the contents of their peer-reviewed journals available to subscribers on-line. In the coming year, Medical Care will join this expanding list of electronically accessible journals. We are working closely with our publisher, Lippincott Williams & Wilkins, to develop an electronic journal that is more than a mere reincarnation of the current paper version. While the move to the electronic medium will be gradual, Medical Care will ultimately offer capabilities and opportunities that are constrained by the paper medium. For example, clicking on a citation in an electronic Table of Contents will take the reader to the abstract of that article. If the reader is a subscriber, the full text will also be available. Nonsubscribers will have the option of receiving the full-text article for a price yet to be established. The electronic medium will provide authors with the opportunity to attach additional information to the Internet version of the article (eg, survey instruments, more details concerning their methods, and additional data), thus allowing more information to be shared with interested readers without having to publish voluminous appendixes that take up precious pages in the paper journal.

Once full-text articles in Medical Care become widely available on the Internet, we anticipate that they will be identified by various search engines and therefore accessed by an increasingly broad spectrum of readers: scientists, health care providers, administrators, and the general public. In anticipation of this new, expanded audience, we will soon request that authors of articles appearing in Medical Care supply a brief (100 word maximum) abstract, in addition to the current scientific abstract, that is understandable to a general lay audience. This will serve to increase the potential impact of Medical Care’s high-quality science. In this new electronic medium, a journal’s health will depend heavily, if not entirely, on the quality of its scientific content. In this respect, we are confident that Medical Care will flourish.

Dealing with this new medium will present the next editors of Medical Care with both challenges and opportunities for creativity. For example, if the number of persons accessing the electronic version of Medical Care increases dramatically, the new editors will have to work with Lippincott Williams & Wilkins to decide whether (and how) to use this opportunity to increase revenues from advertisements, how to price individual articles, and whether Medical Care should contribute its articles to PubMed Central. Much remains to be done; it will be an exciting time.

As usual in this yearly editorial, we would also like to take the opportunity to report statistics on the processing of the manuscripts we have received in the past year. As in previous years, we have restricted this analysis to the manuscripts received between January 1 and August 31 (Table). As can be seen, almost three fourths of the articles sent out for peer review are processed in 2 months. The average time from acceptance to publication is 6 months. These numbers have been essentially stable for the past 3 years.

Manuscript Statistics

In the final analysis, a journal is only as good as its content. We have been fortunate to receive what we believe to be among the best articles in the broad set of disciplines that constitute health services research. For this, we can only thank the authors who have sent us their work and the peer reviewers of Medical Care who have worked so hard and selflessly to assess and improve the manuscripts sent to us.

We wish our successors the best of luck and know that they will receive the generous cooperation of their Deputy Editors, reviewers, and staff at Lippincott Williams & Wilkins. We have derived immense enjoyment from editing Medical Care and believe that the new editors will do so as well.


1. Varmus H. E-Biomed: a proposal for electronic publication in the biomedical sciences. NIH preprint 04.99doc. Bethesda, Md: National Institutes of Health, April 1999:19.
2. Markovitz BP. Biomedicine’s electronic publishing paradigm shift: Copyright policy and PubMed Central. J Am Informat Assoc 2000; 7: 222–229.
3. Jacobson MW. Biomedical publishing and the Internet: Evolution of revolution? J Am Informat Assoc 2000; 7: 230–233.
4. Relman AS. The NIH “E-Biomed” proposal: A potential threat to the evaluation and orderly dissemination of new clinical studies. N Engl J Med 1999; 340: 1828–1829.
5. Floyd E, Bloom FE. Just a minute, please. Science 1990; 285: 197.
6. Greenberg DS. National Institutes of Health moves ahead with “PubMed Central.” Lancet 1999; 354: 1009.

Editorials; electronic publishing

© 2001 Lippincott Williams & Wilkins, Inc.