To sort and to order

Are Brean About the author

The digital age changes the role of journals, but much remain the same.

Photo: Einar Nilsen

«In this journal there will be writing for common learning and benefit; here, as the proverb says, the manifold small streams will gather to form a mighty river. We therefore find comfort in seeing that our effort as editors will not consist in collecting material, but rather therein, from this wealth to sort and to order» (1).

These are the words of the editors in the first editorial of the first issue of the predecessor to the Journal of the Norwegian Medical Association, the Journal of Practical Medicine, in 1881. And «sorting and ordering» was what they did: the editors collected material from Norway and abroad, wrote articles about medical innovations and reviewed relevant books (2). The medical science of the age was undergoing rapid change, but the amount of information was manageable for the average doctor, not least because the editors «sorted and ordered».

Nearly one hundred years would pass before the Journal of the Norwegian Medical Association could make use of new information technology for purposes of «common learning and benefit» among doctors. In the 1970s, the journal’s tape cassette appeared – a monthly digest of voice-recorded articles, two times thirty minutes (3). The first articles on the use of electronic data processing in clinical practice appeared in 1980, in which some were worried whether a computer could at all be accommodated (!) in an emergency ward (4). Nevertheless, with the exception of printed textbooks, a journal subscription remained the only source of professional updates for most doctors.

The Internet has changed all this. We have not only accommodated a vast number of computers in emergency departments and doctors’ surgeries; these machines also provide access to a plethora of medical material that was completely inconceivable in the first 100 years of the Journal of the Norwegian Medical Association. Today, at least 75 original articles and eleven systematic review articles are published every day (5). More than 28 000 scientific journals publish a total of 1.8 million articles every single year (6). Many of them are immediately accessible from any computer, such as the one that you most likely are carrying in your pocket.

Much of this information is useless and often directly erroneous (7). The paradox is that this flood of information helps make it even clearer that in our clinical practice there are few definite answers (8, 9). In a world where keeping up with the literature in even quite narrow specialties has become practically impossible (10), clinical medicine has pursued a solution of increasing specialisation into branches and sub-branches.

Much has been written about the need to redefine the role of journals in this new electronic reality (11). Perhaps the journals of the future should publish fewer research results, and instead devote more of their resources to information, comment and analyses (12)? Paradoxically, such a contextualising role for journals may serve as a counterweight to the fragmentation of medical science. Because, by staying updated about general matters we can maintain a professional identity – first and foremost as doctors, and as specialists only second.

In such a way we may have gone full circle – because this is where it all started, with a journal for «common learning and benefit» (1). We thus see a common thread of continuous development running through the 134 volumes of the Journal of the Norwegian Medical Association, from the first editorial, through tape cassettes, digital issues and our new website that we will launch in a couple of months. The Journal of the Norwegian Medical Association shall remain a unifying element for all of Norway’s doctors and still be produced through an interaction between authors, reviewers, readers and editors – in a community and an identity that we all help create. And yes – we will continue to be published in a paper edition!

In 1890, nine years after it was first published, the Journal of Practical Medicine changed its name to the Journal of the Norwegian Medical Association. In their first editorial, the editors wrote: «The steadily growing recognition of the importance of the medical association and its journal as a bond of attachment between colleagues imbues us with the hope that the new editors will enjoy support in their work. Whether we are too sanguine in this anticipation, only the future will reveal» (13). The current editor agrees.

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