The Changing Character of Medical Literature, 1974 [I]
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the changing character of the medical literature martin m curaraings m d i am pleased to be given this opportunity to speak in am international forum about a subject which has global implications medical literature has grown exponentially since the 17th century today i plan to discuss several other characteristics of the medical literature particularly its source language and changing quality my perspective has been acquired as a physician who for the past ten years has been charged with the responsibility of not only acquiring indexing and cataloging the worlds biomedical literature but of developing new information services based on that literature the emergence of new disciplines in basic medical sciences in the 19th century was clearly reflected in the titles amd the substance of new scientific journals as well as of books and monographs importantly scientific methods were applied to medicine in the late 19th century the site for leadership and innovation changed from italy france germany england to a number of other countries amd this in turn developed into an international interaction with the movement of men and publications the emergence of american medical sciences as no longer totally dependent on foreign science occurred at the turn of the 20th century the importance of medical research and sciences was greatly amplified in the 1950's when large sums of u s federal director national library of medicine addressing the medical society of the world health organization geneva switzerland march 7 1974 analysis of worlds meland literature by origin language etc international amphence impressed of facilities medical staff and medical schools

Page  2 page 2 funds were made available for support of medical research at this time also the unilateral flow and migration of u s physicians and scientists reversed itself our foreign colleagues began to come to the united states in enormous numbers for medical education training and research from its modest beginnings in 1836 when the national library of medicine had only 137 titles of which only two or three were american produced we now have a collection of 1.5 million items with more than 20000 serial titles today the u s produces about one third of the serial titles in medicine it is significant that almost one third of these serial titles no longer exist as active publications each day two new scientific journals are born while one dies data derived from the science citation index provided by the national science board in 1973 1 reveal that the united states produced the largest share of literature in physics and slides geophysics molecular biology systematic biology economics mathematics and engineering the only area analyzed in this report in which the u s did not rank first among nations was chemistry and metallurgy if one separates these disciplines the u s produces more literature in chemistry than any other country in molecular biology the u s produced almost half of the worlds literature with each of the next largest producers 1 science indicators 1972 report of the national science board 1973 national science foundation

Page  3 page 3 providing only 9 uk and france one important change is evident in scientific publications namely the emergence of english as the most frequently used language of science webb 2 reports that during the past 50 years the number of biochemical papers published in english has increased from 40 to 90 in medicine we would estimate a slower transition from approximately 40 to 55 during the same period the following analysis of the biomedical literature reveals some interesting data the national library of medicine slide acquires annually 19000 serials published throughout the world approximately 73 of these originate from eight countries with 36 from the united states approximately 8000 serials are thought to contain original materials related to medicine from these periodicals 2244 are selected by an advisory group of experts for inclusion in our computer-based system medlars and 76 of these chosen serials again come from the same eight these countries but with slightly different order of ranking 2244 serials represent 66 countries and 36 languages sixty two countries publish single-language journals and the number of languages represented in this category is 26 1172 52 are published in english only and are produced in 39 countries addition there are 300 polyglot journals 178 or 59 use in 2 webb e c communications in biochemistry nature 225-228 jan 10 1970 pp 132-135

Page  4 page 4 english as the primary language a comparison of those articles published in the first issue slide of index medicus in 1879 with those in the index medicus of 1972 is revealing the number of articles has increased ten-fold there is a significant shift toward the english language from to 42 to 64.5 with a decline in french german spanish and italian russian japanese and some slavic languages have gained in prominence furthermore whereas the united states and great britain accounted essentially for all the english language articles in 1879 today english language articles now emanate from 52 countries also a significant percentage of these foreign language articles now carry english abstracts russian 59 italian 54 german 49 spanish 39 japanese 32 french all other foreign 52 in any examination of the medical literature one must distinguish between the large amount of uncritical anecdotal writing which characterized the 18th and 19th centuries and the more scientific and technical writing which appeared in the 20th century the former gives an image of medicine as a

Page  5 page 5 reflection of the civilization of the time the latter more clearly portrays the evolution of scientific ideas concepts and inventions when it became generally accepted that research was incomplete until published there was a further rise in the number of manuscripts and reports dealing with scientific and social aspects of human health and disease the published literature expanded at such a rate that it was soon necessary to expand the abstract journals which gave informative summaries of much of the work which had been published in more comprehensive form the great expansion of scientific writing in the 19th century led to the development of index catalog and index medic us prepared by dr john shaw blllings first director of the national library of medicine at the turn of this century dr william h welch identified these awesome products as america's greatest contribution to medicine the 20th century brought forth multi-disciplinary and interdisciplinary research which generated the need for new types of journals some highly specialized discipline-oriented journal titles were soon replaced by those with broader scope and coverage of subject material however as the base for medical science broadened biomedical science itself became more fragmented highly specialized journals reappeared and now greatly outnumber those of a multidisciplinary nature this

Page  6 page 6 is dramatically exemplified by the recent creation of a journal which deals with one series of chemical compounds alone the prostaglandins in the ten years since the isolation and chemical identification of prostaglandins were described in sweden more than a thousand papers dealing with these compounds have been published wm the most important contribution to medical literature came when a more rigorous editing process was introduced here groups of highly competent individuals began to undertake the task of reviewing and evaluating manuscripts prior to publication a process which previously usually fell to a single editor alone despite this important development there is still no guarantee that the quality and accuracy of published medical research is as good as it should be with the introduction of multi-authored papers the style and clarity of writing often deteriorated this was accompanied by an increase in the length of individual articles as well as in the complexity of the material reported in addition to serving as an information source for highly specific scientific events the medical literature also serves to reveal the changing trends and growth of medical thought sometimes it innocently or deliberately ignored the true origin of a new idea but most often through careful historiography one can trace the convergence of previous bits of information into the building of a new hypothesis or into the development of

Page  7 page 7 a new practice or procedure nevertheless there are always some problems of historical interpretation and evaluation which remain for future historians to analyze and explain this is particularly true in the field of social medicine where many external societal factors have influenced medical developments the development of automated systems for bibliographic control of a vast literature has made it possible for physicians scientists and educators to find articles relevant to their interests among the more than 2 million scientific papers which are published annually the national library of medicine which pioneered in the use of computers for technical processing and bibliographic development has made available a most substantial amount of the worlds medical literature for identification and retrieval in a matter of minutes the development of medlars followed by the on-line system medline has kept practitioners and scholars abreast of medical advances without drowning in a sea of publications medline now provides more than 200000 computer searches annually there are 250 health-related institutions connected to our computer system the system also provid es services to sweden uk france and canada it is hoped that the lesser developed countries will soon be able to receive similar services through a who-based med line center here in geneva

Page  8 page 8 i would be remiss in this setting if I did not acknowledge the significant contribution made by the world health organization to the biomedical and health literature the scope of the world health organization publications reflects both the variety of who activities and its user communities thus who publications include periodicals monographs technical reports reference works public health papers directories and official records the publication program is of such a size and complexity that it has been the subject of a number of reviews and analyses-a very detailed one in 1960 and again in 1971 as part of an organizational study on services to members the world health organization publications serve an important function as a link between a large international-intergovernmental organization and the professional medical worker finally one might properly ask why science continues to be concerned with publications as a principal means of information transfer particularly why has the scientific journal survived three centuries of development when few other devices other than oral communications have lasted more than a few decades purpose of the scientific journal has been described by ziman to bring into the public domain an explicit account of some new scientific development or discovery the whole activity of science is dependent on the publication of such 3 ziman j m public knowledge an essay concerning the social dimension of science cambridge university press 1968

Page  9 page 9 documents and their subsequent criticism re-evaluation amd eventual acceptance or rejection as parts of the consensus of public knowledge he also stated that the literature of a subject is quiteequent criticism re-evaluation amd eventual acceptance or rejection as parts of the consensus of public knowledge he also stated that the literature of a subject is quite as important as the research work that it embodies these views ofequent criticism re-evaluation amd eventual acceptance or rejection as parts of the consensus of public knowledge he also stated that the literature of a subject is quite as important as the research work that it embodies these views of a distinguished british theoretical physicist need reinforcement in this period of history when research is expensive and our tolerance for redundancy of effort must be more limited as the funds for support of science become more difficult to acquire few scientists cam make original scientific contributions without an awareness of the previous work of others science i grows sequentially as research leads to new knowledge back ground information can be acquired from many sources but reading still ranks high as a means of learning what has been developed in the past writing about the relative value and efficiency of learning about scientific developments at meetings versus reading the literature said the man who reads providing he is intelligent will always learn more whether this generalization is true for all is an open question nevertheless it is clear that most scientists prefer to describe their original research in publication form and many certainly acquire new knowledge by reading the real problem is that there is inadequate time for both discussing and reading sciencej new mechanisms for engler 4 the way of science hafner publishing co n.y 1970

Page  10 page 10 contributing and retrieving relevant information need to be developed information in written form is available for study evaluation or debate whereas informal information transfer although speedy may not be as reliable or defensible it is much easier to retract or deny what one has said than what one has written i take some comfort in this now as i conclude this brief report