How can the immunization gap be decreased? The a person attending school, then a no-fault insurance differences between the immunization rates in Ontario program must be developed so that in the rare instance and Alberta may reflect more than differences in the of a vaccine-related injury the person may be commethod of delivery of vaccines - that is, private ver- pensated. Finally, if parents and physicians are to know which sus public. In addition to a larger population, Ontario has the substantially larger problem of new immigrants vaccine a child has received and when it was received, in urban areas. Nevertheless, the differences are strik- our disastrous system, or nonsystem, of keeping iming and suggest the need for a very hard look at why munization records must be improved. The vaccines are available - we must find better ways of using so many children are not immunized. If children are not fully immunized because they them. do not have routine health care, then the private approach to immunization is not likely to succeed. References If older schoolchildren are to receive the recommended 1. GRIOG NI: immunizaton Status of School Enterers, 1978, boosters, school health programs should be given the health programs division, program development branch, Ontario Ministry of Health, Toronto, Apr 1979 responsibility and provided with the necessary perIdem: Immunization of the School Population, health prosonnel and funds. Serious attention should also be 2. grams division, program development branch, Ontario Mingiven to the enactment of compulsory immunization istry of Health, Toronto, Jan 1979 laws associated with school attendance. It is not suf- 3. Notifiable diseases summary. Can Dis Wkly Rep 5: 104, ficient to check immunization records only when chil1979 dren start grade 1; immunization must be updated at 4. SHIMA E, WHITE F: Childhood Vaccination Status, Alberta, 1978, report of the director of communicable disease conrecommended intervals. The success of such laws in trol and epidemiology, Alberta Social Services and Comimproving measles immunization rates in the United munity Health, Edmonton, July 9, 1979 States has been dramatic.5 However, if immunization 5. Measles and school immunization requirements - United is made compulsory or even highly recommended for States, 1978. Morb Mortal Wkly Rep 27: 303, 1978

Choosing medical journals N.J.B. WIGGIN,* MD, PH D

Most branches of medical practice demand not only intellectual, emotional and even physical stamina, but also a disciplined use of the physician's time. If patients' problems are to be diagnosed and treated with clinical and scientific competence combined with emotional sensitivity and maturity within the context of a sane perspective on the human condition, doctors must apportion their time so that there is reasonable provision not only for their patients but also for their own family and friends, physical and intellectual recreation and relaxation, and the maintenance of an adequate store and appreciation of current medical knowledge. It follows that there are severe limitations on the total time available to most doctors for whatever mix of refresher courses, scientific meetings, taped lectures and the reading of textbooks and journals has been found to be effective in relation to their personal learning patterns. Because they do not have reading time to waste, doctors must, for the sake of their patients as well as for themselves, be dispassionate *Scientific editor, Canadian Medical Association Journal Reprint requests to: Dr. N.J.B. Wiggin, CMA House, P0 Box 8650, Ottawa, Ont. KiG OGS

in the selection of the journals to be included in their individual knowledge maintenance programs. In contrast to President John F. Kennedy's dictum they must ask What can or does this journal do for me? rather than What can I do for it? Discard any general medical journal for which an honest Yes cannot be given to a number of the following questions: * Can I rely on the clinical and scientific validity of the observations and data reported in this journal, on the methods employed in their collection and analysis, and on the conclusions drawn from them? In other words, are the manuscripts submitted to this journal subjected to rigorous peer review and required to meet adequately high standards before being accepted for publication? (If the answer is No the journal should be avoided until it undergoes a significant change, because continued exposure to the misinformation it currently contains can be dangerous to one's professional health.) * Do the articles in this journal keep me informed regarding the health problems being encountered and the manner of their management by my colleagues in this region and this country within the physical, china-

698 CMA JOURNAL/SEPTEMBER 22, 1979/VOL 121 For prescribing information see page 775-.

tic, cultural, occupational, economic, political and health care environment within which I practise? * Do the articles in this journal provide enough detail regarding the clinical features, diagnostic considerations and therapeutic or preventive management of health problems that I may encounter in my practice to make me more competent to handle such problems, or do they merely fill my mind with vague generalities? * Does this journal help me to maintain a current appreciation of what my colleagues in other fields of practice are doing and what they may be able to do for a patient whom I might refer to any of them, so that I may be in a better position to advise my patients regarding the possible benefits of referral and to evaluate the outcome of such referrals? * Do the editorials in this journal provide authoritative comment on current clinical and scientific problems and advances or assist me in assessing the significance of a report or its relevance to my practice even though the article may lie somewhat outside my field of expertise? * Does this journal assist me by sifting, weighing, correlating and identifying the net results of 100 or more papers on a topic of interest to me in a way that I could not possibly find the time for or have not the requisite expertise to do myself? * Does this journal endeavour to exercise my medical curiosity or deductive capacities or to broaden my professional horizons by presenting me with all the clues required to diagnose an actual but challenging clinical problem before providing me with the answer? Does it endeavour to give me glimpses of the shape of medical things to come by informing me of significant developments on the frontiers of biomedical science? The answers to these questions with respect to the Canadian Medical Association Journal have not been and are not yet all affirmative, but we are working on making them so. All papers submitted to the Journal are subjected to searching review by two to six or more highly and appropriately qualified external referees, depending on the number of different disciplines involved in the assessment of all aspects of the diagnosis and management of a case or the design, execution and analytic components of a study being reported. The roster of referees has undergone major revision and continues to expand on an international scale. Much greater use is being made of a wider range of disciplines, which includes not only the usual clinical and basic biomedical sciences but also such disciplines as epidemiology, biostatistics, medical sociology, clinical and experimental psychology, biomedical engineering and medical pedagogy. The final result of these searching reviews is the rejection of more than 75% of all papers currently being submitted to the Journal because of clinical and scientific deficiencies beyond remedy. It is anticipated that this percentage will increase as the number of papers submitted and the Journal's standards continue to rise. Although some of the remaining 25% of papers are excellent, many of them reach Journal standards only after one or more major revisions have been made on the basis of the critiques of the referees. The credit for the improvement in the quality and 700 CMA JOURNAL/SEPTEMBER 22, 1979/VOL. 121

reliability of articles accepted for publication that has occurred must go to the external referees and the prodigious but largely anonymous effort they put into writing several thousand detailed critiques, requiring countless hours of devoted attention, per annum. Although much of their work results in the return of most manuscripts to authors, copies of their reports accompany the rejected papers and constitute a significant learning experience for many clinicians and investigators. Although the number of editorials per issue varies, the average number devoted to clinical and scientific topics has been rising steadily. The number of authoritative review articles on topics of wide current interest has been increased to at least one and, more often, two in each issue of the Journal. In this issue we introduce what is expected to be a series of periodic clinicopathological conferences from various medical centres in Canada under the caption "Diagnostic Challenge". This series is made possible by a generous grant from Glaxo Canada Ltd. on behalf of Glaxo Laboratories and Allen & Hanburys. The funds provided are being used for only one purpose - honoraria to the authors of the conference reports - and have only one string attached - excellence. All such case reports are submitted directly to the Journal, are subjected to peer review and are accepted or rejected by the editorial committee without reference to the sponsor. A number of multidisciplinary committees are being formed across the country (such committees have already been formed in Vancouver, Calgary, Winnipeg and Halifax) to write and supervise the preparation of pharmacotherapeutic reviews, which will be added as a regular Journal feature within the next few months. Each committee is, or will be, chaired by a pharmacologist of national repute who will be identified along with his or her colleagues when the article appears. Many members of the practising medical community in Canada are unaware of the significant contributions being made by Canadian biomedical scientists to our understanding of the functioning of the human organism in health and disease and to the scientific base required for new or improved diagnostic and therapeutic techniques. With the cooperation of the Medical Research Council of Canada and a number of its senior investigators, a continuing series of articles under the title "Advances in Biomedical Research" will be introduced in the Journal in the coming months. Assess the Journal against the questions listed here and any others you care to add. If we measure up, stay with us. If we do not meet your requirements, leave us for awhile but keep checking on us from time to time because we are changing. If you are an author and you usually submit your papers to one or more prestigious foreign journals, why not try us? We will make no commitment to accept your manuscript, but we will give it a thorough going-over. If it is accepted it will go not only to approximately 35 000 domestic and foreign doctors, medical libraries, and so forth, but also will be listed in "Current Contents" and "Index Medicus" and will result in a surprising number of requests for reprints.E

Choosing medical journals.

How can the immunization gap be decreased? The a person attending school, then a no-fault insurance differences between the immunization rates in Onta...
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