Monday, May 20, 2013

BREATHE DEEPLY AND SAY ‘NINETY-NINE’*


On July 4th 2014, the Medical Journal of Australia will celebrate its centenary, so we are about to turn 99! 
Whatever the outcome of the federal election on September 14th, new national policies for the financing, governance, quality and scope of publicly funded medical and hospital care will soon be under construction. 
For these policies to work well, the new government will need the participation of those who will implement them, including, quite obviously, the medical profession.  For participation to be at its best, the profession needs access to the information that underpins high quality professional performance.  Throughout its 99 years, the Journal has helped communicate that information amongst the profession and beyond.
The Journal has always played this role. My historian colleague Milton Lewis points out that in doing so it has continued a tradition dating back even further to colonial days. The first Australian journal was born in Sydney as early as 1846. Lacking adequate support, it soon ceased publication. But the better organised Victorian profession (has anything changed?!) was able to establish a quarterly journal, the Australian Medical Journal, in 1856.
The Australian Medical Journal continued to be published in Melbourne for over five decades until along with the younger, Sydney-based, Australasian Medical Gazette, it was replaced by the national publication, the Medical Journal of Australia.1 Throughout this time, the other significant source of intra-professional unity (and an effective political player at both State and federal levels) was the British Medical Association, the first Australian branch of which was set up in Victoria in 1879 and the second in NSW the next year.1 Its successor, the Australian Medical Association, operates the Journal.
The Journal has contributed to the development of medical care and health by providing a place where research and clinical observation is published, where thoughtful opinions based upon experience and evidence from the sciences and practice are offered, where concerns ethical, political and legal about health and health care are raised, lifes passage is marked (most often with obituaries), successes celebrated, courage and outstanding professional service recognised. The wit and wisdom of correspondents have entertained and stimulated and the Journal has been a strong component of the professionalisation of medicine in Australia.
The Journal has regularly changed its format and livery but its central purposes have remained largely intact.  Now it is also available online, on mobile phones, laptops and (non-medicinal) tablets anywhere, anytime, as it joins the dance of the Internet. The dynamism that is challenging print media more generally extends its challenge to the Journal.  New business models to sustain it are essential and work continues to develop them. But for a near centenarian it has shown remarkable flexibility, optimism and athleticism!  If only we could all do as well at 99!
This is an excellent moment for the Journal to promote and strengthen the publication of research especially that which assesses clinical effectiveness and new ways of organising and providing care.  Policy-makers, managers and clinical practitioners are hungry for evidence to help them decide. 
As McKeon and colleagues in their review of health and medical research in Australia noted, we spend comparatively little on health care research and development in Australia.2 They call for a substantial increase in R&D investment (to 3-4% of government health expenditures) to address the problem of expenditure on health and hospital care, which is rising faster than our willingness to pay.2 The Journal is here to publish and disseminate such research.
Medical journals depend heavily on voluntary contributions from doctors and other health service professionals, research workers, patients, politicians, health service managers and experts with an involvement in health and medicine from diverse fields of interest and work.  Without the altruism of colleagues presenting their ideas for others to read and examine critically, there would be no journals.  It is the desire to share insights for the benefit of patients that features strongly among the reasons that include professional advancement why contributors write papers, commentaries, case studies and reviews.  A love of the profession leads others to submit material that sustains the spirit, by way of personal stories, art, poetry or letters.
This is a rich background against which to plan for the future.  The Journal takes those gifts, these contributions given to it in the past and sees them as markers of its heritage and future strength.  They explain why we are optimistic and why we look forward to your company when we celebrate our 100th in July 2014!

1.Lewis M, MacLeod R. Medical Politics and the Professionalisation of Medicine in New South Wales, 1850-1901. Journal of Australian Studies 1988; 2: 69-82.
2. Mckeon Report. Strategic Review of Health and Medical Research. Final report Feb 2013. http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf (accessed April 2013).

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