Stephen R.
Leeder
Editor-in-Chief
July 4th 2014
The University of Sydney Great Hall
Welcome
This is a grand day and one to be
savoured. I am delighted to
welcome you to the University of Sydney for this centenary celebration. I thank
deputy vice-chancellor Professor Shane Houston for his warm and dignified
welcome on behalf of the original custodians of this land, the Gadigal people
of the Eora nation.
I also welcome Associate
Professor Brian Owler, national president of the AMA, his predescessor Dr Steve
Hambleton, Ms Anne Trimmer, secretary-general of the AMA and Ms Jae Redden,
general manager of AMPCo. I also want to acknowledge my editorial, journalist and production colleagues from the Journal and from MJAInSight, and our support staff in commercial development, human
resources, finance, business development and information technology who work
together to make the Journal a
success.
I acknowledge members of our
Editorial Advisory Committee who give us strong and careful guidance and to our
many colleagues who send material to us, our reviewers and our commercial
sponsors. I also thank our
splendid array of distinguished presenters.
I am immensely grateful to Dr
Richard Smith, a former editor of the British
Medical Journal who has
demonstrated in his subsequent global health career that there really is life
after being an editor, who comes as our master of ceremonies for today’s
symposium and this evening’s dinner.
Richard will shortly describe to us the order of proceedings.
The organisation of today has
involved a joint effort by many members of our MJA team, especially Zane Colling and Mel Livingstone. Denise
Broeren of Think Business Events, Laissez-faire Catering and DJW Projects for
AV also deserve great appreciation.
And finally I want to acknowledge and thank our sponsors who have been
generous in their support.
Origins
I want first to speak briefly about
our origins as a journal then mention several high impact papers that the Journal has published, then consider
what one hundred years of Journal
publication means beyond the effects
of individual papers. I will
conclude with a glimpse of where I believe the Journal is headed.
When I was approached about the
editorship of the Journal 18 months
ago, Steve Hambleton, who was then national president of the AMA and chair of
the board of the publishing company, talked with me about an event to mark the one hundredth birthday
of the Journal.
I have wondered whether in
approaching me Steve had in mind that I was of an age where I had a natural
empathy for older things. Indeed I can boast of having read and contributed to
the MJA for half its one hundred
years – admittedly the latter half – so it’s true that I know a bit about
it.
The Medical Journal of Australia emerged in 1914. We can thank Dr
Cumpston, the father of public health in Australia, whose achievements are
celebrated in a wonderful book by Milton Lewis, the editor of our centenary
supplement, for providing a short history of the ten principal forerunners of
the MJA between 1846 and 1914. These
were attempts to foster communication among the medical profession in the
colonies. The Australian Medical Journal,
the MJA’s immediate forerunner,
operated impressively from 1856 to 1914.
Cumpston notes that in the
absence of a medical Journal, medicos
had to resort to newspapers to publish their views. He refers to an article
published 110 years before the first issue of the MJA in the October 14, 1804 edition of, The Sydney Gazette and New South Wales Advertiser Australia’s first
newspaper.
The article was by one Dr Thomas
Jamison and was the first on a medical subject published in the public press of
Australia. Dr Jamison had a lot to
say about smallpox vaccination in Australia. He admonished parents who mistook chickenpox for
smallpox. “There is no smallpox here”,
he said, “save for few cases spread among the natives by French ships anchored
in Botany Bay”.
But he warned that it could come
and ‘carry off nine-tenths of those affected’. “Look at the Cape of Good Hope”,
he said, “on the same latitude as Australia, where smallpox is rife.” He urged parents to have their children
vaccinated because “the preventive qualities of the Cow Pock are
incontrovertibly established; [and] it is attended by no sort of danger or
external blemish.”
”Therefore,” he thundered, (quote)
“should parents delay to embrace the salutary benefit now tendered gratuitously
and the vaccine be lost, the most distressing reprehensibility may accrue to them
for their remissness in the preservation of their offspring, whose destruction
heretofore may be reasonably apprehended to ensue from the smallpox should it
ever visit this colony in a natural state.” This is a style cultivated by
relative few contributors to the MJA
today. Jamison’s letter is able to
be viewed in the University of Sydney Fisher Library archives.
Editors
I stand
before you, the 16th regeneration not of Dr Who but of the editor of
the Medical Journal of Australia. The
first three Doctors occupied 63 years of editorship. and passed the torch to the
13 of us who have followed. But the
13 who followed, rather like the Australian cricket team often is in India,
have not lasted long save for Martyn Van Der Weyden, who was a wag in the tail
of the team, so to speak, for 15 years.
My immediate predescessor Annette Katelaris was editor for eleven
months. Her contribution was both controversial and transformative.
High-impact publications
How
should we judge the effect of the Journal?
The social media savvy amongst us will know that clout is measured by clicks. For
example MJA.com.au averages 400,000 clicks
per month and nearly 200,000 from clickers who click and stick to read.
But citations remain the royal currency in Journals. In our centenary issue of the MJA, Dr Diana McKay, one of our medical editors, used the Web of
Science citation analysis tool to examine popularity of articles published in
the MJA from 1949 to 2014 by
citation.
Safety
First
ranked is the 1995 Quality in Australian
Health Care Study by Ross Wilson, Bill Runciman, Bob Gibberd, Bernie Towler
and John Hamilton, a reprint of which you will find in your symposium satchel. I
am delighted that Bill and John are with us today. I have heard them both lecturing recently and twenty years
has only improved their vintage.
Their
paper demonstrated the shocking potential and moral imperative to improve the
quality and safety of hospital care. It prompted the Australian Government to form
the Australian Commission on Safety and
Quality in Health Care launched in 2006. The Commission’s recommendations
were written into legislation with the National
Health Reform Act 2011. The paper also ignited international interest with
replications of the study internationally, including by the WHO in developing
countries.
Ulcers
Ranked
2nd and 3rd are two papers by Barry Marshall, a Nobel
Prize-winner, on pyloric Campylobacter.
In our
Centenary issue, Barry Marshall reflects on his work in an article titled “What
does H pylori taste like?” He
describes “the deliberate self-administration of Helicobacter pylori and the observation that it caused an acute
upper gastrointestinal illness with vomiting, halitosis and an underlying
achlorhydria.”
He remembers
the audacity of my predecessor as editor, Alistair Brass, and being (quote) “impressed
by how far the MJA Editor was
‘sticking his neck out’ in allowing me to publish a hypothesis as to the cause
of peptic ulcer”. Both of them lauded and lamented the beating the paper took
from reviewers to get it into its final published form.
Lithium
The next most popular paper is
probably the most widely recognised, described once as a “jewel in the crown”
of the MJA. Professor John Cade’s
article “Lithium salts in the treatment of psychotic excitement”, published in 1949,
held the Journal’s most-cited paper position
for decades. To this day, lithium retains “its royal status in clinical
practice guidelines”. Gin Mahli, a Sydney psychiatrist, writes. “Lithium is
arguably the best agent for the most critical phase of bipolar disorder, long
term prophylaxis and as such it is the only true mood stabiliser. Put bluntly,
it works”
These papers and many more have
had good and immediate effects. Some
take a while. Recently I read a
paper written 60 years ago on drink-driving. The writer, Dr F S Hansman who had an interest in the
biochemistry of alcohol, had asked doctor-colleagues at what level of alcohol
consumption did they consider their driving to be impaired. “After two whiskies or less”, 90% of
them said. Dr Hansman found that
this corresponded to a blood alcohol of 0.04. It took 23 years before random breath testings using a
standard of 0.05 became law.
Going deep, beyond the published papers
Beside recording scientific
advances for immediate or deferred application, the MJA serves another splendid function. The one hundred years of the Journal comprise a superb record or memory of medical achievement
and of the people who made it happen.
Hilton Als, an American novelist,
theatre critic and staff writer at The
New Yorker, gave a commencement address at Columbia University in NYC on
May 21 this year to the graduating class of the School of the Arts. Als called
his address Ghosts in Sunlight. You
will find it in the July 10 issue of the New York Review of Books.
Als’ address takes its title from
an essay by Truman Capote published when he was 43. Capote’s essay, Als told the graduating students, describes
Capote’s experience on the set of the first film adaptation of his 1966
best-seller In Cold Blood. This was a
non-fiction novel about the 1959 murders of Herbert Clutter, a farmer from Holcomb, Kansas, his
wife, and two of their four children and the
murderers. Some of you may have
seen the recent version of the film.
Ghosts in sunlight
Capote found his encounter with actors
who were developing and forcefully portraying real characters from his book –
victims and murderers – deeply disturbing. Capote described how he felt he was watching ‘ghosts in
sunlight,’ as the characters he had written about had come back to life.
I doubt that we will find
anything quite as exciting as In Cold
Blood when we thumb through the archives of the Journal, but we can easily become absorbed reading the stories of
the science and clinical practice and health policy of past years and as the
characters come back to life in our imagination.
It can be disconcerting to
revisit those memories, to revive the ghosts in the sunlight of our moment. It can be disconcerting to read reviews
of the science of ailments such as obesity that have hardly changed in fifty
years and of other conditions, such as heart attack, that have changed
radically. Stories of sepsis in
the pre-antibiotic era are frightening.
Yet understanding what progress we have made or failed to make can
change us, change our views, and stimulate our imagination.
I hesitate to answer questions
from well-intentioned inquirers when they ask which papers in the Journal changed medical practice. It is a perfectly proper question, and I
have referred already to a list in the centenary issue of the Journal of the ten most cited papers.
But above and beyond those papers
with their tangible achievements and changes to how we do things, though, is the
marvellous artistic process, the alchemy, by which the stories and memories and
encounters contained in those hundreds of thousands of pages came about. This is the story behind the story, if
you will.
The hard work of science
Scientific achievement as
recorded in the MJA is always hard
won. I spent 1963 working with John Pollard on a neuroscience research project
at this university in the pharmacology department as part of a BSc(Med). We
were in search of the elusive transmitter substance between the optic nerve and
the lateral geniculate body in cats.
We did not find it. Indeed when
we presented our finding of a stimulant in extracts of sheep optic nerves that
made smooth muscles twitch and which we could not characterise and wondered if
this was the transmitter it didn’t work.
When we presented our findings at
a neuroscience conference, Sir John Eccles chaired our session and told the
audience that a colleague had found a similar substance in extracts from his
socks after a brisk game of tennis.
In returning to complete my
medical degree I recall opening Cecil’s textbook of medicine and thinking
“Every line in this book represents a research worker’s life.” The ghosts were clear in the
sunlight.
In the commencement address I
have been referring to, Hilton Als quotes Caribbean-born writer Jean Rhys who
said that: “she considered her writing to be the tiniest stream. But without
those streams, there would be no ocean, and if there is no ocean there is no
shore, and if there is no shore there is no place for our ghosts to gather in
the sunlight, those artistic forebears who wave us back to dry land when a
project seems beyond us and we lose our way, which is at least half the time.”
Neils deGrasse Tyson,
an astrophysicist and science
communicator at the Hayden Planetarium at the American Museum of Natural
History in NYC, in his TV series Cosmos
puts it another way: “Science is a
cooperative enterprise, spanning the generations. It's the passing of a torch
from teacher, to student, to teacher; a community of minds reaching back to
antiquity and forward to the stars.” It is the background culture and society
of medicine and medical research that you will find in the MJA that can be as informative and stimulating as individual papers
and articles.
Lessons from the ghosts
The ghosts of the practitioners
and scientists can change us, too, even now, even when we know that past
proposals were often wrong, that many of the lines of inquiry led nowhere
really. They can help us toward
humility; they can help us see how we, too, like the authors of the pages that
we turn, are creatures of our time.
They can make us tolerant of the
false starts, of the well intentioned failures, even of the pomposity of our
colleagues. (‘What’s good for
doctors’, opined the first editorial in the MJA,
‘is good for the community!’ Ahem!)
Ghosts can also frighten us: Capote writes about having to take a bottle
of scotch to bed to obliterate the ghosts of the characters of his book from
his consciousness.
When all of the issues from 1914
the MJA are digitised, as we plan them
to be when we have raised the $70K for that purpose (hint, hint), exploration
of the past and encounters with its ghosts in the sunlight will be a possibility
for all, anytime, anywhere.
Glimpsing the future
Today we celebrate a unique
record of medical memory in Australia that stretches back 100 years. This can be a day to renew our quest
for sounder medicine, for safer and better patient care, for new insights into
preventive possibilities and indeed to recognise and manage our own humanity
and frailty and proneness to error with gentle acceptance. The ghostly values can warm and correct
us and set our hearts racing.
The MJA has a bright future if we maintain our deep respect for
science, for imagination and humane concern for our patients, the profession, and
society and indeed for everyone in the organisation that contributes to the Journal. As we look to possible futures of the Medical Journal of Australia, we need to be open to the unbidden,
the unplanned, and the serendipitous that is never completely captured in a
strategic plan.
We are in the middle of the most
exciting explosion of knowledge in human history, with multiple media to
communicate and sift it. These dynamics will affect the form and style of the Journal and even its ethics. The format
of the Journal will need to become
more attuned to contemporary ways of communicating, the content more flexibly
responsive to the needs of our diverse readership through electronic tailoring
and streaming of content to them where and when they need it. Already we have a substantial presence
in the social media and this will grow.
To remain a trusted instrument of
record, where contemporary medical knowledge and reflection is written
carefully and history is recorded, that
will require all our skill and imagination about new and efficient ways of
communicating through multiple media.
That is what we at the Journal are committed to doing and we
thank all of you for your continuing support as we move into our next century.
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