The role of a general medical journal

22 December, 2019

Dear All,

We share the article below from BMJ archives, our inner thoughts about the need and value of sharing health information from the local to the international arena, in 2004. Amazing how those thoughts hold true even today: Read on

[*see note below]

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT

[*Note from HIFA moderator (Neil PW): For the benefit of those who may not have immediate web access, below is the full text of the article:

BMJ. 2004 March 6; 328(7439): 591.

Personal View

The role of a general medical journal

Joseph Ana, managing editor

Good science, good research, and patients will be the victims unless there is a free exchange of health information worldwide. Because doctors practising in countries with the heaviest burden of disease have the least access to medical journals and other forms of health information, and also have the least access to quality undergraduate or specialist training, the general medical journals that they are likely to see must carry material that is relevant to all doctors, whether in rich or poor countries.

A general medical journal should publish material that is robust enough scientifically to help doctors and other health professionals practise medicine better. It should be influential enough to have an impact on health policy. It should carry interesting educational and peer reviewed papers, so that it retains a reputation for excellence. It should help to remove health policies and practices that are not evidence based. While it should carry international research, papers should be relevant and attractive to local medical practitioners.

Journals should be a rallying point for the local and international exchange of ideas

A vocal minority of health professionals in developing countries have recently argued that all good research conducted in these countries must be published only by local journals. This is a mistake. Countries without the economic, scientific, or technological resources that rich countries enjoy will not catch up if they decide to engage in navel gazing and so miss the dizzying progress beyond.

Isolationism is not the answer. Rather, we in the developing world should embrace “globalisation in health information.” Researchers and editors in developing countries should be supported and encouraged to produce material of the quality achieved in rich countries, but we should be free to publish the material in any journal in the world. It is heartening that already some publishing houses and organisations in the developed countries are helping in several ways to achieve this objective. The recent formation of the Forum for African Medical Editors is a good example of such mutually beneficial cooperation. I can understand the sentiment of colleagues who say that developing countries are disadvantaged when it comes to publishing our local research, but the answer is not to isolate our health community from the best research work, wherever in the world it takes place. While the scientific community in the developed world made unimaginable advances, because of decades of stability, many poorer countries suffered decay. Thankfully, stability is returning to the developing world. Globalisation, cooperation, and a widening of choice must be the way for these countries to catch up. We can overcome bias if health and research institutions in developing countries become better equipped and better run so that their research can compete with that in the developed world.

In several parts of the world more and more health professionals who are not doctors are taking on clinical roles traditionally considered exclusive to doctors. In west Africa this has arisen — and is likely to persist — because of the chronic shortage of doctors. Nigeria, for example, with a population of 120 million people, has fewer than 15 000 doctors across all specialties and all grades. From its beginnings in 1996 the West African edition of the BMJ has advocated multidisciplinary cooperation and practice. It has advocated that rather than waste time and scarce resources in trying to ban professionals who aren't doctors from delivering care the authorities should spare no efforts in training them and structuring and then regulating their practice under close supervision and according to agreed protocols. Good original research in developing countries is constrained by a lack of resources. Thus general medical journals should carry both original research, so that practitioners in the relevant fields can update their skills and knowledge along the lines of the latest international thinking, and clinical studies, so that clinicians can exchange experiences.

A general medical journal should also include other material, such as obituaries, news, topical debates, and expert commentaries. Journals should be a rallying point for the local and international exchange of ideas. Readers in less developed countries may wonder why a general medical journal in their territory should carry original papers. The answer is that they cannot shut themselves off from the enormous scientific and technological progress taking place in richer countries. If doctors are to convince their funding agencies, and if governments are to equip and improve the local health institutions, doctors need to show they are keeping up to date with the latest research worldwide, as shown in improved outcomes among their patients. A general medical journal needs to inform practitioners of the latest developments so that when better facilities and drugs are eventually provided doctors are ready and able to put them to use to the benefit of patients. It will be a pity to seek to produce only “local champions” in the 21st century.]