Contemplation: of medicine and electronics

The end of the year brings out a contemplative mood in us. Perhaps this mood has infected us throughout the year 2000, a year for taking stock of human progress and for peering at the horizon. And so we've been musing on pivotal moments in medicine, discoveries that contain the future within them. The discovery of insulin in 1922. Fleming's observations of mouldy Petri dishes in 1929. Gertrude Elion's discovery in 1950 of 6-mercaptopurine, which launched cancer chemotherapy. Watson and Crick's double helix. The first human heart transplant in 1967. The Human Genome Project.

Contemplating the “Science Odyssey” (www.pbs.org/wgbh/aso/), we wonder whether the events of the last century that will have the greatest effect on health care in the next are not so much medical as in the field of communications: Marconi's first transmission of sound across the Atlantic Ocean in 1901, the prototype of television in 1926, William Shockley's transistor in 1947, or college drop-out Stephen “Woz” Wozniak's Apple I, the first personal computer, in 1976. And the creation of Mosaic — the first Web browser — in 1992 by Marc Andreesen, which gave a huge boost to Tim Berners-Lee's remarkable computer program, “Enquire-Within-Upon-Everything.”

We've spent a lot of our time since we first put the full text of CMAJ online in July 1999 trying to keep up with the Web, learning the lingo of “mark-up languages” and figuring out where we fit in the rapidly expanding universe of electronic publishing and information dissemination. In the past 12 months, monthly page views of eCMAJ have more than doubled, from 81 900 between January and June 1999 to 170 000 in the same period in 2000. Individual user sessions have increased 60% to an average of 44 963 per month. But these are just statistics. Who in fact is reading us?

The Web has widened our readership in more than one dimension. About 44% of respondents to our recent survey of eCMAJ users don't receive the print journal or even see it; of the over 60% who are nonphysicians, a significant proportion are not health care professionals. Almost a third live outside of Canada or the United States. They are from every part of the globe, and many do not have access, even through libraries, to the paper version of the journal. Some of our far-flung readers took the time to emphasize the value of electronic access — such as the physician-in-training in Nepal who wrote, “I am an enthusiastic medical student studying in a developing country that has very minimal facilities for students to stay in touch with the latest developments in medical sciences.” By supporting the print version of CMAJ, CMA members and other subscribers also help to cover the costs of disseminating the journal electronically to a wider world. We asked in our eCMAJ survey how they felt about that fact. Over 80% replied that they do not object, or that they support or strongly support continuing to provide eCMAJ without charge.

A generous gift and worthy of editorial contemplation. Best wishes for the season. — CMAJ