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ContextTo determine whether the views expressed in a research paper are accurate representations of contributors' opinions about the research being reported.MethodsPurposive sampling of 10 research articles published in The Lancet; qualitative analysis of answers to 6 questions about the meaning of the study put to contributors who were listed on the byline of these articles. Fifty-four contributors listed on the bylines of the 10 articles were evaluated, and answers to questions were compared between contributors within research groups and against the published research report.ResultsA total of 36 (67%) of 54 contributors replied to this survey. Important weaknesses were often admitted on direct questioning but were not included in the published article. Contributors frequently disagreed about the importance of their findings, implications, and directions for future research. I could find no effort to study systematically past evidence relating to the investigators' own findings in either survey responses or the published article. Overall, the diversity of contributor opinion was commonly excluded from the published report. I found that discussion sections were haphazardly organized and did not deal systematically with important questions about the study.ConclusionsA research paper rarely represents the opinions of those scientists whose work it reports. The findings described herein reveal evidence of (self-)censored criticism, obscured meanings, confused assessment of implications, and failures to indicate directions for future research. There is now empirical support for the introduction of structured discussion sections in research papers. Editors might also explore ways to recover the plurality of contributors' opinions.

quality care. Plaintiffs’ attorneys, physicians, and patient safety proponents need to work toward achieving their stated central motivation (ie, protecting patients from medical errors and fairly compensating the unfortunate few who nevertheless sustain avoidable injuries). Even as states continue to reform tort law and the patient safety movement makes progress toward its goals, health care generates large numbers of avoidable injuries from medical errors—most of which the legal system fails to compensate. Regardless of how fanciful this may sound in the face of entrenched contrary experience, now is the time for the disparate and opposing forces to find a way to focus together on “the large number of patients who die unnecessarily each year from medical errors” rather than a continuance of actions reflecting the visceral antipathy of many physicians and lawyers to one another.

The American Board of Legal Medicine was incorporated in 1951. Its membership is limited to doctors who also possess a degree in law or who have had at least five years' medicolegal experience. Since its founding, this organization has sponsored a number of meetings. This book represents a collection of papers presented at these meetings on a number of medicolegal subjects. The papers themselves may be said to represent the expression of opinions of the men who have taken the time and trouble to present a point of view. Individually, the papers are of uneven quality. Collectively, they are of interest as they reflect the character of the sponsoring organization.

Physicians should pause before hitting Send on an e-mail, tweet, or other digital communication to ensure that the communication will uphold their professional obligations to patients and not mar the reputation of the profession, urges a new joint position paper (http: //annals.org/article.aspx?articleid =1675927) from the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

Context.—The majority of the peer-reviewed clinical literature is edited by editors whose training in editorial matters may be limited or nonexistent. We suspect that editors are selected for their clinical or academic rather than editorial ability.Objective.—To test the hypothesis that editors of medical specialist clinical journals were recruited from active clinicians rather than those with evident ability or training as editors.Design, Setting, and Subjects.—Anonymous mail survey to editors of the 262 peer-reviewed clinical journals that had received at least 1000 citations in the 1994 Science Citation Index.Main Outcome Measures.—Training and editorial practices of editors.Results.—Replies were received from 191 editors (73%): in 1994 the journals they edited had 6060 (27300/1000 [maximum/minimum]) citations, 234 (740/31) source items, and an impact factor of 2.10 (18.3/0.2); nonresponders' journals had similar characteristics. Of the responding editors, 181 (95%) were part-time, 132 (69%) treated patients, and 164 (86%) were recruited by one of the following methods: election by a scientific society (49 [30%]), nomination by the previous editor (41 [25%]), or response to an advertisement (29 [18%]). There was no strong association between method of recruitment or formal editorial training and the status of the journal. Only 9% of editors in the United States send at least half of the papers to reviewers outside their own country, compared with 41% of editors in the United Kingdom and 73% in other countries, and 69% do not feel bound to follow the advice they receive concerning acceptance of papers.Conclusions.—Clinical journals are usually edited by practicing clinicians who are self-taught part-time editors, but willing to accept further training. They usually consult 2 reviewers, but exercise independent judgment on the acceptability of papers.

THIS ISSUE OF THE JOURNAL MARKS THE FINAL PUBLIcation of STUDENTJAMA, the section of JAMA edited by medical students. The forerunner to this section, Pulse, was first published in 1975 as a periodic news magazine of the Medical Student Section of the American Medical Association. In November 1988, Pulse was inaugurated as a section within THE JOURNAL. In September 1998, the name was changed to MSJAMA, which was then changed to STUDENTJAMA in January 2004. Over the years, the student section of JAMA has primarily published commentaries, essays, and opinion pieces on a wide range of topics relevant to medical students. However, today, with medical schools incorporating teaching about research design and critical appraisal of the literature into the curriculum, medical students are increasingly aware of and learning the importance of emphasizing evidence rather than opinion. Accordingly, it is time to incorporate high-quality articles about, for, and by medical students directly into JAMA. We welcome submission of high-quality original manuscripts on topics relevant to medical students and medical education, especially those for which a student is an author, for consideration for publication in JAMA. Realizing that it is difficult for students to compete with more senior authors, we will provide extra assistance in the following way. Any original data-based paper for which a medical student is the first author will be handled by one of us. Editorial mentoring will be provided to assist the student through the manuscript assessment and peer review process, and if the paper is suitable, through publication of the study in JAMA. If the manuscript does not merit publication in JAMA, we will provide advice with the hope of helping to make the manuscript suitable for publication elsewhere. Where appropriate, current members of the STUDENTJAMA editorial board will be asked to assist in the review process of other students’ manuscripts. In addition, beginning in September 2004, fourth-year medical students will be able to apply for a 1or 2-month elective in medical journalism at JAMA. Specific criteria must be met, including goals and objectives agreed to by the student, the editors, and the dean of students at the student’s medical school. We are grateful to all of the students who have contributed to Pulse, MSJAMA, and STUDENTJAMA as editors, editorial board members, reviewers, and authors. We now look forward to expanding opportunities for students and editors to learn from each other.

Increasingly, writers for JAMA 's MEDICAL NEWS section are encountering the "buttoned-lip syndrome" at national specialty society meetings. Those afflicted with this syndrome are most often young clinical investigators affiliated with productive research groups and obviously enthusiastic about the research findings they are presenting to their peers. But because they fear they may jeopardize acceptance of their reports for publication in the New England Journal of Medicine (NEJM) , they are loathe to give information to the press. The reason? Arnold Relman, MD, editor of the NEJM , has a policy of withdrawing or not considering a paper for publication if a report of the findings—even an abbreviated one—appears in the popular or medical press before formal publication in the NEJM . The situation has progressed to the point that some investigators succumb to the buttoned-lip syndrome just in case , that is, even before they have submitted a paper for consideration to the

Although hallucinogenic drugs have been used for various purposes for centuries, serious medical studies of them began only about one century ago. In more recent years the use of compounds like D-lysergic acid diethylamide (LSD-25), as well as congeners and derivatives, has become the subject of scientific scrutiny. Of major interest to the practicing physician is the value of these compounds either as therapeutic agents or as adjuncts to psychotherapy. While the evaluation of the psychotherapeutic procedure itself is certainly not readily achieved statistically, the psychopharmacologic action of these drugs can be and has been determined by replicable techniques on man. More than 1,000 papers have appeared on the general aspect of the subject since 1943. Previous conferences have tried to integrate results and to clarify the value of these drugs. The present volume covers an extended conference of the Royal Medico-Psychological Association in 1961. Here are reported the papers

To the Editor:— Dr. Collins' criticism of my definition of placebo is somewhat tangential to the main emphasis of my paper, which was on the etiological factors in the placebo effect and not on the definition. The basis for my definition was discussed extensively in another paper referred to in the article.1 Dr. Collins avoids the problem of proposing a formal definition. Hisimplieddefinition seems to be: "A placebo is what a somebody does to a somebody" which is thought by the latter to be helpful. This definition has several shortcomings: negative placebo effects, which may arise when the patient thinks the doctor isnothelping, cannot be included in his definition. I agree with Dr. Collins that the placebo should refer to therapies and that physician and patient, or their cultural and symbolic representatives, are essential to the definition. But a definition should include more than this

WhenRobert O. Bonow, MD, professor of cardiology at Northwestern University’s Feinberg School of Medicine, joined the National Heart, Lung, and Blood Institute in 1976 as a clinical associate shortly after completing his residency at the Hospital of the University of Pennsylvania, he assumed he would be there for only a few years. But the intrigue of cardiovascular research and encouragement from his mentors kept him at the institute for 16years,whereheservedas asenior investigatoranddeputychiefof cardiology, delving deeply into the mechanismsof and therapies forhypertrophic cardiomyopathy and valvular disease. Now director of the Feinberg Center for Cardiovascular Innovation, his years of research, teaching, and clinical practice have prepared him for his new role as editor in chief of JAMA Cardiology. The journal, which published its inaugural edition on February 24, addresses a broad spectrum of subjects in cardiovascular medicine (jamacardiology.com). Bonow, who moved to the Feinberg School of Medicine in 1992 where he has served as chief of the cardiology division from 1992 to 2011, believes one of themost rewarding aspects of his work has been the opportunity to pay forward the support he received at National Institutes of Health by, in turn, mentoring young researchers. Bonow has also been active in the AmericanHeartAssociation,servingaspresident from2002 to 2003. He has published more than500articles and 100book chapters, including editing the landmark Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. In a recent interview, Bonowdiscussed his neweditorial endeavor andwhat the future holds for the prevention and treatment of cardiovascular disease. The following is an edited version of the interview. JAMA: What is your editorial vision for JAMA Cardiology? DR BONOW: We have the opportunity to become one of the top scientific journals in cardiovascular disease.Ourmissionandour goal are to become one of the go-to journals for the best science [and] to attract papers from the best investigators across the spectrum of cardiovascular disease. We do have a couple of specific interests, but we want to be a journal that is sought after and read by the cardiovascular community, primarily a clinical community, that's involved in patient care and patient-based research. We want to cover areas of broad interest— heart failure, coronary arterydisease, acute and chronic coronary interventions, valvular heart disease, adult congenital heart disease, and imaging of the heart. We have a heavy interest in cardiovascular epidemiology and in thequality of and deliveryof care. [Wealsohavean interest in] health services research andmaybe, as the field evolves, the genetics of cardiovascular disease and how that plays out into personalized care,where I thinkwehavea long way to go.

Obstetrician-gynecologist Ruth Haskins, MD, estimates that fewer than 10% of the patients she treats in her Folsom, California, practice take systemic hormones to manage menopausal symptoms. Patients frequently ask about options to ease hot flashes and night sweats, but they don’t want to take hormones, said Haskins, also president-elect of the California Medical Association. “Since the WHI [Women’s Health Initiative] study came out, women are so scared [to take hormones],” said Haskins, referring to the landmark 2002 clinical trial that determined hormone replacement therapy (HRT) increases the risk of breast cancer and coronary heart disease, among other conditions (JAMA. 2002;288[3]:321-333). After the findings splashed across newspaper headlines and dominated television news programs, women abandoned hormones in droves. By one account, HRT use for menopausal symptoms plummeted by 79% from 2002 to 2010 (Sprague BL et al. Obstet Gynecol. 2012;120[3]:595-603). As a result, surveys have reported that about 50% to 80% of menopausal women now turn to nonhormonal therapies (http://bit.ly/1PSpzxt). Largely in response to this shift, the North American Menopause Society (NAMS) recently published a position paper on the effectiveness of various nonhormonal options for managing menopausal vasomotor symptoms (http://bit.ly/1PSpzxt).

The aim of medical research is to advance scientific knowledge and hence--directly or indirectly--lead to improvements in the treatment and prevention of disease. Each research project should continue systematically from previous research and feed into future research. Each project should contribute beneficially to a slowly evolving body of research. A study should not mislead; otherwise it could adversely affect clinical practice and future research. In 1994 I observed that research papers commonly contain methodological errors, report results selectively, and draw unjustified conclusions. Here I revisit the topic and suggest how journal editors can help.

Objective;-To test the hypothesis that the selection of literature in review articles is unsystematic and is influenced by the authors' discipline and country of residence.Data Sources.-Reviews in English published between 1980 and March 1996 in MEDLINE, EMBASE (BIDS), PSYCHLIT, and Current Contents were searched.Study Selection.-Reviews of chronic fatigue syndrome (CFS) were selected. Articles explicitly concerned with a specialty aspect of CFS and unattributed, unreferenced, or insufficiently referenced articles were discarded.Data Extraction.-Record of data sources in each review was noted as was the departmental specialty of the first author and his or her country of residence. The references cited in each index paper were tabulated by assigning them to 6 specialty categories, by article title, and by assigning them to 8 categories, by country of journal publication.Data Synthesis.-Of 89 reviews, 3 (3.4%) reported on literature search and described search method. Authors from laboratory-based disciplines preferentially cited laboratory references, while psychiatry-based disciplines preferentially cited psychiatric literature (P =.01). A total of 71.6% of references cited by US authors were from US journals, while 54.9% of references cited by United Kingdom authors were published in United Kingdom journals (P =.001).Conclusion.-Citation of the literature is influenced by review authors' discipline and nationality.

THE GRAVITY OF THE SHORT REPORT DESCRIBING 5 young men with a possible “cellular-immune dysfunction” published 30 years ago could not have been fully appreciated at the time. However, the fear and frustration associated with subsequent spread of the disease later known as AIDS have been etched into the memory of those clinicians who stood at the forefront of the epidemic. Three decades after the MMWR report, effective antiretroviral drugs are at the clinician’s disposal and prevention strategies are being implemented with vigor. In 2011, the Joint United Nations Programme on HIV/AIDS reported slowing of the rate of new cases of human immunodeficiency virus (HIV) infection globally. This good news is tempered by the reality that an estimated 34 million persons have HIV infection worldwide. For those individuals fortunate enough to receive treatment, several vexing issues remain, including drug resistance, drug toxicity, and coinfections. Although progress in combating HIV/AIDS has been extraordinary, additional approaches are needed. As in prior years, in July 2012 JAMA will publish a theme issue highlighting HIV/AIDS research, scheduled to coincide with the 19th International AIDS Conference in Washington, DC. The issue will have an expanded focus, to include HIV/tuberculosis coinfection and HIV/ hepatitis C coinfection. JAMA invites authors to submit evidence-based manuscripts on HIV-related prevention and treatment for consideration for publication. Original research, particularly randomized controlled trials of HIV therapy, will receive the highest priority. However, systematic reviews and scholarly commentaries are also welcome. Topics on HIV basic science and the clinical application thereof, behavioral and preventive intervention strategies, epidemiology, and studies relevant to an international context are also of interest. Submitted manuscripts will undergo editorial review and, if appropriate, will then be evaluated through the peer review process. Authors should refer to the JAMA Instructions for Authors concerning the preparation and submission of papers, and are encouraged to contact us with any questions. Manuscripts received by February 27, 2012, will have a higher chance of being considered for the 2012 HIV/AIDS issue. Since the initial report in 1981, knowledge has been painstakingly acquired that now points to a hopeful future with a possible end to the pandemic. With that goal in mind, we look forward to receiving your manuscripts for consideration for the 2012 HIV/AIDS theme issue.

UNORTHODOX and unproven treatments for cancer are big business in the United States.1,2Usually, individuals providing these treatments offer the public little or no information on their qualifications to treat cancer. Their science is generally presented in unverifiable testimonials, anecdotal material, and non-peer-reviewed magazines sold in supermarkets or publicized on television talk shows and in throwaway health-fair circulars. When reviewed, they reveal a patchwork of half-truths and scientific misinformation. In contrast, there is no lack of published material for the patient who may be considering antineoplaston therapy. There are hundreds of papers about this therapy and its discoverer, Stanislaw R. Burzynski, MD.3-9They include his curriculum vitae, his list of publications, explanations of his theory of cancer and the way his treatment works, clinical information, press releases, brochures, abstracts of his speeches, reports of his research results, review articles, government reports, court opinions, legal depositions, records of public

IN THIS ISSUE OF JAMA, WE ARE PUBLISHING, WITH OUR SINcere thanks, the names of all peer reviewers who completed manuscript reviews for JAMA in 2009. These peer reviewer consultants represent academic and clinical expertise in every medical specialty and subspecialty, have scientific expertise covering virtually every area of medical research, and represent 40 countries. We extend our appreciation to each peer reviewer for providing objective, insightful, and rigorous critiques of submitted manuscripts, and for making indispensable contributions in maintaining and enhancing the clinical relevance and scientific quality of articles published in JAMA. We also express our appreciation to all authors who submitted manuscripts for consideration for publication in JAMA. These manuscripts address nearly every area of medicine and include major practice-changing clinical trials, cuttingedge basic science and translational investigations, and highquality observational studies; clinically applicable, rigorous, systematic review articles; and insightful, provocative, and scholarly commentaries. In 2009, authors of manuscripts submitted to JAMA represented 70 countries, and international authors accounted for 40% of submitted manuscripts. We extend our thanks to these physician-scientists, medical researchers, clinical investigators, and all other authors for submitting manuscripts to JAMA, and for providing us with the opportunity to consider their work for publication. The rigorous nature of the peer review process and the quality and importance of manuscripts submitted to JAMA are demonstrated in several key measures (TABLE). Even though the number of manuscripts submitted has increased, the turnaround times for editorial decision making, peer review, and time from manuscript submission to publication (a median of 103 days) have all remained efficient. In 2008, JAMA’s impact factor reached 31.7, reflecting the importance with which the scientific and biomedical research communities regard articles that appear in JAMA. We sincerely appreciate the contributions of all JAMA peer reviewers and authors. We look forward to the continued efforts and support of our peer reviewer consultants in helping ensure the scientific quality and integrity of articles published in JAMA, and we invite and encourage authors to consider JAMA as their journal of first choice for publication of their important papers.

Race and Medicine in Nineteenth- and Early-Twentieth-Century America is a collection of papers that chronicle African American health issues from the mid 1860s to the early 1900s. The collection was authored by Todd L. Savitt, PhD, professor of medical humanities and history at Brody School of Medicine of East Carolina University. Dr Savitt has written extensively on this subject, including 3 other books and numerous articles. His first book, Medicine and Slavery: TheDiseases and Health Care of Blacks in Antebellum Virginia, documents African American health issues during that time. This current volume further continues his research by looking at the health care of African American patients as well as at African American physicians and the medical schools at which they trained. In his preface, the author states that the progression of themes in this book developed as his research uncovered relevant topics related to African American health issues.

ing their paper (along with the peer reviews) referred to one of our family of ARCHIVES specialty journals for further consideration. We make every effort to ensure that articles published in JAMA continue to advance medical science, enhance clinical knowledge, and reflect the highest ethical standards of medical journalism. We sincerely appreciate the contributions of all JAMA peer reviewers and all JAMA authors in helping us achieve these important goals. Financial Disclosures: None reported.

IN THE HALF-DOZEN YEARS SINCE THE US Food and Drug Administration (FDA) eased restrictions on directto-consumer (DTC) advertising of prescription drugs, the practice has proliferated—and so has the controversy surrounding it. Proponents have claimed DTC advertising educates the public to make more informed medical choices, while critics charge that aggressive marketing campaigns encourage patients to demand newer, more expensive, and sometimes inappropriate medications. Preliminary findings released last month from a new FDA survey on the practice are unlikely to lessen the controversy. The agency says that the survey, which it conducted in 2002, found that many physicians are comfortable practicing in a world with DTC advertising of prescription drugs. “The results confirm that DTC advertising, when done correctly, can serve positive public health functions such as increasing patient awareness of diseases that can be treated, and prompting thoughtful discussions with physicians that result in needed treatments being prescribed—often, not the treatment in the DTC advertisement,” the FDA stated in a “Talk Paper” summarizing the survey’s findings, which is available at http://www.fda.gov/bbs /topics/ANSWERS/2003/ANS01189 .html. “This study also demonstrated that most physicians view DTC advertisements as one of many factors that affect their practice and their interactions with patients, both positively and, in some respects, negatively.” But critics of the study say the FDA is overly optimistic in its interpretation of the results, and question whether the study design permits drawing definitive conclusions from the data.

Hypertension remains a large public health problem in the United States. 1 Nearly 50 million Americans have elevated blood pressure warranting some type of treatment or monitoring. 2 It is also prevalent in most populations around the world. In addition, this common condition is strongly related causally to important chronic cardiovascular and renal diseases. 3 Two articles in this theme issue ofThe Journalsummarize and expand our knowledge of these risk relationships. 4,5 Hypertension can be treated successfully, and several articles in this issue suggest additional approaches to management. 6,7 However, there is ample evidence that current approaches are less than optimal. Because hypertension is a chronic, usually noncurable disorder, the ultimate aim must be sufficient understanding of the etiology to prevent its occurrence. The papers by Obarzanek et al, 8 Staessen et al, 9 and Midgley et al 10 attempt to direct or redirect such efforts. Cowley and

Objective. —To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants. —A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence. —The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus Process. —Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion. —Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. ( JAMA . 1995;273:402-407)

To the Editor. —The recent publication in JAMA of papers from the Second International Congress on Peer Review in Biomedical Publication 1 demonstrates quite clearly that the strategy of using periodic conferences to generate research on peer review has been successful. It is interesting to note that since the First International Congress on Peer Review in Biomedical Publication in 1989 not only has there been an increase in the quantity of research on peer review generated (from 50 to 110 abstracts submitted), 1,2 but the complexity of research appearing inThe JOURNALis greater. More manuscripts from the second congress used quantitative methods and less were of a descriptive nature. These observations relate to the future study of biomedical peer review. Is there any loss associated with the gain of a shift to quantification in peer review research? Research on diseases where behavioral factors elevate risk has sought to complement

THERE IS A STORY that tells of a wise old lady who had reached her last hours. Her best friend managed to arouse her long enough to ask: "Tell me, what's the answer?" The woman opened her eyes and said, "What is the question?" Defining the question has always been half the answer, and the question before us now concerns a nationwide plan for continuing medical education. The American Medical Association Board of Trustees has approved implementation of the plan, beginning on a pilot scale, using the monograph, "Lifetime Learning for Physicians" as a guide.1,2 The objectives of this paper are at least three-fold: (1) to inform you of this nationwide plan if you do not know about it, (2) to add to your information if you do, (3) and to explore at least two misunderstandings—the first, that an authoritarian agency is being planned, and second, that a scheme

Any physician seriously interested in the pathogenesis of peptic ulcer will find much of interest in this symposium presented at the Second World Congress of Gastroenterology in Munich in 1962. A remarkably catholic selection of 63 teachers and investigators from countries as diverse as Nigeria, India, Japan, and Hungary present 36 papers reviewing current work, concerned largely with the physiological processes attendant upon experimental ulcer production in animals. Dr. S. C. Skoryna has done a fine job of editing out linguistic idiosyncrasies which so often mar these international symposia, but he contributes a mathematical analysis and discussion of "stochastic processes in the causation of peptic ulcer" which can only be classified as ulcerogenic. Gastroenterologists interested in research will want to have this book on their shelves for ready reference, but clinicians will probably prefer to consult a copy in the library. When they do, they will find much useful material.

So many words have been written and so many more have been uttered on this topic that an enormous difficulty is presented to anyone invited to prepare a paper. Evaluation has been defined, described, decried, and defended. The lack of evaluation has been bemoaned, bewailed, and bemused. The need for evaluation has been expressed, exhorted, and extolled. Approaches to evaluation have been proposed, proclaimed, and provided. All in all, one wonders how so much effort can have brought about so little effect. Perhaps that last statement is too harsh; in our interest in the well-turned phrase, we often tend to exaggerate. Indeed, there is every indication that the need for evaluation is now widely accepted. There is no question that evaluative approaches and techniques have become more sophisticated over recent years. There is no question that there is a greater understanding of evaluation as a concept and a process. There

To the Editor.— The reply to your fourth EDITORIAL, "Community Medicine: A Concept in Search of a Definition" (224:522, 1973) is eloquently stated in the three editorials that preceded it. The three editorials based upon papers withinThe Journaldiscuss the relationship between occupation and disease pattern, the importance of research on adverse drug reactions enabling physicians to assess the cost-benefit ratios of prescribed medicines, and an increased incidence of coronary disease among urbanized bedouin. The editorials all pose problems, but give no final answers. They indicate the changing face of disease as it appears to the practicing clinician and demonstrate the complexity of problems facing the doctor in the community. Yet, Dr. Ricketts, in the following editorial on community medicine, remarks that there is no need for such "a splinter department" and that the subject matter of community medicine does not warrant "the dignity of an academic title." The

From time to time I am asked this question by the head of a department in a medical school or other health organization. When the advice requested is more than the naming of a possible candidate, I remember an attempt that I made seven years ago to organize my thinking about the situation of persons who are expected to give help in a miscellany of problems brought to them from any or all departments in a medical school. Such statisticians might be called "all-purpose statisticians" or "statisticians at large," even if they are based in a particular department such as preventive medicine or pharmacology. I presented the results of my thinking at the Fourth International Biometric Conference held in Ottawa, in 1958, in a paper entitled "Some Non-statistical Problems Met By Medical School Statisticians." I read it again recently and asked myself: "Have some or all of these problems disappeared

To the Editor.— Bellville et al ( 217 :1835, 1971) present an interesting and provocative analysis of the influence of age on pain relief from analgesics. However, in their discussion they refer to an old paper by me and my former colleagues at Harvard that interprets peculiarly both our data and theirs. They interpret our findings of a relationship between placebo response and age as reflecting "a difference in sensitivity to pain and its interpretation." I have never been sure how to analyze our correlation, but believe that the facts are reasonably clear, ie, older people tend to respond to placebos with a greater frequency of beneficial response than do younger people. This was the case not only in relieving pain but also in a separate placebo study that involved the administration of inert medication designed to influence reports of energy and appetite. If our findings are correct, they have important

Scientific and empirical information exchanged at last month's Symposium on the Use of Anticoagulants, held in Miami Beach, dealt principally with these two questions: Should anticoagulant drugs be used in treating ischemic heart disease? How should a controlled study be administered to assure the highest degree of scientific validity? Two investigators—Arthur J. Seaman, MD of Portland, Ore, and Christian F. Borchgrevink, MD of Oslo, Norway—express their differing views on these questions in the following MEDICAL NEWS debate. Their respective papers are also reported in this issue.

MENTION marijuana and you will evoke a range of reactions to match every color of the spectrum. Still, such impassioned arguments are no reason to ignore possible therapeutic uses; I address the current status of these studies. Humans and Cannabis sativa have coexisted for millenniums. The stems of the plant served as a source of hemp fiber for rope, canvas, clothing, and paper. The seeds provided oil for food and are still found in packages of mixed birdseed (sterilized, of course). The leaves and flowering tops have been used by many primitive societies as a folk medicine for a wide variety of ailments. Every human complaint has been treated with Indian hemp at one time or another, and certain uses were clearly inappropriate. On the other hand, recent careful investigations have substantiated the effectiveness of a few ancient therapeutic applications of the plant. Pain, whether from toothache, dysmenorrhea, or rheumatism

IN THE 1880s the aristocrat of medical journals was undoubtedlyThe American Journal of Medical Sciences(founded in 1827). A quarterly, with about 300 octavo pages per issue, it was easily the most scholarly medical periodical in the United States. The contributors included leading British as well as American physicians and surgeons. Publication was prompt, and there was "liberal compensation for articles used." Each issue had about ten "original communications." Some dealt in depth with clinical conditions, others with various aspects of the preclinical sciences. Much experimental work was included. In a single issue the papers would range from an experimental study of ulcerative endocarditis to pancreatic surgery to a clinical study of cerebral localization. Much of the journal was devoted to long, critical, and analytic book reviews that were usually superbly informative. At least 90 pages per issue were given to a systematic survey of current literature, arranged in

This little book has a remarkable history. A paper by Drs. Richard K. Young and Benjamin S. Patrick, "Outpatient Pastoral Counseling in a Medical Center," was published in The Journal on Septemberber 6, 1958. Mr. Clarence Hall, senior editor of the Reader's Digest, was so impressed with it that he made two visits to the North Carolina Baptist Hospital, the teaching hospital of the Bowman Gray School of Medicine, to collect material for an article on the work of Chaplain Dick Young and his associates in the department of pastoral care. In order to justify the length of the article, he published it in the Book Section of the Reader's Digest as "condensed form of a forthcoming book" and extracted a promise from Dr. Young that he would write the book thus condensed. "Spiritual Therapy" is the result.The book shows a new approach to the relation between physician and

This book consists of collected papers which outline laboratory procedures for estimating the various lipids and steroid hormones. There is little continuity of the collected data from one chapter to the next. The clinical interpretation and application are meager. The book, therefore, should be more useful to the biochemist or physician interested in basic analytical research than to the practicing or clinical investigative physician.

This new textbook printed on good quality paper with good type is pleasantly readable. The author has made some new approaches to facilitate the teaching of gynecology. The purpose of the book is to present a new and modern summary of present-day gynecology in a brief and clear manner. Most textbooks are much too detailed and contain so much philosophy that they are too voluminous for practical purposes. This book may act as an outline for teachers, and, in addition, it is intended to interest the practicing physician. Pathology is stressed. After the pathogenesis of the individual disease has been considered, the symptoms of the patient become more understandable. Similarly, the diagnosis based on the physical examination and laboratory findings may be reached more logically, and the treatment can be more appropriately prescribed. Certain operative techniques are described briefly. The author spends much time describing the various hormones and their

This book continues the fine tradition of summarizing the important publications of the past year that relate to pathology. The editorial comments of the author, as usual, help place the contributions of these papers into proper perspective. After reading this book, one has the feeling that few new techniques are described, and few new areas of interest have been opened up during the past year. The single special article by Dr. Robert Schrek, entitled Fashions in Cancer Research, is an interesting analysis of the trends in cancer research over the years. He explores the controversy over the role of experimental tumors, the furor over genetic or environmental factors in experimental cancers, and the current interest in viral etiology of neoplasia. The possible effects of these fashions in research on the outcome of the quest for solution to the "cancer problems" are considered.