For us doctors, medical publications aren't just vital knowledge. They're gossip.
Forget books and magazines. Turn off the television. Put down the Starr report. If you really want the lowdown, something that will tell you almost anything you want to know about people, medical journals are where the action is. One of medicine's hidden pleasures is that while there is a fantastic amount to learn about human beings, most of it is already spelled out in some journal.
In 1997 alone, the National Library of Medicine added references to 519,012 new articles from some 3,200 journals to its Medline database. The fact that all these journals can survive and multiply should be a clue that there's something compelling about them. Subscribers are willing to pay dearly to keep their favorite journals going. Rates run to $3,000 a year or more for some journals. As a result, while The New Yorker lost millions last year, the scientific publishing giant Elsevier put out some 1,200 journals and made a whopping 40 percent profit on them.
To be sure, for many doctors and scientists, the interest in a given journal is purely parochial. Even the smallest ones--Elsevier produces some with fewer than 500 subscribers--can be the prestige publication for a tiny field. Moreover, behind the glossy covers and stilted prose, many of these little journals function as the gossip rags, the People magazines, for the science niches. My pet journal is Health Affairs (circulation 8,000), the journal that all health policy wonks get and therefore write in. It's how we keep tabs on what everyone is up to. An infectious disease specialist friend of mine reads the Journal of Virology (circulation 5,000). My parents subscribe to the Journal of the American Association of Physicians of Indian Origin (circulation 26,000).
But people should not let all the Balkanization and technical-sounding talk scare them away. Poke around in a few medical journals, and you're bound to find material as absorbing as anything you'll find in Vanity Fair.
The names alone are worth perusing. Many journals follow the standard "Annals of" or "Archives of" or "Journal of" approach--you know, like the International Journal of Leprosy. But the best are the direct, in-your-face journal names: Placenta, Gut, Brain, Blood. When you pick up Placenta, you know exactly what you're getting. What's more, you get the impression that the editors are proud to give it to you, that they have no second thoughts about the field they have chosen. Consider, by comparison, Foot and Ankle International. It's a terrible name. It conveys embarrassment, a sense that the editors thought "Foot" alone wasn't good enough for them. Even adding "Ankle" was still too minor league for their ambitions, so they had to tack on that "International." You want a journal more willing to glory in its small, arcane world.
Clearly, however, the cool stuff is what's inside, and a few journals always have the cool stuff. The Journal of Sex and Marital Therapy is, not surprisingly, reliably fascinating no matter what your profession. A recent issue I browsed through at the library (while hiding it in a copy of Science) had such topically relevant reports as "
Each of these specialized journals offers an obsessive's-eye view of the world around us, a new look at the seemingly familiar. International medical journals, however, can do the opposite. They tend to share the common language of doctors everywhere and so can make the unfamiliar reassuringly accessible, while still conveying a revealing sense of their national Zeitgeist. I recently picked up the Annals of Saudi Medicine, for example, and discovered, to my surprise, the telling obsessions of a modernized country: ulcers, a growing epidemic of obesity, smoking, heart disease, child abuse. The Indian Journal of Medical Research, on the other hand, despite all the press reports about India's burgeoning middle class, is currently filled with reports on infectious diseases--the scourge of poor nations.
Sadly, few people appreciate the refined charms of medical journals. Occasionally, however, I'll come across a fellow journal junkie. We'll exchange tips like frat boys do. "Have you seen the Journal of Personality and Social Psychology?" one such friend asked me not long ago. "That journal is hot." I looked it up at my next opportunity. It did not disappoint. The first issue I read, for example, had a study of 219 subjects who were instructed to put on a specific facial expression while looking in the mirror. What the psychologists found was that participants told to do nothing more than put on a happy face developed a significantly more positive mood than those told to adopt a neutral expression. And those made to assume an unhappy expression had the worst moods of all. The journal was full of strange little studies like that. I made a mental note to check it out again. And, when I left the library that evening, you can bet I had a smile on my face.
Atul Gawande, a surgical resident in Boston, is a staff writer on medicine for The New Yorker and author of the new book Complications: A Surgeon's Notes on an Imperfect Science.