My back pages

1971 was a heckuva year, as George W. Bush might have said. Justin Trudeau was born in 1971; so too were Elon Musk, Amy Poehler, and Pavel Bure. So, too, was Greenpeace. As if that wasn’t enough, 1971 was the year in which I graduated from medical school. That was 47 years ago, and medical practice was … different. 

In 1971, the BCMJ was already 12 years old and had become an essential part of provincial medical life. The pages of the BCMJ at that time included some clinical articles, but the majority of space was taken up with that era’s pressing practice issues: a physician’s take-home income, difficulties with peer review of practices, and (believe it or not) the increasing problem of “narcotic addicts.” The April 1971 issue gave an overview of a proposed treatment program, noting that the treatment facilities at the Narcotic Addiction Foundation of BC should be expanded to include subclinics in the four major “problem areas” outside the Greater Vancouver area: Victoria, Prince George, Kamloops-Vernon, and Trail-Nelson. The July 1971 issue included the results of a survey of general practitioners’ contact with heroin users. Other articles reported on perinatal mortality rates in the province and pediatric bed utilization. The only article in 1971 that described a study with a prospective design was one reporting the effects of different forms of exercise on cardiac rehabilitation in 14 men after myocardial infarction. The authors noted that the average attendance of participants for the exercise programs was more than 95%, in contrast with the dropout rate of 50% in such programs elsewhere, and programmed exercise resulted in significant improvements in physical work capacity, blood pressure, and serum cholesterol. In the context, it was a brave and important study, and the related article was starkly different from the others published in that year. Did it change things? There was no immediate related correspondence.

Many of the tools of practice that we now cannot do without were either unavailable in 1971 or were in the earliest stages of development. In medical imaging, there was no ultrasound, no CT scanning, and certainly no MRI. According to the BCMJ, in 1971 surgical management of intracranial vascular anomalies relied entirely on arteriography; hemispherectomy was performed in children with neurological challenges characterized primarily by EEG findings. Thinking back to those glory days, radio-immunoassays had limited availability; steroid hormone assays were performed using colorimetry in large-volume urine collections. Antibiotics had barely reached a second generation. The management of cancer was aggressive and grim. How did we manage?

Well, medical practice relied on a basis of theoretical knowledge followed by an accumulation of clinical experience. The older you were, the more you had seen. In 1971 there were far fewer medical journals than today, and those that were most read contained many more clinical studies and case reports than is the case today. The BCMJ did provide some, but it primarily provided a community for BC physicians—a place to share experiences in a collegial way. 

As such, the BCMJ was invaluable and, now in its 60th year, it has remained invaluable for those of us who live and work here in a vibrant medical community. In another 60 years, though, will there be a BCMJ? Will advancing technology and social media have made everyone a physician—and thereby marginalized the need for a medical profession? Discuss.

Timothy C. Rowe, MBBS, FRCSC, FRCOG. My back pages. BCMJ, Vol. 60, No. 3, April, 2018, Page(s) 142 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

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