Re: Availability of electronic full text

In your article “Availability of electronic full text (BCMJ 2002;44(4):181), you looked at 44 articles in the February issue of Sites and Bytes.

I have tried to do research in cardiovascular subjects, and my findings are significantly different from yours.

• The CMA site is becoming more and more “membership only.”
• The New England Journal of Medicine—you need a subscription.
• The Journal of the American College of Cardiology—you need a subscription.
• The American Heart Journal—you need a subscription.
• Circulation—you need a subscription.
• Annals of Internal Medicine—you need a subscription.
• Lancet—you need a subscription.
• British Heart Journal—you need a subscription.

I can keep going on. I have already passed, I believe, the number of “nine” in which you suggested a subscription was required, and I have stuck to but one subject.

The truth is, in the mid-1990s, a bill was introduced to make medical publications free to those who needed them. Individuals like myself, who are trying to do research on subjects which present before us at our offices, are unable to access the database.

It costs me $330 to take the Journal of the American College of Cardiology for 1 year. It cost me approximately the same amount for the British Heart Journal, and I didn’t take a paper review—the expenses are inordinate, inappropriate, and defeating to the concept that we, the physicians, should keep up our education.

I could not possibly afford or read the 10 most prominent cardiac journals. I can’t access them online.

I came across the reference in the New England Journal of Medicine to an article published in the Lancet. I had read the article four times in preparation for giving a lecture on the subject, and knew it well. I was sure that the quote in the New England Journal was incorrect. I tried to access the Lancet, where the article had been originally written, over a 3-day period. I was unable to get to the original journal, and I don’t have it printed out and in my files.

What are we to do, the MDs who are supposed to keep up their education on their own, at their own cost, when you, one of the people who controls the access to the literature, are unable to help us, and publish an article which suggests that the majority of the electronic text is available?

With regards to the published ones, charges of US$7 to $35 are somewhat ridiculous in order to get an article to read once or twice—even a $3 charge for a College member is a bit steep.

Journals pay for themselves for the large part—especially the larger ones they quoted, with their expensive advertising. Perhaps the BCMJ and the CMAJ have to be assisted with subscription money—they are small and have a very small readership. The New England Journal of Medicine costs hundreds of dollars per year in order to access it on the web.

I am afraid your article falls on deaf ears. From my point of view, it is incorrect.

—Peter M. Richardson, MD

Mr Henderson replies

Thank you very much for your detailed and thoughtful response. In fact, I agree with your analysis and feelings on the accessibility of research in support of clinical practice. My column analyzed, hopefully dispassionately, the availability in electronic form of research relevant to BC College members. In being unbiased and brief, I may have conveyed a more positive view of electronic accessibility than intended. Library people are upset when told that everything is free via the Internet. We know it is not so and that electronic resources are not generally cheaper or more accessible than print. With costs of equipment and of time to access via myriad interfaces, we realize they are more expensive for users, with users bearing more of the costs directly.

As a first step, the College Library has offered MDConsult to all College members. In the future, we will open access to more electronic journals and books for College members via our web site. Sign-in will be required, perhaps additional charges to reflect the increased costs of print over electronic publications.

The Library offers free access to MDConsult for all College members—user name and password available on request. Included is online access to only one of the journals you mentioned, American Heart Journal. Some good sources you did not mention are also offered. Cardiology Clinics is available, as is Braunwald, the standard cardiology textbook, and Cecil’s for internal medicine. I concur with your appraisal of the CMA web site, but note that CMAJ is now available to the world via the excellent HighWire (subsidiary of a library, Stanford University’s) interface at

I would also ask that you consider using our, or your local hospital library’s, services in your efforts to keep up. We offer access to the best resources, be they print or electronic. The Lancet article you were seeking may not have been available online, but had you e-mailed or phoned us, we would have had the article from the print journal on the fax machine in short order with less of your time spent than retrieving, or attempting to retrieve, the electronic version. You are entitled to 18 free articles a year from the MLS or the UBC Library collection, free via mail, MediTran courier, or non-rush fax; $3 for each you request over 18. We do literature searches for free on any topic—less immediate perhaps, but much of your time saved, and you receive an expert’s search. You can decide whether you have the patience and expertise to use an electronic interface to the literature, or you can choose a human librarian as an alternative.

—Jim Henderson
Library Director

Jim Henderson, Peter M. Richardson, MD. Re: Availability of electronic full text. BCMJ, Vol. 44, No. 7, September, 2002, Page(s) 341 - Letters.

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.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

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