OUT OF FIVE STARS
High quality content ******
Up to date *****
Good presentation  ****
Level of unfettered access ***
Useful patient information **
Interactive CME *

Website : http://www.thelancet.com

The Lancet has just this week revamped its online journal site so it seemed an opportune time to have a look at what was on offer from this 185-year-old London-based publisher.

One of the very first journals to go free full-text some 10 years ago was in fact The Lancet and along with the BMJ and the New England Journal of Medicine (both reviewed here previously), The Lancet has been one of those most highly sought after clinical publishing tools for some 18 decades.

Unfortunately, the exciting days of free full-text articles are now well gone with the initial access rights subsequently discontinued and the medical publishing houses appear to be enjoying the consequent and overt lack of competition. Admittedly, the NEJM did, around four years ago, offer to make a number of its articles available six months after publication, perhaps after being roundly criticised by the outspoken George Lundberg, editor in chief of the MedScape online journal (and previously editor in chief of JAMA) for exploiting governmental/federal research funds without making the generated and publishable findings accessible.

The Lancet, as with its competitors, delights in revelling in its own prestigious status reminding us, "The Lancet is one of the foremost general medical journals in the world, publishing ground-breaking research that attracts headlines worldwide, and helping to shape the medical agenda globally."

Some of the frequent authors - the Beagleholes, Bonitas, Beasleys and Jacksons - it must be said, hail from our very own shores, subsidised by our very own institutions, grants committees, taxes and perhaps, even on occasions, our very own RNZCGP Faculty Trust.

An annual international "online only" subscription is US$132 and around US$250 for the online plus print subscription. I only mention the cost because as with most of the other journals - notably the BMJ and NEJM - it became increasingly difficult for primary care clinicians to get access to significant full-text articles after the decision some five or more years ago of all these "prestigious" publications to renege on the free access availability of any significant number of their published articles.

The result has meant several things - first, all of these publishers have become enormously wealthy from a form of "compulsory" subscription (albeit at a partly if not patronisingly reduced rate) to their online journals, and second, primary care clinicians all over the civilised world have remained deprived of the learned reviews and journal articles which supposedly help to form, mould and re-form the platform for our supposedly scientific practice of medicine.

Also, primary care clinicians the world over tend to have limited access to local library facilities (Auckland's Medical School must be one of the worst) and are thus relatively informationally deprived in comparison to their academic clinician counterparts.

The absurdity is we have articles on real primary care such as "the management of persistent hemicranial headache" and a detailed review on vertigo inaccessible to primary care and yet available freely to researchers who might be spending a year investigating the molecular medicinal patho-physiological properties of brain natriuretic peptide.

Textbooks are notoriously out of date by the time they are published, and yet most of us probably have a five or maybe even 10-year-old textbook of medicine in our offices which we regularly consult.

From the publisher's point of view, they are keen to sell their online subscriptions and, yet, they can hardly expect a primary care clinician to have a subscription to perhaps 10 of the top journals to enable clinical currency.

And quite how they can be happy to charge some US$30-40 for access to a single article (and without the author or the study's funding agency obtaining any pecuniary compensation) is in my opinion thoroughly outrageous.

Anyway, the new format for The Lancet has a kind of tabloidal appearance. I must admit to not having looked at the older version, for some year or more so I cannot compare the earlier version however, it was especially notable that it is now a little more difficult to browse a particular issue. One can certainly search for a specific topic (as an academic may be wont to do), but browsing is clearly of lower priority. They may well have this fixed in due course as the new site is only just up and running this week.

The new site is clearly publisher dominant - The Lancet journals are overtly promoted (being The Lancet, The Lancet Infectious Diseases, The Lancet Oncology and The Lancet Neurology).

The Lancet site also offers similar benefits to its competitors, most notably the "trailblazing" NEJM podcasts, RSS feeds, conference sub-menus, and on line first (articles published ahead of the print articles). The notable omission in the website was of an integrated CME facility, which perhaps reflects The Lancet's focus on research rather than clinical and particularly primary care medicine.

Nevertheless, for all the above criticism of the "new millennium" medical publishing houses, I can honestly state that, had I not checked out The Lancet site today, I would have had little idea two leading diabetic societies have come out strongly against the use of rosiglitazone in type 2 diabetes. And I am happy to state the editorial at least was in full-text so I did not end up with a simple teaser headline on this occasion.