1589
those at 5-7 days and the persistent excess of GI symptoms in the exposed group at site A may represent infection with pathogens such as Cryptosporidium spp or Giardia intestinalis. The finding that illness occurred more frequently after canoeing in fresh water at a site A receiving sewage effluent agrees broadly with results of sea bathing research in the UK.8 Bacterial concentrations were not strikingly high by comparison with UK seawaters. The enterovirus concentrations, however, were considerably higher14 than those recorded in marine waters with similar enteric bacterial concentrations.8 This may be explained by the contribution from sewage works effluent. Sewage treatment produces greater attenuation of bacterial than viral concentrations.1s Thus enteroviruses, although presumably not causing the symptoms, may provide a better indicator of fresh water quality than the bacteria measured. White-water canoeing in poor quality water leads to a measurable amount of illness. Further studies are needed to determine whether there is a dose-response relation with microbial contamination. If so, knowledge of this relation would be valuable for both water quality standard formulation and public education. We acknowledge the help of Mr John Davies and his staff; the British Canoe Union; Mr Mike Hubbard and Mr John Gregson; Miss Gillian Davies and her colleagues in the National Rivers Authority; Dr R. Stanwell-Smith (Communicable Diseases Surveillance Centre, Colindale); Prof Jay Fleisher (State University of New York); Mr Trevor Harris; Mrs Paula Hopkins; Mr Jerome Whittingham; Dr Ann Delahunty; Dr Helen Merrett (Enviros Ltd); and Dr E. B. Pike and colleagues, Water Research Centre.
2. Godfree AF, Jones F, Kay D. Recreational water quality: the management of environmental health risks associated with sewage discharges. Marine Pollution Bull 1990; 21: 414-22. 3. United States Environmental Protection Agency ambient water quality criteria for bacteria-1986. EPA440/5-84-002. Washington DC: Office of Water Regulations and Standards Division, 1986. 4. Anonymous. EEC Council Directive of8 December 1975 concerning the quality of bathing water (76/160/EEC). Offic J Europ Commun 1976;
L/31,
1-7.
Ferley JP, Zimrou D, Balducci F, et al. Epidemiological significance of microbiological pollution criteria for river recreational waters. Int J Epidemiol 1989; 18: 198-205. 6. Philipp R, Evans EJ, Hughes AO, Grisdale SK, Enticott RG, Jephcott AE. Health risks of snorkel swimming in untreated water. Int J Epidemiol 1985; 14: 624-27. 7. Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R. Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol city docks. Publ Health 1989; 103: 123-29. 8. Jones F, Kay D, Stanwell-Smith R, Wyer MD. Results of the first pilot-scale controlled cohort epidemiological investigation into the possible health effects of bathing in seawater at Langland Bay, Swansea. J Inst Water Environ Management 1990; 5: 91-98. 9. Anonymous. The bacteriological analysis of drinking water supplies. (Rep Publ Health Med Subj no 71). London: HM Stationery Office, 1983. 10. Alico RK, Dragonjac MF. Evaluation of media for recovery of Staphylococcus aureus from swimming pools. Appl Environ Microbiol 1986; 51: 699-702. 11. Goyal SM, Gerba CP. Concentration of viruses from water by membrane filters. In: Gerba CP, Goyal SM, eds. Methods in environmental virology. New York: Marcel Dekker, 1982: 59-116. 12. Lightfoot NE. A prospective study of swimming related illness at six freshwater beaches in southern Ontario. PhD thesis, University of Toronto, 1989. 13. Stevenson AH. Studies of bathing water quality and health. Am J Publ 5.
Health 1953; 43: 529-38. 14.
Merrett-Jones M, Morris R, Coope C, Wheeler D. The relation between enteric viruses and indicators of sewage pollution in UK seawaters. In: Morris R, ed. Meeting on health related microbiology, IAWPRC,
Glasgow, Sept 12-14, 1991, 158-64. REFERENCES 1. Fewtrell L. Freshwater recreation: 11: 215-26.
a cause
for concern.
Appl Geogr 1991;
15. Consultants in Environmental Sciences. Review of operational and experimental techniques for the removal of bacteria, viruses and pathogens from sewage effluents. PECD 7/7/260, London: Department of the Environment, 1988.
VIEWPOINT Indian medical journals
Although Indian doctors produce half the articles published from the third world, little has been written about Indian medical journals. We examined 75 of the 113 serious English-language journals published in India. Of the 22 included in the Cumulated Index Medicus only 8 were judged by Indian and foreign referees to be of international standard. A survey of Indian authors indicated that foreign journals were chosen for the best papers because of their wider circulation, better refereeing practices, and punctuality. More than 98% of medical articles from India probably go unnoticed by the international medical community.
Introduction Medical journals published in western countries have been catalogued and studied in great detail, often from the Science Citation Index. This provides data on nearly 3000 of
estimated 50 000 journals that are published internationally. It includes, however, only 3 Indian medical journals despite the fact that India (which has approximately 250 000 practitioners of western medicine) accounts for almost half the articles published from the third world. India produces a large number of journals that are not included in any indexing system and have never been studied in detail. We therefore undertook an in-depth examination of Indian medical journals. the
Methods Lists of Indian medical journals were made from the Annual Report of the Registrar of Newspapers for India of 1984 and 1986, and from these we recorded the date of first publication, subjects covered, periodicity, circulation, and sponsoring bodies. ADDRESS. Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India (P. Sahni, MS, P. P. Reddy, MS, R. Kiran, BLibSc, K. S. Reddy, MS, G. K. Pande, MS, Prof S Nundy, FRCS). Correspondence to Professor Nundy.
1590
Punctuality
was
assessed from the interval between date of
publication and receipt in the National Medical Library in New Delhi. Quality was assessed in two ways-by recording whether they were included in Biological Abstracts, Current Contents, Excerpta Medica, the Cumulated Index Medicus, and the Science Citation Index; and by sending copies to Indian and foreign experts
TABLE I-CITATIONS, IMPACT FACTOR, AND IMMEDIACY INDEX OF THE THREE INDIAN JOURNALS INCLUDED IN THE SCIENCE CITA TION INDEX
for their opinions.
Through a postal questionnaire we inquired into the practices followed and problems encountered by the editors of Indian medical journals; and, finally, we scoured all the volumes of the Cumulated Index Medicus for 1985 for authors with Indiansounding names and asked those who had published in foreign journals why they had done so. There were 546 medical publications, 47% in English, 25% in Hindi, and the rest in eleven other languages. Allopathic or western medicine was covered by half the journals and the others dealt with homoeopathy, Ayurveda, the Unani and Siddha systems of medicine, and nature cure. After excluding newsletters, drug company in-house publications, non-allopathic journals, and those published in the vernacular languages we were left with 113 serious journals which included original articles and reviews. We examined these in greater detail. We sent money for subscriptions (and three reminder letters) to all these, asking for a year’s supply, but were able to obtain complete issues of only 75 to send to our referees. Most of the others probably do not appear at all: we tried to visit the editorial offices of 3 of these publications and were told that, although still included with the Registrar of Newspapers, they had been closed for up to five years.
Results The first Indian medical journal, Transactions of the Medical and Physical Society of Calcutta, was published in 1823 and is thus an exact contemporary of The Lancet. Looking at the years of first issues we noticed a striking rise after independence in 1947: before 1920, 5; 1920-29, 9;
1930-39, 9; 1940-49, 14; 1950-59, 73; 1960-69, 111; 1970-79,214; 1980-85,100. About a third of the journals were general rather than specialist publications, Among those examined there were no weeklies, 1 fortnightly, 19 monthlies, 11 bi-monthlies, and 48 quarterlies; 2 come out every four months and 20 every six
months; for
unable to determine the (70/113) of the journals were periodicity. funded by professional societies, 20 by academic institutions (universities, medical colleges, and institutes), 5 received government support, 4 were published by private firms, and 3 came from private hospitals. We could not determine the source of funding for the remaining 11. Most of the journals had a circulation of less than 1000. The one with the largest circulation (70 000) was the Journal of the Indian Medical Association, which is distributed free to members. The prestigious Indian Journal of Medical Research had a listed circulation in 1986 of 715, the Journal of the Association of Physicians of India 4500, and the Indian Journal of Surgery 4000. Only 4 out of 64 journals subscribed to by the National Medical Library of India were received on time. 8 were less than a month late, 15 from 1 to 3 months, 12 from 4 to 6 months, 10 from 7 to 12 months, and 5 more than a year. 10 journals were not received at all, despite acknowledgment of 12
we were
Two-thirds
subscriptions being paid. Quality Inclusion in indexing services-37 journals were indexed in Biological Abstracts, 22 in Cumulated Index Medicus, 3 in Current Contents and Science Citation Index, and 26 in Excerpta Medica. Table I shows the number of citations, impact factor, immediacy index, and rank (1988) of the 3
Nos in
parentheses indicate ranking.
journals included in the Science Citation Index. The figures for The Lancet are shown for comparison. Of the 1022 times the Indian_7ournal ofmedical Research was cited in 1988,200 were in its own pages, 15 in other Indian journals, and the rest in foreign journals. Assessment by Indian and foreign referees-The opinion of the 40 Indian and 46 foreign referees to whom individual journals were sent for assessment is shown in table II. The Indian referees considered Indian Journal of Tuberculosis, Indian Journal of Urology, Journal of Applied Medicine, and Journal of Genetics to be of international standard, while their foreign counterparts’ choices were Indian Journal of Medical Research, Indian Journal of Physiology and Allied Sciences, National Institute of Mental Health and Neurosciences Journal, and Tropical Gastroenterology. Regarding the content, layout, appearance, and printing the foreign referees seemed to be consistently more generous than their Indian colleagues. Descriptions of quality included "needs a good subeditor to correct printing and spelling errors", "mostly a magazine", and "should be closed down".
Editorial practices We wrote to the editors of the 75 medical journals asking them to fill in a proforma, and 44 replied. They received between 10 and 625 articles a year and thirty sent articles for refereeing. Eight sent articles abroad for assessment. The time taken from submission to publication was 2-36 months (median 8 months); and the reasons for delay in prompt appearance of the journal were said to be printing (22), editing (14), and postal (4). Eleven editors declared that their journals always appeared on time. For forty, editing was a part time occupation and thirty-three of them not only edited the journals but also did most of the administrative work. Raising funds was stated to be the major obstacle by 24, delays involving referees and authors by 6, lack of good-quality articles by 6, shortage of advertisements by 4, lack of administrative help by 3, and lack of library facilities
by 1. Indians publishing in foreign journals In 1985, 486 authors with Indian-sounding names had in foreign journals included in the Cumulated
published
TABLE II-JUDGMENTS OF 75 JOURNALS BY INDIAN AND FOREIGN REVIEWERS
1591
Index Medicus. 339 of them were based abroad, the greatest number being in the USA (239), followed by the UK (50), Canada (24), and 14 other countries, and 147 in India. They published on a large number of subjects but seemed to concentrate on biochemistry (88), cardiology (33), and the paramedical sciences. When we asked the authors based in India why they had chosen to publish in foreign rather than Indian journals 60 replied, and the main reasons given were that being accepted by a foreign journal carried greater prestige, and that these journals had wider circulation, had better refereeing practices, and came out punctually.
Discussion There is a common misconception that Indian scientists publish a sizeable proportion of their total number of papers in foreign journals. We have calculated that these form not the 35-40% figure usually quoted’ but only 2% of the total number of publications from Indian medical institutions. However, it may be true that the better Indian papers are sent to foreign journals. For instance, in 1986, two-thirds of the "most important" articles written by fellows of the Indian National Science Academy were published abroada generation ago the proportion was only a quarter. We also found that Indian authors have a low opinion of the quality of indigenous journals and this judgment was echoed by foreign scientists. Other studies of Indian medical journals (again only those included in the Science Citation Index which are probably among the best) have shown that even these do not meet the highest standards.3 The fact that 90% of the references are to work published in foreign journals and half to papers more than 10 years old/ suggests that Indian scientists generally look abroad for inspiration and investigate matters that are no longer of much interest to their western colleagues. We were disappointed in the response from our own medical editor colleagues. Only forty-four editors of the 75 journals we know existed replied to our questionnaire. There was a considerable discrepancy between their
assessment of their own problems and the assessment of authors. Only 14 % of the editors said there was a shortage of good articles-in contrast to the opinion of Indian authors who had published abroad. The reasons for the poor quality of Indian journals have been discussed previously.4 They include scarcity of good medical data, inadequate investment in medical research and health care, ill-trained personnel in understaffed laboratories, and shortage of foreign currency to pay for expensive western journals to keep up with international trends. The most important is that only 5% of Indian doctors read journals regularly, compared with 80% in the USA (Relman AS, personal communication): the pressure for quality is therefore low. What can be done about this vicious circle, in which the low quality of journals deters submission of the best research papers? The first steps should be to raise the level of scientific content by use of foreign as well as indigenous referees, to attend to presentation, and to make them come out on time. Only when Indian journals are included in the international indexing services will they begin to attract the sort of papers that now go abroad. Indian medical journals are broadly based, but, there is much work to be done before they attain the heights. We thank the Indian Council of Medical Research and The National
Medical Journal of India for support.
REFERENCES 1. Garfield E. Mapping science in the third world. Current Contents 1983; 33: 6-15. 2. Krishnan CN, Visvanathan B. The performance of modern science and technology in India: the case of scientific and technical journals. Patriotic and People Oriented Science and Technology Bulletin 1987; 11: 1-19. 3. Arunachalam S, Manorama K. The status of scientific journals of India as seen through Science Citation Index. J Sci Indust Res 1988; 47: 359-67. 4. Nundy S. Medical journals in developing countries. In: Lock S, ed. The future of medical journals. London: British Medical Journal, 1991: 74-80.
BOOKSHELF The Medical Treatment of Epilepsy Edited by Stanley R. Resor Jr, Henn Kutt. New York: Marcel Dekker. 1992. Pp 735.$195. ISBN 0-824785495.
Although we don’t really need another textbook on the management of epilepsy, this is rather a good one. The 82 chapters from over 100 contributors are short, precise, and clearly set out. Such brevity has ensured rapid production and so the referencing is reasonably up-to-date, an important consideration in this ever changing area of medicine. Practical matters are given priority, such as seizure classification, when to start treatment, assessing efficacy, principles of drug use in children and the elderly, exacerbating factors, and when and how to stop antiepileptic drugs. I liked the overview sections on management of different seizure types. The problem of non-epileptic events presenting as seizures is covered, and so is choosing patients for surgical evaluation. The chapter on "parasomnias" should be read by everyone diagnosing epilepsy, as should that titled "drugs that can precipitate seizures" by those treating it. Each antiepileptic agent is highlighted in a short monograph.
What didn’t I like? More guidance on the practical use of individual drugs would have raised this book high above its competitors. Outmoded drugs such as bromides, mephenytoin, and sulthiame are allocated too much space and widely prescribed anticonvulsants perhaps too little. Newer compounds-eg, vigabatrin and lamotrigine-are not given appropriate prominence. Allow me to ride just one hobby horse. Why, if "the futility of this therapeutic window has been widely discussed", do the authors recommend monitoring serum valproate concentrations when the dose is adjusted? In addition, no one need take this drug more than twice daily. Who will buy this book? Presumably libraries (although they too have been hit by the global recession) and those clinicians whose shelves are not already groaning under tomes on epilepsy and its treatment. I know one neurologist who collects all the texts in his chosen field. Perhaps there are more. I hope so.
Epilepsy Research Unit, Western
Infirmary, Glasgow G116NT, UK
MARTIN J. BRODIE
those at 5-7 days and the persistent excess of GI symptoms in the exposed group at site A may represent infection with pathogens such as Cryptosporidium spp or Giardia intestinalis. The finding that illness occurred more frequently after canoeing in fresh water at a site A receiving sewage effluent agrees broadly with results of sea bathing research in the UK.8 Bacterial concentrations were not strikingly high by comparison with UK seawaters. The enterovirus concentrations, however, were considerably higher14 than those recorded in marine waters with similar enteric bacterial concentrations.8 This may be explained by the contribution from sewage works effluent. Sewage treatment produces greater attenuation of bacterial than viral concentrations.1s Thus enteroviruses, although presumably not causing the symptoms, may provide a better indicator of fresh water quality than the bacteria measured. White-water canoeing in poor quality water leads to a measurable amount of illness. Further studies are needed to determine whether there is a dose-response relation with microbial contamination. If so, knowledge of this relation would be valuable for both water quality standard formulation and public education. We acknowledge the help of Mr John Davies and his staff; the British Canoe Union; Mr Mike Hubbard and Mr John Gregson; Miss Gillian Davies and her colleagues in the National Rivers Authority; Dr R. Stanwell-Smith (Communicable Diseases Surveillance Centre, Colindale); Prof Jay Fleisher (State University of New York); Mr Trevor Harris; Mrs Paula Hopkins; Mr Jerome Whittingham; Dr Ann Delahunty; Dr Helen Merrett (Enviros Ltd); and Dr E. B. Pike and colleagues, Water Research Centre.
2. Godfree AF, Jones F, Kay D. Recreational water quality: the management of environmental health risks associated with sewage discharges. Marine Pollution Bull 1990; 21: 414-22. 3. United States Environmental Protection Agency ambient water quality criteria for bacteria-1986. EPA440/5-84-002. Washington DC: Office of Water Regulations and Standards Division, 1986. 4. Anonymous. EEC Council Directive of8 December 1975 concerning the quality of bathing water (76/160/EEC). Offic J Europ Commun 1976;
L/31,
1-7.
Ferley JP, Zimrou D, Balducci F, et al. Epidemiological significance of microbiological pollution criteria for river recreational waters. Int J Epidemiol 1989; 18: 198-205. 6. Philipp R, Evans EJ, Hughes AO, Grisdale SK, Enticott RG, Jephcott AE. Health risks of snorkel swimming in untreated water. Int J Epidemiol 1985; 14: 624-27. 7. Philipp R, Waitkins S, Caul O, Roome A, McMahon S, Enticott R. Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol city docks. Publ Health 1989; 103: 123-29. 8. Jones F, Kay D, Stanwell-Smith R, Wyer MD. Results of the first pilot-scale controlled cohort epidemiological investigation into the possible health effects of bathing in seawater at Langland Bay, Swansea. J Inst Water Environ Management 1990; 5: 91-98. 9. Anonymous. The bacteriological analysis of drinking water supplies. (Rep Publ Health Med Subj no 71). London: HM Stationery Office, 1983. 10. Alico RK, Dragonjac MF. Evaluation of media for recovery of Staphylococcus aureus from swimming pools. Appl Environ Microbiol 1986; 51: 699-702. 11. Goyal SM, Gerba CP. Concentration of viruses from water by membrane filters. In: Gerba CP, Goyal SM, eds. Methods in environmental virology. New York: Marcel Dekker, 1982: 59-116. 12. Lightfoot NE. A prospective study of swimming related illness at six freshwater beaches in southern Ontario. PhD thesis, University of Toronto, 1989. 13. Stevenson AH. Studies of bathing water quality and health. Am J Publ 5.
Health 1953; 43: 529-38. 14.
Merrett-Jones M, Morris R, Coope C, Wheeler D. The relation between enteric viruses and indicators of sewage pollution in UK seawaters. In: Morris R, ed. Meeting on health related microbiology, IAWPRC,
Glasgow, Sept 12-14, 1991, 158-64. REFERENCES 1. Fewtrell L. Freshwater recreation: 11: 215-26.
a cause
for concern.
Appl Geogr 1991;
15. Consultants in Environmental Sciences. Review of operational and experimental techniques for the removal of bacteria, viruses and pathogens from sewage effluents. PECD 7/7/260, London: Department of the Environment, 1988.
VIEWPOINT Indian medical journals
Although Indian doctors produce half the articles published from the third world, little has been written about Indian medical journals. We examined 75 of the 113 serious English-language journals published in India. Of the 22 included in the Cumulated Index Medicus only 8 were judged by Indian and foreign referees to be of international standard. A survey of Indian authors indicated that foreign journals were chosen for the best papers because of their wider circulation, better refereeing practices, and punctuality. More than 98% of medical articles from India probably go unnoticed by the international medical community.
Introduction Medical journals published in western countries have been catalogued and studied in great detail, often from the Science Citation Index. This provides data on nearly 3000 of
estimated 50 000 journals that are published internationally. It includes, however, only 3 Indian medical journals despite the fact that India (which has approximately 250 000 practitioners of western medicine) accounts for almost half the articles published from the third world. India produces a large number of journals that are not included in any indexing system and have never been studied in detail. We therefore undertook an in-depth examination of Indian medical journals. the
Methods Lists of Indian medical journals were made from the Annual Report of the Registrar of Newspapers for India of 1984 and 1986, and from these we recorded the date of first publication, subjects covered, periodicity, circulation, and sponsoring bodies. ADDRESS. Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India (P. Sahni, MS, P. P. Reddy, MS, R. Kiran, BLibSc, K. S. Reddy, MS, G. K. Pande, MS, Prof S Nundy, FRCS). Correspondence to Professor Nundy.
1590
Punctuality
was
assessed from the interval between date of
publication and receipt in the National Medical Library in New Delhi. Quality was assessed in two ways-by recording whether they were included in Biological Abstracts, Current Contents, Excerpta Medica, the Cumulated Index Medicus, and the Science Citation Index; and by sending copies to Indian and foreign experts
TABLE I-CITATIONS, IMPACT FACTOR, AND IMMEDIACY INDEX OF THE THREE INDIAN JOURNALS INCLUDED IN THE SCIENCE CITA TION INDEX
for their opinions.
Through a postal questionnaire we inquired into the practices followed and problems encountered by the editors of Indian medical journals; and, finally, we scoured all the volumes of the Cumulated Index Medicus for 1985 for authors with Indiansounding names and asked those who had published in foreign journals why they had done so. There were 546 medical publications, 47% in English, 25% in Hindi, and the rest in eleven other languages. Allopathic or western medicine was covered by half the journals and the others dealt with homoeopathy, Ayurveda, the Unani and Siddha systems of medicine, and nature cure. After excluding newsletters, drug company in-house publications, non-allopathic journals, and those published in the vernacular languages we were left with 113 serious journals which included original articles and reviews. We examined these in greater detail. We sent money for subscriptions (and three reminder letters) to all these, asking for a year’s supply, but were able to obtain complete issues of only 75 to send to our referees. Most of the others probably do not appear at all: we tried to visit the editorial offices of 3 of these publications and were told that, although still included with the Registrar of Newspapers, they had been closed for up to five years.
Results The first Indian medical journal, Transactions of the Medical and Physical Society of Calcutta, was published in 1823 and is thus an exact contemporary of The Lancet. Looking at the years of first issues we noticed a striking rise after independence in 1947: before 1920, 5; 1920-29, 9;
1930-39, 9; 1940-49, 14; 1950-59, 73; 1960-69, 111; 1970-79,214; 1980-85,100. About a third of the journals were general rather than specialist publications, Among those examined there were no weeklies, 1 fortnightly, 19 monthlies, 11 bi-monthlies, and 48 quarterlies; 2 come out every four months and 20 every six
months; for
unable to determine the (70/113) of the journals were periodicity. funded by professional societies, 20 by academic institutions (universities, medical colleges, and institutes), 5 received government support, 4 were published by private firms, and 3 came from private hospitals. We could not determine the source of funding for the remaining 11. Most of the journals had a circulation of less than 1000. The one with the largest circulation (70 000) was the Journal of the Indian Medical Association, which is distributed free to members. The prestigious Indian Journal of Medical Research had a listed circulation in 1986 of 715, the Journal of the Association of Physicians of India 4500, and the Indian Journal of Surgery 4000. Only 4 out of 64 journals subscribed to by the National Medical Library of India were received on time. 8 were less than a month late, 15 from 1 to 3 months, 12 from 4 to 6 months, 10 from 7 to 12 months, and 5 more than a year. 10 journals were not received at all, despite acknowledgment of 12
we were
Two-thirds
subscriptions being paid. Quality Inclusion in indexing services-37 journals were indexed in Biological Abstracts, 22 in Cumulated Index Medicus, 3 in Current Contents and Science Citation Index, and 26 in Excerpta Medica. Table I shows the number of citations, impact factor, immediacy index, and rank (1988) of the 3
Nos in
parentheses indicate ranking.
journals included in the Science Citation Index. The figures for The Lancet are shown for comparison. Of the 1022 times the Indian_7ournal ofmedical Research was cited in 1988,200 were in its own pages, 15 in other Indian journals, and the rest in foreign journals. Assessment by Indian and foreign referees-The opinion of the 40 Indian and 46 foreign referees to whom individual journals were sent for assessment is shown in table II. The Indian referees considered Indian Journal of Tuberculosis, Indian Journal of Urology, Journal of Applied Medicine, and Journal of Genetics to be of international standard, while their foreign counterparts’ choices were Indian Journal of Medical Research, Indian Journal of Physiology and Allied Sciences, National Institute of Mental Health and Neurosciences Journal, and Tropical Gastroenterology. Regarding the content, layout, appearance, and printing the foreign referees seemed to be consistently more generous than their Indian colleagues. Descriptions of quality included "needs a good subeditor to correct printing and spelling errors", "mostly a magazine", and "should be closed down".
Editorial practices We wrote to the editors of the 75 medical journals asking them to fill in a proforma, and 44 replied. They received between 10 and 625 articles a year and thirty sent articles for refereeing. Eight sent articles abroad for assessment. The time taken from submission to publication was 2-36 months (median 8 months); and the reasons for delay in prompt appearance of the journal were said to be printing (22), editing (14), and postal (4). Eleven editors declared that their journals always appeared on time. For forty, editing was a part time occupation and thirty-three of them not only edited the journals but also did most of the administrative work. Raising funds was stated to be the major obstacle by 24, delays involving referees and authors by 6, lack of good-quality articles by 6, shortage of advertisements by 4, lack of administrative help by 3, and lack of library facilities
by 1. Indians publishing in foreign journals In 1985, 486 authors with Indian-sounding names had in foreign journals included in the Cumulated
published
TABLE II-JUDGMENTS OF 75 JOURNALS BY INDIAN AND FOREIGN REVIEWERS
1591
Index Medicus. 339 of them were based abroad, the greatest number being in the USA (239), followed by the UK (50), Canada (24), and 14 other countries, and 147 in India. They published on a large number of subjects but seemed to concentrate on biochemistry (88), cardiology (33), and the paramedical sciences. When we asked the authors based in India why they had chosen to publish in foreign rather than Indian journals 60 replied, and the main reasons given were that being accepted by a foreign journal carried greater prestige, and that these journals had wider circulation, had better refereeing practices, and came out punctually.
Discussion There is a common misconception that Indian scientists publish a sizeable proportion of their total number of papers in foreign journals. We have calculated that these form not the 35-40% figure usually quoted’ but only 2% of the total number of publications from Indian medical institutions. However, it may be true that the better Indian papers are sent to foreign journals. For instance, in 1986, two-thirds of the "most important" articles written by fellows of the Indian National Science Academy were published abroada generation ago the proportion was only a quarter. We also found that Indian authors have a low opinion of the quality of indigenous journals and this judgment was echoed by foreign scientists. Other studies of Indian medical journals (again only those included in the Science Citation Index which are probably among the best) have shown that even these do not meet the highest standards.3 The fact that 90% of the references are to work published in foreign journals and half to papers more than 10 years old/ suggests that Indian scientists generally look abroad for inspiration and investigate matters that are no longer of much interest to their western colleagues. We were disappointed in the response from our own medical editor colleagues. Only forty-four editors of the 75 journals we know existed replied to our questionnaire. There was a considerable discrepancy between their
assessment of their own problems and the assessment of authors. Only 14 % of the editors said there was a shortage of good articles-in contrast to the opinion of Indian authors who had published abroad. The reasons for the poor quality of Indian journals have been discussed previously.4 They include scarcity of good medical data, inadequate investment in medical research and health care, ill-trained personnel in understaffed laboratories, and shortage of foreign currency to pay for expensive western journals to keep up with international trends. The most important is that only 5% of Indian doctors read journals regularly, compared with 80% in the USA (Relman AS, personal communication): the pressure for quality is therefore low. What can be done about this vicious circle, in which the low quality of journals deters submission of the best research papers? The first steps should be to raise the level of scientific content by use of foreign as well as indigenous referees, to attend to presentation, and to make them come out on time. Only when Indian journals are included in the international indexing services will they begin to attract the sort of papers that now go abroad. Indian medical journals are broadly based, but, there is much work to be done before they attain the heights. We thank the Indian Council of Medical Research and The National
Medical Journal of India for support.
REFERENCES 1. Garfield E. Mapping science in the third world. Current Contents 1983; 33: 6-15. 2. Krishnan CN, Visvanathan B. The performance of modern science and technology in India: the case of scientific and technical journals. Patriotic and People Oriented Science and Technology Bulletin 1987; 11: 1-19. 3. Arunachalam S, Manorama K. The status of scientific journals of India as seen through Science Citation Index. J Sci Indust Res 1988; 47: 359-67. 4. Nundy S. Medical journals in developing countries. In: Lock S, ed. The future of medical journals. London: British Medical Journal, 1991: 74-80.
BOOKSHELF The Medical Treatment of Epilepsy Edited by Stanley R. Resor Jr, Henn Kutt. New York: Marcel Dekker. 1992. Pp 735.$195. ISBN 0-824785495.
Although we don’t really need another textbook on the management of epilepsy, this is rather a good one. The 82 chapters from over 100 contributors are short, precise, and clearly set out. Such brevity has ensured rapid production and so the referencing is reasonably up-to-date, an important consideration in this ever changing area of medicine. Practical matters are given priority, such as seizure classification, when to start treatment, assessing efficacy, principles of drug use in children and the elderly, exacerbating factors, and when and how to stop antiepileptic drugs. I liked the overview sections on management of different seizure types. The problem of non-epileptic events presenting as seizures is covered, and so is choosing patients for surgical evaluation. The chapter on "parasomnias" should be read by everyone diagnosing epilepsy, as should that titled "drugs that can precipitate seizures" by those treating it. Each antiepileptic agent is highlighted in a short monograph.
What didn’t I like? More guidance on the practical use of individual drugs would have raised this book high above its competitors. Outmoded drugs such as bromides, mephenytoin, and sulthiame are allocated too much space and widely prescribed anticonvulsants perhaps too little. Newer compounds-eg, vigabatrin and lamotrigine-are not given appropriate prominence. Allow me to ride just one hobby horse. Why, if "the futility of this therapeutic window has been widely discussed", do the authors recommend monitoring serum valproate concentrations when the dose is adjusted? In addition, no one need take this drug more than twice daily. Who will buy this book? Presumably libraries (although they too have been hit by the global recession) and those clinicians whose shelves are not already groaning under tomes on epilepsy and its treatment. I know one neurologist who collects all the texts in his chosen field. Perhaps there are more. I hope so.
Epilepsy Research Unit, Western
Infirmary, Glasgow G116NT, UK
MARTIN J. BRODIE
