Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Saturday 17 March 2007

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) Who will care for the oldest people?

(2) Are journal rankings distorting science?

(3) BMJ joins call for action against Reed Elsevier±s arms trade

(4) Is America failing its wounded soldiers?

(1) Who will care for the oldest people?

(Analysis: Who will care for the oldest people?)
http://www.bmj.com/cgi/content/full/334/7593/570
(Editorial: Caring for the oldest old)
http://www.bmj.com/cgi/content/full/334/7593/546

With the number of carers for frail elderly people set to fall steeply, researchers in this week±s BMJ propose a way to help plan for the deficit.

Many people fear that population ageing will generate a demand for long term care that will outpace the supply of formal care. So to anticipate the future long term care needs of the oldest people, researchers in Switzerland suggest introducing the ±oldest old support ratio.±

Their ratio is based on four age groups - the young, those of working age, younger retired people (aged 50-74), and the oldest people (aged 85 and over) - and provides information on the number of people potentially available to care for one person aged 85 or over.

Based on current trends, they estimate that the young retired generation will have to play a greater caring role in the future.

They illustrate this by using trends in Switzerland and the United States. For example in Switzerland, the oldest old support ratio has fallen from 139.7 in 1890 to 13.4 in 2003 and the same trend applies in the US. These ratios are expected to decrease to 3.5 in Switzerland and 4.1 in the United States by 2050.

These forecasts highlight the large fall in the potential pool of informal carers, say the authors. And they warn that failure to anticipate the consequences of these expected trends today will be a mistake that will be heavily paid for tomorrow.

The use of this new ratio should help make governments realise the implications of the substantial intergenerational changes that are occurring and aid policy makers to formulate adequate policies, they conclude.

±We need to face up to the huge cost of care in both the formal and informal sector,± add experts in an accompanying editorial.

In England it is estimated that 8.5 million people provided informal care in 2000, 3.4 million of whom cared for people over 65 years. Informal care is often unseen and unmeasured and usually falls to families, but as the retirement age increases and families become increasingly fragmented, we do not know if they will be around to help, or indeed, will be willing to help. And with the crisis in pensions, there will be less money for people to buy additional care.

±First world countries have swapped infant mortality and childhood illness for the burden of care of the elderly,± they write. ±Caring for the oldest old is the price of affluence.±

Contacts:
Paper: Dr Francois Herrmann, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
Email: francois.herrmann@hcuge.ch

Editorial: Domhnall MacAuley, Primary Care Editor, British Medical Journal, London, UK
Email: dmacauley@bmj.com

(2) Are journal rankings distorting science?

(How impact factors changed medical publishing ± and science)
http://www.bmj.com/cgi/content/full/334/7593/561
(Head to Head: Should we ditch impact factors?)
http://www.bmj.com/cgi/content/full/334/7593/568

This week±s BMJ raises concerns over whether journal rankings (known as impact factors) are distorting publishing and science.

The impact factor is a measure of the citations to papers in scientific journals. It was developed as a simple measure of quality and has become a proxy for the importance of a journal to its field.

But a report by the BMJ this week warns that the popularity of this ranking is distorting the fundamental character of journals, forcing them to focus more and more on citations and less on readers.

Concerns include the fact that a bad paper may be cited because of its infamous errors and that a journal±s rank has no bearing on the quality of individual papers it publishes. But more worrying is the trend towards using impact factors to guide decisions on research funding. This has been particularly noticeable in the UK, where universities now prioritise scientific fields that produce research published in the highest impact factor journals, causing substantial damage to the clinical research base.

In an accompanying article, two researchers discuss whether impact factors should be ditched.

Gareth Williams of Bristol University believes that the academic community should consign the impact factor to the dustbin. He sees the measure as fatally flawed and highly damaging to the academic community.

±The impact factor is a pointless waste of time, energy, and money, and a powerful driver of perverse behaviours in people who should know better,± he writes. ±It should be killed off, and the sooner the better.±

But Richard Hobbs of Birmingham University thinks that rather than just discarding impact factors we should consider solutions to the problems. For example, extending the citation surveillance period, applying weightings to adjust for the average number of references across journals, or scoring journals on only their most important papers.

It±s easy to criticise bibliometrics, but we should attempt to refine them and debate in parallel how we can track academic careers and encourage fewer, but better studies that affect the wider community, he concludes.

Contacts:
Gareth Williams, Dean, Faculty of Medicine and Dentistry, University of Bristol, UK
Email: gareth.williams@bris.ac.uk

Richard Hobbs, Head of Primary Care, Department of Primary Care and General Practice, University of Birmingham, UK
Email: f.d.r.hobbs@bham.ac.uk

(3) BMJ joins call for action against Reed Elsevier±s arms trade

(Editorial: Reed Elsevier±s arms trade)
http://www.bmj.com/cgi/content/full/334/7593/547

The BMJ has joined the call for action against Reed Elsevier over its links with the arms trade.

In a recent editorial in the Journal of the Royal Society of Medicine, the former editor of the BMJ, Dr Richard Smith, called on researchers and authors to boycott Reed Elsevier, the world±s largest publisher of scientific and medical journals, including The Lancet, to pressure the company to divest itself of holdings in the arms trade. He argues that, by facilitating the sale of armaments, Reed Elsevier is directly implicated in causing untold damage to health.

In this week±s BMJ, Editors Dr Fiona Godlee and Dr Charles Young support his call.

The BMJ is often seen as being in competition with The Lancet, but the BMJ has no wish to see The Lancet diminished, they write. The two publications are in many ways complimentary, and together they represent important evidence of the continuing influence of British publishing and science around the world. Anyone interested in global health should want The Lancet to continue to thrive unhampered by such disastrous bedfellows.

They urge the scientific and health communities to ±exert their influence± by signing petitions, looking for alternative publishers, and expressing disgust at the company±s arms trade activities through collectives such as the World Association of Medical Editors.

Furthermore, they believe that academic and industry funded researchers should now agree not to submit their high profile randomised controlled trials to Reed Elsevier journals until links with the arms trade are ended. And they should make these decisions public, thus ending their tacit support for the company±s links with the arms trade.

Direct loss of revenue in this way would quickly identify to Reed Elsevier that the scientific world will no longer tolerate its warmongering and health damaging business activities, they conclude.

Contacts:
Dr Fiona Godlee, Editor, British Medical Journal, London, UK
Email: fgodlee@bmj.com or Dr Charles Young, Editor, BMJ Clinical Evidence, London, UK Email: charles.young@bmjgroup.com

(4) Is America failing its wounded soldiers?

(Observations: The trouble with US military medicine)
http://www.bmj.com/cgi/content/full/334/7593/565

Reports of squalor at a US military hospital show how out of touch America±s elites really are, argues a leading US professor in this week±s BMJ.

According to several recent reports in the Washington Post, seriously wounded soldiers at Walter Reed Army Hospital are housed in rodent infested facilities with holes in the ceilings and paint peeling off the walls ± right in the nation±s capital, less than six miles from the White House.

Meanwhile, a flood of reports from wounded soldiers and veterans elsewhere suggests that America, in too many instances, fails its wounded warriors and veterans in general, writes Professor Uwe Reinhardt of Princeton University.

Americans never tire of professing in words their gratitude to the brave men and women who fight the nation±s wars, he says. Yet, with few exceptions, America±s government, financial, academic, and business elites are routinely shielded against the blood cost of war, as few of their offspring volunteer to serve in the military.

It is perhaps understandable, if not forgivable, that an elite so carefully shielded from the physical and fiscal consequences of war, and so self absorbed in accumulating wealth and power, will almost innocently neglect its wounded soldiers, taking it on faith that ±someone± will take good care of them, without ever bothering to check whether it is so.

He believes that the army must shoulder part of the blame, saying that the sorry conditions of some facilities at Walter Reed and the mindless and often cruel bureaucracy routinely visited on wounded soldiers should have been known to the generals in charge.

And he concludes, ±Conditions in US military medicine will not change until its entire bureaucratic system is imbued with the idea that wounded soldiers no longer are pieces of human capital ± but that they are fellow human beings worthy of our utmost gratitude and compassion, in deeds and in words.±

Contact:
Uwe Reinhardt, James Madison Professor of Political Economy, Princeton University, Princeton, USA
Email: reinhard@princeton.edu

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division, BMA House, Tavistock Square London WC1H 9JR

(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)