Importance of preventive medicine not reflected in major medical publications

July 23, 2000

Major medical journals publish relatively few articles about preventive medicine, which may affect how doctors and society regard it, suggest the results of a study.

"A clear signal about the importance of prevention is conveyed when both journals and the news media focus on tests and treatments for disease and not on ways to prevent them," said lead author Steven H. Woolf, MD, MPH, a family physician and specialist in preventive medicine at the Medical College of Virginia at Virginia Commonwealth University in Richmond. "Given the prominence of journals as a leading information source for physicians and clinical trainees, the attention they give to primary prevention signals its importance in patient care."

Woolf and co-author Robert E. Johnson, PhD, also of Virginia Commonwealth University, examined all articles published in 1998 in the two most popular U.S. medical journals: The Journal of the American Medical Association (JAMA), and The New England Journal of Medicine (NEJM).

Only 9 percent of the articles focused on primary prevention or screening, and only 2 percent focused on the basics of a healthy lifestyle, through diet and exercise for example. No study focused on how to help patients quit smoking. "In contrast, 60 percent of articles published in 1998 addressed treatment, epidemiology, and basic science," said Woolf.

The two magazines published 32 articles on HIV treatment but only four on prevention of sexually transmitted diseases. "Only two studies focused on ways to improve the delivery of childhood immunizations, which may be the most effective preventive service in the United States," said Woolf.

The researchers report their findings in the August 2000 issue of the American Journal of Preventive Medicine.

Funding issues may play a role in the low representation of prevention research. "Only a small proportion of grants from the National Institutes of Health are awarded for preventive research," said Woolf.

However, inadequate funding is probably not the sole explanation. Although JAMA and NEJM did not publish a single study on how to help patients quit smoking, 26 such studies appeared that year in preventive medicine, public health, and primary care journals.

The study has limitations, Woolf and Johnson note. They only examined two journals; others, such as the Lancet and British Medical Journal, may have included more prevention research. Also, topics neglected in 1998 may have received more coverage in other years. The researchers called for further studies to expand their analysis.

"We limited the analysis to two journals and one calendar year to pilot the methodology. We hope the approach will be extended in future studies to more journals and a longer time period to facilitate research on the link between topic priorities and public policy," said Woolf.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the Journal, contact the editorial office at 619-594-7344.

Posted by the Center for the Advancement of Health For information about the Center, call Petrina Chong, 202-387-2829.

Center for Advancing Health

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