The 101 most-cited papers from the British Medical Journal by elyah


									Essays of an Information Scientist, Vol:10, p.40, 1987                  Current Contents, #7, p.3, February 16, 1987

                                                                                EUGENE GARFIELD
                                                                                     F           INFORMATION-
                                                                             3501MARKET              PA19104

                                                    The 101 Most-Cited Papers from
                                                       the British Medical Jownd
                                                      Highlight the Important Role
                                                      of Epidemiology in Medicine

               Number       7                                                            February      16, 1987
                  The British Medical Journal began pub-              Medical Journal, but of these only 20 per-
               lishing in 1840 as the organ of the Provin-            cent are eventually published.s (p. 243) The
               cial Medical Association (PMA), a group                current editor, Stephen Leek, who authored
               of physiciartspracticing in the provinces out-         a 1985 book on peer review in medicine,4
               side England’s major cities. They had                  follows extensive refereeing practices (a re-
               banded together in 1832 to share their indi-           cent review of which appears in a 1986 ar-
               vidual medical experiences with one another            ticle in Schokwly Publishing.s) He alw sub-
               in much the same fashion as the metropoli-             scribes to the rule promulgated by Franz
               tan physicians who had earlier formed their            Ingelfinger, former edkor of the New En-
               own society and journal. The PMA”s first               gland Journal of Medicine. The essence of
               periodical was called 7he Provincial Medi-             the Ingelfinger rule is that articles submit-
               cal arrd Surgical Journal; in 1853 it merged           ted to a journal cannot have been previous-
               with the Lmdon Journal of Medicine to be-              ly published in, or be simultaneously sub-
               come the Association Medical Journal. Four             mitted to, other joumals.b The British Med-
               years later the PMA acknowledged its grow-             ical Journal is also a founding member of
               ing memkaship throughout Great Britain by              the frstemational Committee of Medical
               renaming the society the British Medical               Journal Editors-the Vancouver Group—
               Association. The journal was rdso re-                  which is responsible for issuing the Uniform
               named. 1 Today the British Medical Journal             Requirements for the Submission of Manu-
               is the third largest general medical journal           scripts to Biome&cal Journals and guidelines
               in the worldz and, as the official organ of            on multiple publication. These requirements
               the British Medical Association, is sent free          are now followed by over 300 biomedical
               to its 70,000 members; the journal also                journals throughout the world.
               has over 20,000 nonmember subscribers                     Since 1840 the British Medical Journal
               throughout the worlds (p. 239)                         has published over 50,000 papers, letters,
                  This weekly journal primarily publishes             and other items. In this study my ISI” col-
               peer-reviewed, clinically oriented papers in-          leagues and I identified and then examined
               tended to “educate, inform, and entertain”             the 101 British Medical Journal items most
               physicians from academia to general prac-              cited in the 1955-1985 Science Citation
               tice to administration. These papers consti-           Index@ (NY ). (See Bibliography.) Of
               tute about half of the journal’s pages each            these, 99 are research papers and 2 (W.J.
               week. The remaining pages of the journal               Irvine and A.W. Liley) are notes published
               comprise letters, book reviews, social-pol-            in the preliminary communications section
               icy articles, topical items, and “leading ar-          of the journal. The citations received by the
               ticles” commissioned to keep physicians up-             101 items range from 182 to 803. The me-
               to-date with the latest advances in medicine           dian citation rate is 240. The notes received
               and to explain their uses in clinical settings.        186 (Irvine) and 264 (Liley) citations.
                  Every year over 5,000 items, including                 The articles in the Bibliography represent
               2,900 letters, are submitted to the British            over 5 percent of those.British Medical Jour-
mzl items cited at least 50 times in the          Worcester Royal Infh-mary, the paper dis-
1955-1985 SCI. Table 1 provides the cita-         cusses campylobacter enteritis.
tion breakdown, by groups of 100 citations           B.N.C. Prichard and P.M.S. Gillarn,
or less, for those British Medical Journal        University College Hospital Medical
articles cited 50 or more times. Only 9 items     School, University of London, authored
have received 400 or more citations; 28,           “Treatment of hypertension with propran-
more than 300; and 73, at least 200 citations.    0101,” the third most-cited paper, with 520
The majority of the articles-1 ,029—were          citations. This 1969 paper continues to be
cited between 50 and 74 times.                    cited— 12 times in 1986.
                                                     As yet, the authors of these three papers
Methods                                           have not published commentaries in the
   As mentioned earlier, the 101 articles         Cita~ion Ckzrsics series that appears in Cur-
were chosen by examining citation data            rent Contents” each week. These are auto-
culled from the 1955-1985 SCI. Only cita-         biographical accounts of informal events
tions from journals and other serials are in-     leading up to a paper’s publication. How-
cluded. While the SCZdoes include citations       ever, Alice M. Stewart, Department of So-
to textbooks and other monographs, they are       cial Medicine, University of Oxford, one of
not treated as sources. The purpose of this       the authors of the fourth most-cited article,
analysis was simply to ident@ the 1(K) ost-       did comment on the survey of childhood ma-
cited “classic” articles from this prestigious    lignancies she wrote with Josefine Webb and
medical journal. Using citation counts as the     David Hewitt, also then at Oxford. Accord-
sole selection criterion, we previously iden-     ing to Stewart’s commentary, their work
tified a similar series of Citation Classicsw     was “a triumph for a small group of epi-
for the Annals of Internal Medicine,7             demiologists... [who] were anxious to dis-
JAMA-Joumal     OJ the American Medical           cover why the post-war increase in leuke-
Association,8 Z%e Lmcet,g and the New             mia had produced an early peak of leuke-
England Journal of Medicine. 10No hypoth-         mia mortality consisting only of lymphatic
eses were proposed about the types of items       cases, but.. even with the increase, leuke-
that might appear in the list.                    mia remained a rare cause of childhood
  Selection of papers was limited by the 31       deaths. ” An association between fetal irra-
years of citation data covered by the             diation and cancer was later identified by the
1955-1985 SC1. Understandably, older pa-          group. 12
pers that received the bulk of their citations       The fifth most-cited work, by Martin G.
prior to 1955 were not identifkd. This prob-      Lewis, Chester Beatty Research Institute,
lem will be remedied, however, once the           Institute of Cancer Research: Royal Cancer
SC1 is extended back to include citations         Hospital and Royal Marsden Hospital, Lmn-
from papers published in the first half of the    don, and six colleagues, has been referenced
twentieth century.                                445 times since 1969. In his commentary
                                                  Lewis says that this work “resulted in one
Five Most-Cited Papers and Citation               of the first detailed studies of humoral im-
Ckssics                                           munity in a human tumor system. ” 13At the
   The most-cited paper in the Bibliography,      end of his commentary, which illustrates the
by Andrew W. Kay, Western Intlrmary,              type of information not usually included in
University of Glasgow, Scotland (803 cita-        scientific papers and that authors are encour-
tions), describes the ‘‘Effwt of large doses      aged to share in Citation Classics, he also
of histamine on gastric secretion of HC1,”        relates the sad news that three of his
or’ ‘the parietal cell response in man to large   coauthors-D.C.      Bodenham, R.L. Ikono-
doses of histamine. “~ 1 It is now over 30        pisov, and G. Hamilton Fairley–are de-
years old but continues to be cited occasion-     ceased, the latter the victim of a terrorist
ally. The second most-cited work is of mom        bomb attack in London. 13
recent vintage. Published in 1977 by                 Seven additional papers in the Bibliogra-
M .B. Skirrow, Public Health Laboratory,          phy, two coauthored by W .H. W, Inman,
Table 1: Citation-frequency distribution of Bn”tish           Research at Mill Hill. His autobiographyl’t
  Medical Joumd  articles cited 50 or more ties in the        has recently appeared. While the number of
  1955-1985 SCF. A total of 1,969 articles were
  examined.                                                   distinguished physicians in the Bibliography
                                          Percent of
                                             Tutat            is obvious, the Nobel Prize reflects basic
  Number of            Number of           Articles           preclinical research.
   Citations            Artidea           Examined               Exactly 303 authors appear on the 101 pa-
        5(KI                  4               0.2
                                                              pers. Doll is listed on 11 of these, while Ves-
    400-499                   5               0.3             sey wrote 5, G.M. Besser and A.B. Hill
    300-399                  19               1.0             each are represented by 4, K. G.M.M. Al-
    200-299                  45               2.3
                                                              berti, R. Hall, Inman, and A.S. McNeilly
    100-199                                  22.0
      75-99                 435              22.1             authored 3 each, and 23 authors wrote 2 pa-
      50-74               1,029              52.3             pers. Many of the papers by these authors
Committee    on Safety of Medicines, London,                  are companion pieces on the same subject
about the relationship of oral contraceptive                  published back-to-back in the British Medi-
                                                              cal Journal (N. Hurwitz, J.I. Mann,
use to thromboembolic disease, have been
discussed in Citation Classics commentar-                     Speizer) or similar papers published within
ies. The other five papers were authored by                   a year of one another (I. Aird, Doll, Ves-
D.J.R. Laurence, M.O. Thorner, F.E.                           sey); three of Doll’s works contain the re-
Speizer, M.P. Vessey, and B.M. Wright.                        sults of an originrd study (two 1964 papers)
Vessey’s paper, coauthored with Sir Richard                   and a follow-up published in 1976.
Doll, also discusses oral contraceptives and                     However, each of these “paired” papers
venous thromboembolism. Vessey, inciden-                      contained enough unique information that
tally, is also coauthor on both of the Inman                  researchers cited them more often by them-
articles.                                                     selves than in conjunction with their com-
                                                              panion papers. For example, 101 articles co-
Author Information                                            cited both of Aird’s papers that examine the
   Numerous studies at 1S1have demonstrat-                    relationship of blood groups to various types
ed that Nobel Prize winners consistently                      of cancer. The 1953 paper received an ad-
publish classic papers. However, only one                     ditional 213 citations and the 1954 article,
of the authors in the list of 101 British Med-                165 citations from 1955 to 1985, Doll has
ical Journal articles, Sir Peter Brian Med-                   threx papers in the Bibliography that discuss
awar (UK), is a Nobel laureate. He was                        mortality in relation to smoking. Thirteen
honored in 1960 with Sir Frank Macfarlane                     articles eo-cited these papers. However, 162
Bumet (Australia), recently deceased, for                     co-cited the two 1964 papers.
their discovery of acquired immunological                        The two Hurwitz papers in the Bibliog-
tolerance. Medawar is represented in the                      raphy were published back-to-back in the
Bibliography by two papers written with first                 British Medical Journal in 1969, but they
authors R. E. Billingham, then at the Uni-                    have been co-cited in only 32 articles. How-
versity of Birmingham, and L. Brent, Na-                      ever, Mann’s articles on oral contraceptives
tional Institute of Medical Research, Medi-                   and myoeardial infarction, also published
cal Research Council (MRC), London.                           consecutively, in a 1975 issue of the jour-
These works discuss skin homografts and                       nal, were co-cited together in 127 papers,
tissue transplantation, activities that proved                while Speizer’s two papers were similarly
important to the later Nobel Prize-winning                    co-cited in 122 articles. The full citation
research on acquired immunological toler-                     count for each paper can be found in the
ance. According to Medawar, “he was ter-                      Bibliography.
ribly sorry that the [Nobel] distinction could
not be so far subdivided as to have includ-                   Multiple Authorship      and Age of Papers
ed my friends Bill [Billingham] and Leslie                       In the past 20 years various scholars have
~rent]. ”14 (p. 137)                                          noted a growing trend toward multiple au-
   Until his recent illness, Medawar was di-                  thorship of scientific papers. Papers pub-
rector of the National Institute of Medicrd                   lished in journals such as 7ke Lancer, New
England Journal of Medicine, Annals of In-               example, the University of London, listed
ternal Medicine, and Surgery, Gynecology,                54 times by authors in the Bibliography, in-
and Obstetrics have all experienced a rise               cludes 13 papers from St. Bartholomew’s
in mean authorship in the last decade. 15-17             Hospital Medical College, while the MRC,
   In this study only 12 papers list just one            with a total of 21 papers, has 10 from its
author. Of the remainder, 31 have 2 authors;             Biostatistics Unit in Cambridge.
 18, 3; 18, 4; 8, 5; 2, 6; 3, 7; 3, 8; 4, 9;
 1, 10; and 1, 11. Of course, the group of               Table 3: Itemized breakdown of the three affiliations
papers in the Bibliography is only a small                 that appear most often in the Bibliography.
sampling of articles drawn from just one                                                  Nmnber of T:mes
journal, and the papers’ publication dates are                                          Instkutinn Appeared
                                                          Name of                                in the
clustered rather heavily in two decades.                 Institution                         Bibliography
Forty-three articles were published in the
 1970s, 38 in the 1960s, and 18 in the 1950s.            University of Lmndon                               54
Table 2 provides the chronologic distribu-                  St. Bartholomew’s Hnspikd Medical          13
tion of all 101 papers by decade of publi-                     College
cation.                                                     Universi~ College Hospital Medical         12
Table 2: Chrono[ogic distribution of publication dks        King’s College Hospital Medical             7

  of the 101 British Medical Jourrwl papers mnst cited         Schnol
  in the 1955-1985 SCP.                                     Royal Postgraduate Mtilcal Schnol           7

           Decade of            Number of                   London Schonl of Hygiene & Tropicsl         4
          Publication              Papers                      Medicine
                                                            Middtesex Hospital MdlceJ Scheol            4
              1920s                    1
                                                            Guy’s Hnapitsl Medical Schonl               2
              1930s                   o
                                                            St. Tbomss’s Hospitat MdIcal Schnnl         2
              1940s                   o
              1950s                  la                     Institute of child Health                   1
                                                            London Hospital Medical College             1
              1960s                  38
                                                            St, Mary’s Hospital Medical Schnol          1
              1970s                  43
              19s0s                    1
                                                         MRC (Medical Research Council)                     21
   T.J. Crow, Division of Psychiatry, Clin-
                                                             Bkoststistics Unit, Cambridge             10
ical Research Centre, MRC, London, wrote                     Nationel Institute of Medical Research,    3
the most recent paper in the Bibliography,                     London
a 1980 review on the moiecular pathology                     Clinical Effects of Rallation Research     I
                                                               Unit, Edinburgh
of schizophrenia. It is the ordy paper in the
                                                             Clinical Research Cenere, London           1
table from the 1980s. The oldest paper is                    Demyelinating Disease Unit,                1
A. Cecil Alport’s 1927 article on ‘‘Heredi-                    Newcastle upnn Tyne
                                                             Epidemiology Unit, CarrMf                  1
tary familial congenital hemorrhagic ne-                                                                1
                                                             Gastroenterology Unit, f.modon
phritis, ‘‘ cited 235 times between 1955 and                 Group Metabnlic Haemndynsrrric Lker        1
 1985. The second oldest paper, from 1951,                     Disease, f..ardon
was mentioned earlier, authored by Billing-                  MRC                                        1
                                                             Snciai Medical Research Unit, London       1
ham, P.L. Krohn, and Medawar.
Geographic and Institutional Information                 University of Oxford                               13
  Alport was affiliated with the University                  Rsdcliffe Infnnsry                         6
of London, St. Mary’s Hospital Medical                       Department of SUCisland Community          2
School, 1 of 73 institutions listed by the au-                 Medicine
                                                             Nuftleld Department of Clinical Medcinc    2
thors of the 101 papers. Seventeen of these                  Department of Phsnnacology                 1
affiliations appear more than once in the list.              Department of Sncial Medicine              1
The three with the greatest number of papers                 University Mrnratory of Physiology         1
are the University of London, the MRC, and
the University of Oxford. These institutions                All the institutions represented are located
in turn represent many smaller colleges and              in just 12 countries; not surprisingly, the UK
schcmls, which are itemized in Table 3. For              has the greatest number of papers-90. The
Table 4      Geqraphic   reprewnted by tie 101British
                              areas                                 troversial research. See, for example, our
  Medical      Journal   most cited in the 1955-1985
   SCf@, in descending order of the number of papers
                                                                    recent study of the 100 most-cited papers
                                                                    from JAJL4-Jownal of the American Med-
                                                                    ical A.ssociation,a which compared their
                                                                    landmark Serieslg to our list of 100 articles.
                                                                       The citation and source-item data con-
                                                                    tained in the SC1 and used in this study can
 UK                             90     6 Australia, Bulgaria,
                                          Denmark, S.
                                                                    also be separated into spcxific categories for
                                          Africa, Sweden. US        more sophisticated analyses of journals and
    England              82                                         articles. For example, the types of journal
    Scotland              6
                                                                    items-letters, original articles, reviews, and
    N. Ireland            3
    Wales                 3                                         so on—that give out and receive references
 Denmark                         4  1 Sweden, UK                    can be identified, and then these can be ex-
 Sweden                          4  3 Denmark, UK, US               amined to ascertain which types are most
 Finland                         30
 us                              3  2 Sweden, UK                    cited. Impact factor, the average number of
 Australia                       2  1 Bulgaria, UK                  citations given to a journal’s articles during
 S. Africa                       2     2   UK
                                                                    a specified period of time, can also be cal-
 Bulgaria                         1    I   Australia,   UK
 New   Zealand                    10                                culated to help normalize the varying rates
                                                                    of citation between journals from different
gap between it and the two next most-listed                         fields. Two recently published articles use
countries-Denmark and Sweden with four                              SC] data, obtained from customized com-
each—is quite large. (See Table 4.) Accord-                         puter printouts prepared by 1S1,to examine
ing to the British Medical Journal, about 25                        generaJ medical journals such as the British
percent of the articles they now receive and                        Medical Journal and the New En@mdJour-
publish every year are from authors over-                          nal of Medicine. lg,zo
seas.’2                                                              Unfortunately, it is not within the scope
                                                                   of this essay to discuss all the different ways
                                                                   that Xl data can be used to analyze articles
   This concludes our study of the 101 most-
                                                                   and journals.
cited Bn”tish Medical Journcd items. While
citation counts alone do not always identify                          My thanks ~ A~ig~il k. &ssom, Karen
important papers, they can help us quickly                         Maguire, and Giliian Wilson for their help
recognize articles that contain lasting or con-                    in the preparation of this essay.  @lea? 1s(

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The 101 most-cited Bridsh Medical Journal articles from the 1955-1985SCP, in alphabetic order by first author,
Asterisks (*) indicate articles with Cirrrdon Ckz.r.rics@commentaries. The issue number, year, and edition of Cur-
rent Crmrents” in wh!ch these commentaries appeared are in parentheses. Readers should be aware when scanning
this table that the Bridsh Medicaf Joumof’s system of numbering each volume changed in 1980 frnm a yearly cycle
of volume numbers to a consecutive volume numbering system cm’ricdover from one year to the next. They starred
with #280 rather tharr #1 tn account for the earlier volumes of the journal that had been numbered 1, 2, 3, or 4
each y=.

 citations                                            Bibfiographk   Data

    314      Akd I, Bentalf H H & Fraser Roberts J A. A relationship between cancer of stomach and the
               ABO blond groups. Brif. Med. J. 1:799-801, 1953. Univ. London, Roy. Postgrad. Med. Sch.
               and Londnn sch. Hyg. Trop, Med., England,
    266      Aird 1, BentaU H H, Mehigaa J A & Fraser Roberts J A. The blood groups in relation to
               pqrtic rdcerarion arrd carcinnms of colon, recrom, breast, and bronchus, Brir. Med. J. 2:315-21,
               1954. Univ. London, Roy. PostWad. Med. sch. rmd London Sch. Hyg. Trop. Med.; Burden
               Neurnl, fnst., Merit. Res. Dept., Bristol, England.
    280      Afexanderaon B, Evans D A P & S]nqviat F. Steady-state plasma levels of nortriptyline in
               twins: influence of gerretic factors srrd dmg therapy. Brif. Med. J, 4:764-8, 1%9. Ksrnlinska
               Inst., Dept. Phannaccd., Stnckholm, Swedeu Univ. Liverpml, England.
    280      AlfkanrrA C. Prnteztion afforded by sickfe-cell trait against subtertian malarial infection. Brir.
               Med. J. 1:290-4, 1954. Univ. Oxford, Radcliffe Infirm., England.
    235      A@urt A C. Hereditary famifial congenital haemnrrbagic nephritis. Btif. Med. J. 1:504-6, 1927.
               Univ. Lmrdnn, St. Mary’s Hosp. Med. Sch., England.
    407      Asberg M, Crorrhofm B, Sjnqvkt F & Tuck D. Relationship between plasma level and
               therapeutic effect of rrnrtriptylirm Brit. Med. J. 3:331-4, 1971. Ksrolinska Inst., Dept.
               Psychiat., Stockfroti, Linkoping Univ., Sch. Med., Sweden.
    272      AtMme H, Hayward J L, Kkrgman D J & Wayte A B. Trcamr+nt Of r=lY br~st c~cer: a
               repnrt after ten years of a clinicaJ triaf, Bn”t. Med. J. 2:423-9, 1972. Univ. London, Guy’s
               Hosp. Med. Sch., England,
    313      Be$aer G M, Parke L, Edwards C R W, Fnreyth I A & NfcNeiffy A S. Gafactomhoea:
               successful treatment with reduction of plasma prolactin levels by bcnm-ergncryptinc. Brif. Med.
               J. 3:669-72, 1972. Univ. Lzmdon, St. Bartholomew’s Hosp. Med. CoIl., Univ. Reading, Natf.
               Irrst, Res. Dairying, England.
    197      Bigga R, Dougkm A S, Macfarlane R G, Dacke J V, Pitney W R, Merskey C & O’Brfen J R.
               Christmas disease. A cotilrion previously mistaken for hemophilia. Brif. Med. J. 2:1378-82,
                1952. Univ. Oxford, Radcliffe Infirm.; Univ. London, Roy. Postgrad, Med. sch.; South Devon
               E@ Comwsff Hosp., Plymouth, Engfand; Univ. Capetown, ScmehAfrica.
    188                    R
             14kfflrrgham E, Krobrr P L & Medawar P B. Effect of corrisrme on survivsf of skirr
               homografta in rabbits. Bn’t, Med. J. I: 1I57-63, 1951. Univ. Birmingham, Depts. Znol. and
               Anat., England.
    182      Brent L & Madawar P B. Tksue transplantatinrx a new apprnach to the “typing” problem.
               Brir. Med. J. 2:269-72, 1%3, MRC, Natk. Inst. Med. Res,, London, Engfrmd.
    328      Bullen J J, Rogers H J & LA@ L. Iron-birrdhg proteins in milk and res~sram!eto Kcclw?chia
               coli irrfection in infants. Brit. Med. J. I :69-75, 1972, MRC, Natf. brst. Med. Res., London,
               Engfsn& Dept. Agricult. Fkheries Scotfsod, Rowett Res. Inst., Aberdeen, Scotfrmd.
    236      Burn J H & Rand M J. Noradmrrafine in artery wefls sod its dispaaal by resecpirre Brir. Med.
               J. 1:903-8, 1958. Univ. Oxford, Dept. Pharmscol., Engfsrrd.
    224      Caltre D B, Teycherme P F, Cfaverfa L E, E.@man R, Greenacre J K & Petr& A.
               Bromocriptirre in Parfdnsonism. Brir. Med. J. 4:442-4, 1974, Univ. fmndon, Roy. Postgcad.
               Med. Sch., England.
             Caaprrry E A & Ffefd E J. Specific lymphncyre sensitization in carrcer: is there a common
               antigen in irumsn mrdignant ncojdasia? Bolt. Med. J. 2:613-7, 1971. MRC, Oemyelinating Dis.
               Urtit, Newcm+rke pon Tyuc, Enghutd.
    227      CbamberMn D A, White R J, Howard M R & Smkth T W. Plasma digoxin concentrations in
               patients with are’ialfibrillation. Brit. Med. J. 3:429-32, 19’70.Univ. Lmrdnn, St. Bartbnlomew’s
               Hosp. Med. CoU., f3n@n& Massachusetts Oen. Hosp., Cardiac Unit, Buston, MA.
    199      CO&.m A J, Sp@ W G S, Mackk R M & Thomas C E. Postoperative depression of tUlOOUr-
               directed cell-medated immunity in patierxa with mahgnarrt disease, Brir. Med. J. 4:67-70, 1972.
               Univ. Glasgow, Depts. Patbol. and Dermstol., Scotfsnd.
    284      Coltart D J & Shand D G. Plasma propranolol levels in the quantitative assessment of&
               adrenergic blockade in mrm, Brir. Med. J. 3:731-4, 1970. Univ. London, St. Bartholomew’s
               Hosp. Med. Colt., England,
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