243 JMAJ, July / August 2009 — Vol. 52, No. 4 Research and Reviews Can National Medical Association Journals Make Greater Contributions to Global Health? An international survey and comparison JMAJ 52(4): 243–258, 2009 Mieko HAMAMOTO,* 1 Masamine JIMBA,* 2 Donald D. HALSTEAD,* 3 Grace WYSHAK,* 3 Michael R. REICH* 3 Abstract Background National medical associations (NMAs) publish many kinds of periodicals to educate their members and improve medical science, clinical care, and public health. As the internet and related forces continue to disrupt this mode of communication, NMAs will increasingly face complex decisions in areas such as their new responsibilities to global society, whether to publish in print or electronically, to focus on domestic or international audiences, and which languages to publish in. However, little is known about the nature, purpose, underlying policies and other aspects of periodicals published by NMAs worldwide. Purpose To determine the characteristics of the NMAs and their periodicals, with a focus on general medical journals and the obstacles to their having a greater international scope. Methods We surveyed the 92 NMAs that are members of the World Medical Association (WMA) and/or the Confederation of Medical Associations in Asia and Oceania (CMAAO) on the characteristics of their organization and periodicals. Some responses were clarified by interviews and reviews of NMA websites. Results The response rate to the survey was 34% (31/92). NMAs varied greatly in their human resources, including number of members (1,150–395,000), staff (3–1,000), and staff density (staff per thousand members 0.12–5.44). The type of membership in 86% (25/29) of NMA respondents was voluntary, and the participation rates ranged from 5 to 99%. Journals’ revenues came mainly from NMA budgets (46%) and advertising revenues (43%). Approximately 73% (19/26) of journals provided free online access to full text, and 71% (22/31) were fully or partly published in English. Most NMA journals were domestically focused in terms of readers and first authors (93%). Only a few journals had a scientific influence, as measured by “impact factors.” Conclusions While NMAs had different capacities and business models, most of their general medical journals had a domestic focus. For a journal to have a global impact requires substantial resources and intelligent marketing in highly competitive markets. NMAs can more likely make meaningful global contributions by using English and the internet, and by developing a unique niche. Key words Medical association, Periodical, Journal, Impact factor, International, Communication with their physician members, and to advance medical science, clinical care, and public health. 1 This communications environment is being irre- vocably changed by the internet and other new media technologies that have greatly increased *1 Japan Medical Association, Tokyo, Japan (hamamoto@po.med.or.jp). Takemi Program in International Health, Harvard School of Public Health, Boston, MA, USA. *2 University of Tokyo, Tokyo, Japan. *3 Harvard School of Public Health, Boston, MA, USA. Introduction For decades, national medical associations (NMAs) have published a wide range of newsletters and medical journals to educate and communicate