Real impact
Authors: Trish Groves
Journal: BMJ (2007)

Here's something that affects the behaviour and even careers of many contributors to the BMJ, yet many readers couldn't care less about it. Editors fall somewhere in between. It's the impact factor, a measure of citations to articles in the journal, which is “capable of recognising some value, some quality” (doi: 10.1136/bmj.39146.545752.BE) or “worthless” (doi: 10.1136/bmj.39146.549225.BE), or has indirectly “distorted the fundamental character of journals” (doi: 10.1136/bmj.39142.454086.AD), or has yielded “a league table that no one but a fool would take seriously” (doi: 10.1136/bmj.39142.475799.AD), depending on your point of view.

Despite all of this, we're quite pleased with the BMJ's current impact factor of around 9, and we would be fools not to tell prospective authors about it. But Groucho Marx said he didn't care to belong to any club that would have him as a member, and he had a point. The BMJ is not going to put impact factors above what matters to readers.

Readers' views greatly influenced our recent redesign. Your rapid responses keep us on our toes, day in day out. Your hits on and downloads of research articles on bmj.com, along with citation rates, show us whether our peer review system is on the right track. Indeed, this week we announce the top 10 BMJ research papers of 2005 (doi: 10.1136/bmj.39153.350174.DB)—and, no, this wasn't a ploy to bump up those papers' citation rates. We shorten research papers to make them more readable in the print journal and provide immediate open access to their full text on bmj.com, even though, for many researchers choosing a journal, impact factor still eats open access for breakfast (http://resources.bmj.com/files/talks/open-access-and-quality.ppt).

Richard Lehman, in his weekly blog on medical journals, describes another long running saga: the stent wars (http://blogs.bmj.com/category/comment/medical-journals-review/). He's talking about coronary artery stents, but he notes that the generic term came from a dentist, Charles Stent, who invented a metal stay to keep gingival grafts in place. In a systematic review this week Ghuluam Nabi and colleagues look at another kind of stent, the sort that is often inserted into the ureter after extracorporeal shock wave lithotripsy and ureteroscopy (doi: 10.1136/bmj.39119.595081.55). The nine randomised trials they included in their systematic review and meta-analysis lacked some important details but suggested that such stenting does little for patients and leaves them with irritating lower urinary tract symptoms.

In a linked editorial Colin Wilson and David Rix ask what impact this evidence should have on doctors' decisions (doi: 10.1136/bmj.39149.561134.80). Strike a balance, they say, between the morbidity associated with stents and the possible risk of ureteric obstruction; develop a grading system for ureteric trauma; and produce validated guidelines on when to insert stents. Best of all, make ureterorenoscopy safer in the first place.

I can't finish without mentioning the issue that, right now, is having more impact on many of our UK readers' lives than anything else—the UK's process for selecting candidates for specialist training, the Medical Training Application Service. As Tony Delamothe says, doctors in other parts of the world such as the US have lived and worked with similar systems for years, and it's going to take time to work out what or how much has gone wrong in the UK (doi: 10.1136/bmj.39154.476956.BE) Meanwhile, keep telling us what you think.