Swiss Medical Digest

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Swiss Medical Digest was a series of 10 medical journals was introduced in Switzerland by publisher Robert G. Coenen in 1977. The journals dealt with cardiology, dermatology, psychiatry, urology, orthopedic and rheumatology, ophthalmology, Gynecology and obstetrics, geriatrics, internal medicine, otolaryngology.

The series published - under supervision of senior medical peer reviewers - abstracts from non-Swiss medical scientific journals from all over the world. A similar concept was launched in the Netherlands and Austria.

As Swiss medical specialists had only direct access to medical journals published in German or French, the new series - exclusively in the English language - opened the door to the medical profession educational system which was many times larger than the Swiss national system.

For medical specialists used to English language in international congresses and publications, the new medical journals promoted use of the English language as a standard language for medical publications.

Each publication contained around 25 medical abstracts from leading medical journals like the Lancet, the British Medical Journal, The New England Journal of Medicine, the Archives of Cardiology, or the Annals of Pediatrics.

As cardiologists were used to get information from their own sources within the Swiss cardiology society, directing their attention to pediatric or geriatric cardiovascular medicine published by a pediatric society in New Zealand, India or a leading medical publication from Canada was novel and caught on immediately. The Swiss Medical Association supported the journal through a Scientific Board which included leading Swiss Medical Professors as Ugo Fisch, Hans Säuberli, Brunello Wütrich, A.P. Naef, Joseph Schmidt, Felix Gutzwiler, Daniel Scheidegger, Ulrich F. Gruber et al.

The concise and easy to read information of maximum 4 abstracts per page was printed on one side of the paper only, another unusual feature in publishing. The concept of printing on one side of the page only allowed the abstract to be cut out and used as a clipping, readily appreciated in an environment in which photo-copiers were to be found in special shops and were non-existent in private medical practice.

The journals appeared 8 times a year and were mailed – free-of-charge – to each medical specialist on record of the related medical association in Switzerland.

Responsible for the economic success was the Meducation Foundation, founded on the principles of Freedom of Information in the Interest of the Patient. (FIIP)

The Swiss Medical Digest had another new and unique feature: the publisher offered its readers a service to request the original article from the author. The publisher took over the hassle of communication with overseas authors and / or publishers. Those overseas authors were quite surprised but flattered by the attention received from a specialist circle of high quality medical specialists in Switzerland.

In order to overcome the costs of distribution, 3 pages of pharmaceutical advertising were allowed. On the other hand, in order to prevent any lobbying by the pharmaceutical industry, the contents of the publications were kept secret till the publication day. The publisher also stayed away from pharmaceutical therapy which is a very controversial side of medicine. Thus essentials like diagnosis and compliance, preventive medicine and epidemiology as well as intervention were topics dealt with; therapy (except for the negative impact or large multi-center double blind studies and evidence based medicine) was seldom a theme.

Publication of medical journals was in hands of Clyancourt Corporation AG, a publishing company in the Canton of Zug, Switzerland. The “window to the medical world”, opened by the series in Switzerland was followed by extensions in Austria and the Middle East. Together with Manfred Bolschkoff of Acron Verlag in Berlin another series of German Language publications followed; the “extracta medica” in which post graduate medical information as well as lectures for members of the different medical associations were offered.

In 1979 a German and French Language Editions of the Journal of the American Medical Association (JAMA) followed.

The next was the Schweizerische Zeitschrift für Permanente Aertzliche Fortbildung (PAF) which included in advance of the then following lecture in general medicine a multiple choice questionnaire testing the reader’s knowledge of the lecture’s subject, followed by another multiple choice questionnaire as a control of the understanding of the lecture. This concept was conceived in co-operation with Professors Jerry Lewis and Gene Usdin of Tulane University, New Orleans. Meducation Foundation became a pioneer in the field of the permanent post-graduate medical education which had not been in practice yet in Switzerland.

In co-operation with Mr. Peter Wolfe of Wolfe Medical Atlases of London a series of diagnostic picture tests was published. In total, over 100 different titles were distributed free of charge to medical specialists in Switzerland, the most popular being L. Hampton’s “The ECG made Easy”.

In 1985 the 40-odd titles of Clyancourt Corporation started to compete with the dissemination of medical information through the Internet. Pressure on medical professors to “publish or perish” demanded cooperation with a larger publishing entity which could provide computer expertise and infrastructure to meet the new challenges of publishing advanced medical information.A merger for the Swiss Medical Digest series with Swiss Publishing Partner Eurotax was arranged on recommendation of the University of Fribourg’s Professor Robert Purtschert.

Unfortunately this match turned out to be ill-conceived from the very beginning; the new partner was more interested in fast recovery of its investment rather than in the long term prospects of providing high quality medical information to the medical community in Switzerland.

The Meducation Foundation and Freedom of Information in the Interest of the Patient (FIIP)

In a "Piece of My Mind" Katherine Lindner, a medical librarian, touches upon a topic that went directly to the bottom of the physician - patient relationship: confidence and trust: two emotions that regulate the relationship between those two. She tells that often she has to refuse access to medical literature as patients are often required to "ask their doctor" for relevant information.

She would have to say "our policy requires that I consult with your physician, as sometimes he or she likes to select the material himself."

She than began to investigate the ethics of restricting access to any information. As a consequence the library has developed guidelines for providing information to the public and patients. They keep requests confidential and enclose a disclaimer letter, they state that they are not recommending a particular treatment and that the material might not represent all that is available on the subject; that the information might not apply specifically to the patient's own condition and that the material should be used to formulate questions for discussion with the physician. 1)

Physicians and health professionals should continue on the path of sending patients through the doors of medical libraries. Every scrap of information leading patients in the directions of discovering more about their diseases becomes "information therapy" They found that the physician - patient relationship is greatly enhanced when the physician says to the patient "go to the library, read about your disease, let me know what you find and we'll discuss it.

The same attitude has been taken by the BMJ: they developed two series of booklets: the ABC's (An essential text for GPs, medical students, nurses and anyone dealing with the treatment of a disease in both adults and children the guides are on many different topics like "The ABC of Asthma" and "Life with Diabetes", two of numerous topics who help patients with "information therapy".)

Patients and relatives have become more aware of risks and often put detailed questions to their doctors. The "ABC" series covers in a simple way all aspects of the subject, the information is easily accessible, so they can serve as a source of reference and can provide doctors, nurses and other health professionals with - illustrated - answers to questions from patients. I think that this might be a good idea for National Medical Societies to help their members in the relationship with their clients, the patients.

All of us are exposed to risks. Some risk we choose, others are avoidable. Taking medicine continues a further risk, but few people are sufficient well informed to choose which drugs they will take. Instead they delegate this responsibility to an informed doctor.

Traditionally doctors have told their patients little about possible unwanted effects of prescribed medicines.

Careful thought is needed about how much information should be made available Most people probably do not want to know all of the risks entailed and doubt exists over whether many of them have sufficient understanding of medical benefit and risk to make truly informed decisions. Nevertheless is should be stimulated to make patients more aware of available options and the risks of taking medicine.

Shortage of time is a major factor in general practioners' failure to realize their potential in health promotion. General practise should be organized so that doctors can run a minimum of 10 minutes appointment sessions. 2)

Substantial progress can be made by inserting "patient information leaflets" and by handing the patient a small booklet explaining the whereabouts of a disease. It all belongs to the package of "information therapy".

As it would be in the interest of all concerned that patients play a more active part in decisions about their treatment, doctors should make patients more fully aware of the available options and risks, thus also provoking progress in compliance and maybe even in preventive medicine by sharing knowledge.

When things go wrong, what many people and their relatives want is an explanation of what has happened, why it happened, and an assurance that it will never happen again.

The frame of modern medicine is not only found in the latest therapy, state of the art appliances and technical performance, it is more and more that preventive care, quality control, audit, communication skills and that doctor and patient work together to tackle a problem - which if well done can be turned into an opportunity - as patients need to feel an emotional investment from the side of the physician.

1) JAMA, May 20, 1992 - Vol. 267, No. 19.

2) BMJ, Jan 25, 1992 - Vol. 304, page 227.

3) Pioneered by Charles Hotze, Omicron '41 of Northfield, Illinois died June 10, 2006 in Glenview, Illinois at the age of 87. Born February 19, 1919 in Moline, Illinois. graduate of New Trier East High School and the University of Illinois. He was a veteran of the U.S. Army having served as a lieutenant during World War II. He was the retired president of the Medical Digest, Inc.