The Journal has been on the World Wide Web for more than five years.1 During that time, rapid, global dissemination of new scientific information has come to be expected. Broad searches of the medical literature and of scientific data bases are now possible. Information on line is becoming highly interlinked and increasingly is available in multimedia formats. To serve the diverse needs of our readers, we are taking steps to use the technology of electronic publication to enhance and complement the print version of the Journal. However, the many new electronic possibilities must not obscure our fundamental goal: to communicate the best in medical information in a way that physicians will find useful as they provide care for their patients.
This week, visitors to the Journal 's Internet site (http://www.nejm.org) will see that it has been expanded and redesigned. It may take users some time to become familiar with the new site, but they should find many substantial improvements. For example, it will be easier to see at a glance what is in the current issue. There are now collections of articles, including Original Articles, Special Articles, review articles, and editorials published since 1996, organized under 51 topics. There are more links from articles to related materials, including summaries and related articles in the Journal and in Medline.
An improved search system makes it possible to search the full text of all Journal articles as far back as 1993, and one can now search specifically for figures or Images in Clinical Medicine. Abstracts of Journal articles are available from 1975 on. Users can now track where an article has been cited and go directly to the sources of the citations. Users can also sign up for e-mail alerts when a given article is cited in the future. The new Web site has been created in conjunction with Stanford University's HighWire Press, and it is therefore possible to search more than 240 medical and scientific journals hosted there (including 8 of the 15 journals most often cited by articles in the Journal ).
With the new Web site has come a major change in our publishing policies. Beginning six months after publication, the full text of all Original Articles and Special Articles will be available on line for free. For nonsubscribers, a brief, one-time registration is required to gain access to the full text of past research articles and to receive the table of contents each week by e-mail. However, nonsubscribers no longer have free access to editorials, Sounding Board articles, and letters to the editor. These articles will be available for a fee, and there is now an option to purchase access to the site for 24 hours.
After an initial registration, Journal subscribers will have access to all the features of our improved site, as well as to every article published since January 1993. The Web site will recognize the passwords of subscribers who have registered previously. Articles released early on the Web because they contain information of immediate clinical importance will continue to be available at no charge, as will all abstracts. The Journal has a strict policy regarding privacy, so no information about visitors' use of the site will be sold or shared with any commercial enterprises.
Our new policies relate to the steps taken by the National Institutes of Health over the past two years to create a public repository for the full texts of articles from biomedical journals (http://pubmedcentral.nih.gov). Although the Internet makes it possible to create such a centralized electronic archive, PubMed Central has been slow to grow and so far includes fewer than 10 journals. Concern has been expressed about the effects that an open, government-run archive might have on journals.2-5 Offering free on-line access to the Journal's archives of research articles is a way to balance the goal of open communication with our publishing obligations. It should be possible someday to establish a single, searchable archive of biomedical-research reports in a way that does not threaten the peer-reviewed journals that help create the literature. We believe our commitment to providing the full texts of past research articles without charge is a step toward a useful central way to search the biomedical literature.
For the first time, advertising will appear on the Journal 's redesigned Web site. Commercial advertising is present on the Web sites of some, but not all, medical journals. Because we believe electronic publication of scholarly material will have to become economically self-sufficient if it is to survive and grow, we are adopting policies that are consistent with those that are in effect for advertising in the print version of the Journal.
Over the past three years, the number of users of the Journal's Web site has increased by a factor of more than five. Each week more than 250,000 people visit this site. About 75 percent of these visitors are not subscribers, and more than half of the visits originate outside of North America. The objective of the new Web site is to communicate what we publish in a way that users will continue to find useful and convenient. We invite comments on both the new site and our electronic-publication policies.
