The decision to publish the New Zealand Medical journal on a Web site only from July 2002 is both momentus and sad. My class of 1958 were offered free copies until graduation, and many have welcomed the regular arrival of the journal ever since. The gradual attrition of membership of the NZMA which published the Journal has triggered this decision to go electronic, and this should be a concern to all members of the medical profession. No doubt even the majority of our ageing generation will adjust to the situation, but the risk of progressive loss of readers of the Journal must be real.

Major medical and scientific advances are almost always published in prestigious journals serving the subspecialty. Smaller regional journals nevertheless serve very important roles. They provide a medium for introduction to research and the discipline of publication, key elements in the pursuit of evidence based medicine: for exploration of the social and financial problems which impinge so forcefully on any community, particularly in New Zealand, on the health and opportunity of Maori and Polynesian people: for the assessment, including ongoing audit, of strengths and weaknesses of systems of healthcare in hospitals and the community, and the ability to pursue opportunities to improve morale and performance in both sectors: for study of the impact on national health of funding in the public and private sectors: for assessment of the role of ‘alternative care’: and for the ability to publicise ever-changing opportunities to introduce new initiatives and to improve efficiencies in all areas - excluding incessant politically driven changes in management!

At this time I would like to acknowledge the debt of gratitude we owe to the contributions of the editors and sub-editors who have served us over so many years. The longstanding contribution of the Otago group has been recorded previously. The Christchurch group are now ‘passing on the baton’, having made a major contribution over the last three years. In addition to producing some innovations in presentation, they have written many stimulating editorials and commentaries -sometimes controversial, as they should be. Thanks are due for the creation of a style which became compulsory reading. Most readers will appreciate the time and skills which have maintained a lively and professional period in the history of the journal.

I write to support Professor Barry Colls, with regard to the disappearance of the printed Journal, and to agree with all his sentiments (NZ Med J 2002; 115: 226). There is little that has less appeal aesthetically than sheets of downloaded paper. It is like comparing a Folio edition Shakespeare with an old paperback. However, as you point out, it is a matter of finance, and like so much in New Zealand from the Defence Force to the rugby World Cup, this tiny nation is having increasing difficulty in "going it alone" as we descend into third world status.

Perhaps like the specialist colleges, we should look at increasing links with the Australian Medical Association, and even ride on its back to get a subsection in their printed Journal. After all, if it is good enough for our own Government to leave our Air Defence in the hands of our neighbours, an historic precedent has already been set, which as good citizens we may consider following! For the record my email is vict@xtra.co.nz.

'It's very difficult to make predictions - especially about the future'. Rather than foretelling a gloomy outcome or lamenting the past one might usefully concentrate on some of the challenges that the new format will present to readers.

For those who do not possess a computer the acquisition of such a device in basic form but including a modem is reasonably inexpensive. Virus checking software is essential, don't leave home without it. The costs of obtaining Internet access can be modest, if one shops around. These days there are many sources offering instruction in the operation of the computer and in accessing electronic sources. The medical library may be a good place to begin.

The biggest challenge is in fact weaning from the paper magazine culture to one of either reading off the computer screen which is not very enjoyable or printing material onto paper which may be carried about and read at leisure. It may be possible to have the computer read the text aloud, through speakers or headphones although presently at some cost. However, even to print a few articles negates one of the advantages of the new system - less trees used for paper, less storage required, and less waste eventually.

I hope I am in time before the demise of the printed version of the New Zealand Medical journal to offer the following comments. I read with empathy the letters of my colleagues Barry Colls1 and Ron Jones2 for they echo my thoughts about the demise of the printed Journal.

The first scientific paper I had published was printed in the New Zealand Medical Journal in April 1960,3 and I have enjoyed contributing a number of articles to the journal over the years, and much more importantly receiving my copy of the journal on a regular basis whilst practising in the United Kingdom, United States, Saudi Arabia, Australia and New Zealand. I hesitated to write this letter until I re-read the Editorials4,5 and the charter on Medical Professionalism.6

In my opinion, electronic publishing will not completely replace hard copy of the printed word. And whilst the words of Richard Horton, Editor of The Lancet echo in my mind, in particular "effectiveness gave way to efficiency",5 I wish to express my dismay at having my name removed from the New Zealand Medical Register simply because I have not practiced medicine for a certain period of time in New Zealand during the immediate past few years. I had been proud to have my name on the list of registered Medical Practitioners since graduating from Otago in 1959, and I believe contributing my fair share to medicine in New Zealand during the past forty two years.

At a New Zealand Medical Association (NZMA) meeting in Hamilton on February 12th 2002 it was passed by a significant majority that the paper version of the New Zealand Medical Journal (NZ Med J) should not be discontinued after June 2002. In my view, dismantling the paper version will be a hindrance for continuing medical education. I believe the image of the NZMA, the NZ Med J, and New Zealand in general will suffer as regards reputation if the paper version is not readily to hand.

Many persons now use electronic devices but this is not the same as being able to read the paper version in a convenient way.

The electronic and paper versions, once established, would be complementary to one another, as for the British Medical Journal. Money should not come into it. This aspect could be overcome. Both electronic and paper versions should be available as options for members.

Let us hope the NZMA Council and Board will agree to the reinstatement of the paper version as soon as the electronic version is established.