Abstract
EDITOR—Citations are deemed the currency of science, and their utility in measuring the quality and impact of scientific articles and journals is generally accepted.1–3 Citation based impact factors and rankings of leading general medical journals have changed substantially in recent years, and this seems to have been associated—unexpectedly—with simultaneous changes in publication volume.4 Numbers of substantive items published annually and impact factors for five leading journals in general and internal medicine, 1989-2001. Impact factors are number of citations in a given year to any article published in …

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