With the foregoing as background, the story now fast-forwards to 1988. Using this as a base year, one notes that there were 238 medical journals included in the definitive Journal Ad Review maintained by PERQ/HCI. In that year, medical journals shared $359 million in advertising revenue. The lion's share of revenue appeared in a category known as multi-specialty. The 84 journals in that realm garnered $226 million of advertising, or 65 percent of the total. In the vernacular of the day, those publications typically targeted GPs/FPs/IMs/DOs, which of course means general practitioners (remember them?), family physicians, internists, and osteopaths. That lineup was often augmented by some cardiologists. A prevailing view on Medicine Avenue was that those physicians who engaged in primary care wrote far more than their share of prescriptions. As a result, the presumed "heavy writers" were the target of many an ad schedule. While the 84 multi-specialty journals secured 65 percent of all ad dollars, the remaining 154 specialty journals subsisted on 35 percent of the revenue. Of course, their circulations and staffs were smaller and therefore their costs were lower. So subsist they did. Meanwhile, important new therapies were being developed that needed to be promoted to specialists rather than generalists. This was most clearly the case in oncology and psychiatry, two specialties that have exploded with advertising, even as the multi-specialty category has withered. Consider the spectacular growth of journals in the oncology marketplace. In 1988, there were seven oncology journals in the PERQ.database. They carried $3.8 million of advertising. By 2008, the field had ballooned to 37 journals, loaded with $44.6 million in advertisements. The compound annual growth rate was 13.1 percent, not adjusted for inflation. The story is a little less dramatic in
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