part of the that grouping, the transformation becomes more lopsided. In 1988, the combination of multispecialty plus IM/DO circulations dominated journal advertising with a market share of 75.1 percent. That has plummeted to 37.9 percent as specialty journals have soared from a share of 24.9 percent to 62.1 percent. Meanwhile, publishers have had to confront an enormous explosion of media choices. They have responded by expanding their publishing programs. And that is the second major trend of the past 20 years. Call it the leveraging of traditional journals. They have been transformed into brands that support a growing battery of line extensions. In the old days—say, pre-1988—a publisher sold display ad pages, maybe had paid circulation, perhaps sold some classified advertising, and also some reprints. In a limited number of cases, there also were sponsored supplements. But in most instances, the great majority of revenue came from display advertising. Now, it's common to augment those traditional revenue streams with other brand extensions—notably, a variety of digital offerings and events. The mantra of publishers has become "in print, online, in person." Part of the reason is a natural evolution. The media industry has become fragmented. Gone are the days of three TV networks, morning and evening newspapers, newsweeklies, and the choice of AM or FM stations as primary means of mass communications for America. The splintering of media to include the Internet, podcasts, PDAs, iPhones, satellite radio, satellite TV, cahle TV, and much more has infiltrated medical communications as well. The extent to which publishers have modified their business models is impressive. It's routine now for medical journals to have Web sites. A leading site is operated by The New England Journal of Medicine, which boasts 280,000 visits per month by US physicians, and a
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