And Debbie Renner, senior vice president and media director at SSCG Media Group, noted that despite a decline in journal consumption by physicians and a steady increase in online and emerging media, an overwhelming majority of internists and family physicians still rank print journals as their preferred source of clinical information. As everyone knows, what's past is prologue. Everyone also knows that one of the hardest things to change is a trend. If that's the case, how will the major trends of the past 20 years play out over the next 20? Will the trend toward specialization in medicine, and therefore toward specialty journals, continue? Or, putting the question another way, will the focus on primary care continue to fade? Society as a whole continues to move toward niches. The wry observation that a specialist is someone who knows more and more about less and less is both true and necessary. A complex world, and the growing complexity of medicine, demand specialization. So it seems inevitable that this narrowing of focus will persist in medical journals. Similarly, it's reasonable to assume that over the next two decades the medical publishing industry will see continuing attention to line extensions as publishers seek to maximize brand value. Publishers' digital endeavors will escalate. Web sites will have more features, with emphasis on video and interactive elements. Digital journals are likely to be a significant part of the journal business, in many cases supplanting print journals. And they won't be simply digital versions of today's print journals. Rather, they will be created especially for the Web, formatted for a screen, for example, and richly endowed with video, audio, layered photos, charts, and so forth. Furthermore, advanced versions of today's Kindle from Amazon will enable physicians to download
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