Guest blogpost - Thailand physician

Submitted by Dean Giustini on July 31, 2007 - 23:22

The problem of accessing literature in Thai rural hospitals  - by Weekitt Kittisupamongkol


Accessing journals is difficult in remote areas. Thai physicians who read journals usually work in medical schools and other tertiary care hospitals. The reasons why rural doctors do not read journals are numerous: they have more workload but less research and seldom treat complicated diseases, textbooks are old editions and lacking and despite the many benefits of Internet (1), searching is not as popular as joining a medical conference.


Common habits to update novel therapies are via drug reps that influence prescribing their product (2) and encourage off-label use (3). If only doctors knew how to find EBM (4). Some rural doctors do not know that journals are online so they expect only to find journals at libraries, which are usually closed at night. For the others, Medline is the only database they know despite many free online databases (5).


Most journals are open access to research libraries for developing countries through the HINARI program (6). Unfortunately, Thailand is not included on this list. Furthermore, among the 2006 top impact factor journals of general medicine, only a couple (PLoS, CMAJ) are freely accessible in Thailand from publication date. And despite open access, librarians often subscribe to print journals. The transport systems of print copies are also poor: journals published in January are delivered to libraries in May and that’s why journals are furniture rather than literature. The subscription rate is another reason: costs of print and online issues are much higher for Thai compared to developed country subscribers despite Thailand’s lower GNP. It’s more economical to purchase lower-price illegal versions from underground bookshops, which buy print issues and copy them infinitely. Drug companies are also the major clients, which give illegal literature as a free lunch. The win-win solution is lowering online subscription rates for Thais so that more rural doctors can access literature (7) and raise journals’ impact factors.



1. Tang H, Ng JH. Googling for a diagnosis--use of Google as a diagnostic aid: internet based study. BMJ 2006; 333:1143-5.

2. Fugh-Berman A, Ahari S. Following the script: how drug reps make friends and influence doctors. PLoS Med 2007;4:e150.

3. Steinman MA, Harper GM, Chren MM, Landefeld CS, Bero LA. Characteristics and impact of drug detailing for gabapentin. PLoS 2007;4:e134

4.Gazarian M, Kelly M, McPhee JR, et al. Off-label use of medicines: consensus recommendations for evaluating appropriateness. Med J Aust 2006; 185: 544-548.

5.Falagas ME. World Databases of Summaries of Articles in the Biomedical Fields. Arch Intern Med 2007; 167:1204-06.



7.Barbour V, Chinnock P, Cohen B, Yamey G. The impact of open access upon public health. Bull World Health Organ 2006;84:339.


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Dr. Kittisupamongkol, may be a good resource for physicians in Thailand. We have links to free, non-pharmaceutical company funded information about drugs under "drug information" and slideshows and other materials about the influence of drug companies on prescribing. PharmedOut is funded through public state funds from a legal settlement with Warner-Lambert/Pfizer for off-label promotion of Neurontin (gabapentin).