The Fletchers came to the College in July of 1990 to assume the seventh editorship of Annals. As practicing internists and distinguished academicians, they have taken the leading specialty journal in the world to new levels of excellence. During their tenure, the circulation of Annals first topped 100 000. Many of their accomplishments can be traced to their unique ability to understand the needs of practicing internists, both generalists and specialists. They have been hands-on editors who have worked tirelessly to make accepted manuscripts more readable and understandable; their goal has been to bring the best scientific data to clinicians in order to facilitate better patient care. They have also understood the many societal forces affecting medicine and have introduced new sections, such as On Being A Doctor, that have captured the vital human dimension of medical practice.

Annals now bears the unmistakable stamp of the Fletchers. This has resulted from a systematic effort to improve the entire editing process. The capable Annals staff was enlisted to work in an environment in which "goals were clear and individual effort and initiative were rewarded". A strong team of Deputy and Associate Editors was recruited. Several important innovations were introduced. These included shortening the turnaround time for submitted manuscripts, shortening the publication time with on-line editing, introducing a "fast track" for publishing uniquely time-dependent articles, and computerizing the advertising department. The Fletchers have also focused on identifying and acknowledging excellent reviewers. These efforts contributed to a steady growth in the number and quality of manuscripts submitted for publication.

The Fletchers worked to improve the format and design of Annals. For example, structured abstracts were refined, and a box containing brand and generic drug names, abbreviations, and SI unit information was placed on the first page of articles. Subtle but important changes were made in the appearance and organization of Annals.

Annals has long been active in the International Committee of Medical Journal Editors, a group that sets standards accepted by over 500 medical journals. The Fletchers have made important contributions to this organization, and for the past year Annals has served as its secretariat. The Fletchers have also been leaders in doing original research on the peer review and editorial processes and involving young investigators from leading institutions in these studies.

ACP Journal Club has received widespread acclaim for highlighting the relatively small number of published research articles that meet explicit criteria for scientific excellence. The Fletchers, working with Dr. Brian Haynes and colleagues, have nurtured this newest College publication to its current position of prominence.

When the Fletchers began their tenure as Editors of Annals, they expressed the hope that "the Annals will help supply (the) needed information by harnessing the many strengths of internal medicine—its traditions of asking important questions, answering them with strong methods, communicating effectively, and providing leadership in patient care and medical education" [1]. They have met and exceeded their goal. Annals is a convincing testimony of their lasting contributions to internal medicine.