The impact factors reported by the JCR tacitly imply that all editorial items in BMJ, JAMA, Lancet, New England Journal of Medicine, etc, can be neatly categorized, but such journals publish large numbers of items that are not substantive in regards to citations. Correspondence, letters, commentaries, perspectives, news stories, obituaries, editorials, interviews, and tributes are not included in the JCR's denominator. However, they may be cited, especially in the current year. For that reason, they do not significantly affect impact calculations. Nevertheless, since the numerator includes later citations to these ephemera, some distortion will result, although only a small group of leading medical journals are affected.