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Until recently there was little proof that medical errors spike in the summer when new medical trainees start working at teaching hospitals -- a phenomenon known as the ''July effect.'' But a new review has found evidence that death rates do increase in July, and that many patients stay in the hospital longer than in other months. The paper, published Tuesday in Annals of Internal Medicine, is believed to be the first systematic review of the data from previous studies. While the analysis found inconsistencies among nearly 40 studies examined, the data produced by the largest and best-designed ones indicated that patient death rates in teaching hospitals increase by 8 percent in July. [ABSTRACT FROM AUTHOR]

To the Editor: Re ''Our Pen-and-Paper Doctors'' (editorial, June 24): [ABSTRACT FROM PUBLISHER]

Discusses the creation of two peer-reviewed online journals on biology and medicine by a group of prominent scientists. Goal of quickly placing scientific papers in the public domain; Challenge to publishing practices of journals like 'Science' and 'Nature'; Intent of providing a vast electronic library which has no subscription fees; Comments of Dr. Harold E. Varmus, chairman of the nonprofit publisher, Dr. Michael B. Eisen and others; Background on the publishing venture; Arguments of academic publishers.