New England Journal Of Medicine Question Of The Week

[Lyric Maro]

Thereare about 30,000 medical journals published around the world, but only a handful of titles, such as The New England Journal of Medicine and JAMA, are household names. The National Library of Medicine (which is part of the National Institutes of Health) maintains an online database called PubMed, which allows anyone to search for studies and other research on a given disease or treatment. Doctors, scientists, and medical students make up the primary audience for medical journals, though anyone with enough curiosity and ability to make sense of often-complex scientific terms and concepts can read one.

The earliest medical journals were published in the 17th century. For the first 300 years or so of their existence, medical journals were printed on paper and eventually came to resemble magazines. Most were published weekly or monthly and mailed out to subscribers. But that all began to change in the late 20th century with the arrival of the digital era. Today, most users read medical journals on computers, tablets, or smartphones. For example, JAMA delivers about 293,000 copies of its print edition each week, but 1.8 million subscribers link to the journal online.

Some medical journals are owned by medical societies and other health-focused organizations. For example, the Massachusetts Medical Society owns TheNew England Journal of Medicine, while the American Medical Association publishes JAMA. The American Heart Association produces Circulation, a journal devoted to research on the cardiovascular system. But a handful of large commercial publishers produce most other medical journals.

The publishers of most traditional medical journals charge a subscription fee to cover production costs and generate profits, just like magazines you may subscribe to at home. (Nonsubscribers can read or download an article from a medical journal if they pay a fee.) But, unlike most popular consumer publications, medical journals do not pay authors who contribute studies and other articles for their time and effort. The payback for these doctors and scientists is the knowledge that their work will be recognized by their colleagues and others, and perhaps influence the practice of medicine.

Over the last generation, an alternative to this traditional approach has emerged, known as open-access (OA) publishing. Publishers of OA journals do not charge readers any fees, either for subscribing or for reading and downloading individual papers. Instead, OA journals make money other ways, notably by charging doctors and scientists fees to publish their manuscripts.

The arrival of OA journals has had benefits and downsides. Doctors, researchers, and patients who have been frustrated by high fees charged by traditional medical journals have welcomed the ability to read about new research for free. The presence of OA journals may also have contributed to a trend in which traditional journals are making more of their content free, too. For example, any study completed with funding from the National Institutes of Health must be made publicly accessible within 12 months of publication in any journal.

In September 1811, Boston physician John Collins Warren,[3] along with James Jackson, submitted a formal prospectus to establish the New England Journal of Medicine and Surgery and Collateral Branches of Science as a medical and philosophical journal.[4] Subsequently, the first issue of the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science was published in January 1812.[5] The journal was published quarterly.[6]

The editors of the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science purchased the weekly Intelligencer for $600 in 1828,[8] merging the two publications to form the Boston Medical and Surgical Journal, and shifting from quarterly to weekly publication.[9]

The journal's logo depicts the snake-wrapped Rod of Asclepius crossed over a quill pen. The dates on the logo represent the founding of the components of The New England Journal of Medicine: 1812 for the New England Journal of Medicine and Surgery and Collateral Branches of Medical Science, 1823 for the Boston Medical Intelligencer, 1828 for the Boston Medical and Surgical Journal, and 1928 for the New England Journal of Medicine.[12]

On April 25, 1996, the NEJM announced a new web site, which published each week the abstracts for research articles and the full text of editorials, cases, and letters to the editor. After print publishing for 184 years this was the NEJM's first use of the Internet for electronic publication.[30]

The site was launched several months earlier in 1996, but the editors wanted proof that weekly electronic publication would work. Only then was an announcement approved for publication on the editorial page. In 1997, the website included prepublication releases of certain articles prior to their print publication.[31] In 1998, online publication extended to include the full text of all its articles from 1993 forward.[32]

The George Polk Awards site noted that its 1977 award to The New England Journal of Medicine: "...provided the first significant mainstream visibility for a publication that would achieve enormous attention and prestige in the ensuing decades."[36]

The journal usually has the highest impact factor of the journals of internal medicine. According to the Journal Citation Reports, NEJM had a 2017 impact factor of 79.258,[37] ranking it first of 153 journals in the category "General & Internal Medicine".[38] It was the only journal in the category with an impact factor of more than 70. By comparison, the second and third ranked journals in the category (The Lancet and JAMA) had impact factors of 53.254 and 47.661 respectively.[39]

Theodore Dalrymple feels that this influence is unwarranted. In False Positive: A Year of Error, Omission, and Political Correctness in the New England Journal of Medicine, he examines various articles on medical and social issues that the NEJM published over the course of a year. He found that many arrived at conclusions which were not supported by the evidence presented, or ignored easily available evidence that contradicted their conclusions.[40]

The New England Journal of Medicine requires that articles it publishes have not been published or released elsewhere. Referred to as the Ingelfinger rule, the policy is intended to protect newsworthiness, and to subject research to peer review "before it is touted to the public or the profession".[41] By 1991, four types of exceptions were recognized, including when "prepublication release of research conclusions is warranted because of immediate implications for the public health".[42]

The rule was first described in a 1969 editorial, "Definition of Sole Contribution", by Franz Ingelfinger, the editor-in-chief at that time.[41][43] A number of medical journals have similar rules in place.[44][45]

In the early 2000s, The New England Journal of Medicine was involved in a controversy around problems with research on the drug Vioxx. A study was published in the journal in November 2000 which noted an increase in myocardial infarction amongst those taking Vioxx.[46] According to Richard Smith, the former editor of the British Medical Journal, concerns about the correctness of that study were raised with the journal's editor, Jeff Drazen, as early as August 2001. That year, both the US Food and Drug Administration and the Journal of the American Medical Association also cast doubt on the validity of the data interpretation that had been published in the NEJM.[47] Merck withdrew the drug from market in September 2004. In December 2005, NEJM published an expression of concern about the original study following discovery that the authors knew more about certain adverse events than they disclosed at the time of publication. From the Expression of Concern: "Until the end of November 2005, we believed that these were late events that were not known to the authors in time to be included in the article published in the Journal on November 23, 2000. It now appears, however, from a memorandum dated July 5, 2000, that was obtained by subpoena in the Vioxx litigation and made available to the Journal, that at least two of the authors knew about the three additional myocardial infarctions at least two weeks before the authors submitted the first of two revisions and 4 1/2 months before publication of the article."[48] During the five-year period between publication and Expression of Concern, it has been estimated that Merck paid NEJM as much as US$836,000 for article reprints that Merck used for promotional purposes.[49] The journal was publicly rebuked for its response to the research issues in editorials appearing in publications including the British Medical Journal[47] and the Journal of the Royal Society of Medicine.[50]

NEJM makes articles that meet the criteria for global and public health importance freely available to all readers upon publication at NEJM.org. NEJM also partners with Research4Life in their Access to Research in Health (Hinari) program to grant to low-income countries immediate free access to NEJM.org.

For research articles submitted before February 1, 2024, NEJM makes the full-text Version of Record available at NEJM.org six months after publication. For research articles submitted on or after February 1, 2024, NEJM will provide authors with a PDF file of the Author Accepted Manuscript that may be deposited in a noncommercial repository after publication.[51]

NEJM also has two podcast features, one with interviews of doctors and researchers that are publishing in the journal, and another summarizing the content of each issue. Other offerings include Continuing Medical Education, Videos in Clinical Medicine (showing videos of medical procedures), and the weekly Image Challenge.

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