Criticizing the NEJM

Unholy medicine

We now know where the “prestigious” New England Journal of Medicine (NEJM) can be found, at least on one issue. And while we applaud its honesty, we must point out that in the issue of human cloning, honesty without objectivity is not the best policy – for medicine or humanity.

In the July 17 issue of the NEJM, editor Jeffrey M. Drazen, M.D., took issue with the House of Representatives’ decision to ban research on and medical use of treatments “derived from embryonic stem cells.” He then wrote:

“The editors of the Journal will do our part by seeking out highly meritorious manuscripts that describe research using embryonic stem cells.”

Two weeks later, Wesley J. Smith, a fellow of Seattle’s Discovery Institute, pointed out in National Review Online the downside of this honest advocacy. While everything the NEJM might publish on the subject could be entirely true, it would be far from the entire truth. What would happen, he wondered, “if the Journal received a manuscript reporting that an attempt to use embryonic stem-cell therapy in mice to treat, say, diabetes, had failed? Disclosing failures is as essential a part of the scientific process as touting successes. Or, what if a submission for publication indicated that embryonic stem cells’ known propensity to cause tumors when injected into animals may be insoluble? What then?”

Smith’s questions expose the dreadful problem of conflating objective science with political advocacy. They also demonstrate how “peer review” can be suborned to non-scientific agendas. But they also reveal two other problems rampant in the medical and scientific communities.

The first is Political Correctness. We’ve been writing for years that peer review as practiced by the editors of the NEJM often includes an ideological review to be certain that the manuscript agrees with its worldview or agenda. Public news media of all persuasions have similar policies. But they don’t do science.

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Second, there’s the matter of snobbery. Most practicing physicians in this country are quite aware that unless a manuscript is from a “prestigious” Eastern or elite medical school and is consistent with the editors’ worldview, there is little chance of being published. The NEJM has abused this editorial privilege filtering out medical science for years, just as the New York Times and CNN have filtered out the news. Rather than “All the News That’s Fit to Print” these media giants disseminate “All the News That Fits.”

But again, scientific and medical publications aren’t mass media, and when PC snobbery joins with the hauteur of the scientist, it’s doubly troublesome.

While I believe the authors engage in hyperbole, their message is important. Too often our medical journals choose amongst many important and interesting submissions, those which excite them. The editors do have political agendas, and those agendas are manifest in article selection.

How does this impact medical knowledge? The more presitigious the journal, the more likely that other scientists will read your article. If you choose to submit to prestigious journals, you often go through a cycle of submission, rejection, resubmission, etc. Sometimes an important article will take multiple journal submissions prior to acceptance. Let me give a personal example.

I, along with several co-authors, have an article which is currently in press in the Journal of Clinical Epidemiology. This article was read and reviewed in multiple clinical journals prior to submitting to this journal (which, by the way, is very prestigious amongst clinical epidemiologists). I believe the message was one which the journal editors and reviewers did not want to hear.

This article describes physician adoption of a guideline prior to the guideline’s creation . The article explores who physicians adopt new information, and asks whether guidelines might sometimes just reflect practice. The article focuses on an important question – how does technology diffuse?

We are please with the journal and the impending publication. We first thought of “prestigious” general journals because we thought the the findings would stimulate debate about guidelines. Perhaps the article is not as interesting as we thought. Perhaps the message is threatening to the establishment. And we will never know.

Once the paper is published, I will post the details of the study for reader comment.

In the meantime, remember that we should evaluate each article independent of the journal in which it is published. I have seen weak articles in the New England Journal of Medicine, and strong articles in supposedly weaker journals. We must never assume that the article is important because an important journal publishes it.