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The New England Journal of Medicine as News Source

The New England Journal of Medicine is a primary global source of medical information published in English. Time, a frequent forum for the journal's research, considered the publication's articles so important and often controversial that "hardly a week goes by without some mention of the magazine in the press."1 Only the Journal of the American Medical Association, Science and Great Britain's Lancet, the British Medical Journal and Nature rival of the 177-year-old publication. Nelkin viewed journals such as the NEJM and Science as competitively eager to maintain their status through skillful use of the press.2 Wade saw the NEJM and JAMA competing for public attention as "leading oracles of new advances in medical research."3 The Journal has been published under the aegis of the Massachusetts Medical Society since 1921. Arnold S. Relman, the journal's editor, reported paid circulation at more than 225,000 with nearly 50,000 subscribers outside the United States in 125 countries.4 News media begin receiving advance copies of the weekly journal on Monday, customarily respecting the publication's Thursday release date. The publication sends no advance press releases. Some stories from the Journal occasionally appear in Friday or weekend editions of newspapers, but more typically, North American newspaper readers learn of medical research developments in their Thursday papers or from Wednesday evening radio and television news programs. Traditional news values, rather than precise reporting on scientific information, may be at work in the reporting of medical news. Culbertson and Stempel found no relationship between medical topics that readers considered important and the medical news editors gave prominent play in the newspapers.5 O'Keefe found that only 24 percent of the physicians questioned in a survey said medical information they obtained from the mass media was of any importance to them.6 Johnson found that newspaper editors judge science news stories differently than either scientists or readers, favoring excitement and color over significance as news values.7 From an editor's point of view, the Journal may be an ideal source of medical news because the publication often reflects the conflict and controversy within the medical profession. The publication sometimes echoes these debates, and the Journal's editors stimulate attention by soliciting opposing viewpoints. Because the JournaPs editors have so much authority as gatekeepers within the medical profession, it is not surprising that they and the Journal are themselves the source of controversy. Relman bars publication in the Journal of any research that has received substantial medical coverage in other forums. Journalists, naturally, find this a barrier to the timely reporting of medical news. The Journal's editors insist they must retain such controls in order to preserve the integrity of the research they publish.8 Nevertheless, errors do occur. For example, papers published in 1979 and 1981 by Dr. John Darsee, a cardiology researcher at Emory and Harvard, were retracted after data were proved fraudulent. The editors can show humility in their understanding of the publication's limitations. In a 1980 interview, then deputy editor Drummond Rennie thumbed through a 1959 volume of the Journal and said: "This was the finest medical research of its time, and most of it has already been proved wrong. The best we can say about today's Journal is that it's publishing today's lies, and we hope next year's are a little better."9 At the same time the editors can be quick to defend their intellectual turf. Harry Schwartz, writer-in-residence of the College of Physicians and Surgeons of Columbia University, charged that Relman had "great power to determine what socio-economic viewpoints will be presented" in the Journal's pages, and brought a list of prejudices, including opposition to for-profit hospital chains, to his editorial task. …