An investigative article published by ProPublica takes aim at The New England Journal of Medicine, compiling and amplifying many criticisms into one report that challenges the direction of what it dubs "arguably the best-known and most venerated medical journal in the world."
NEJM has recently faced a considerable amount of criticism for some of its editorials, controversial articles, delayed responses to errors and its "paternalistic arrogance" toward dissenters, according to the report, suggesting the journal's quality may be deteriorating. However, its seasoned leader, Jeffrey Drazen, MD, whose 16-year tenure as editor-in-chief is one of the longest of any editor at a major medical journal — says these controversies are not particularly unusual.
Here are five things to know about the recent challenges NEJM faces, based on ProPublica'sfindings.
1. NEJM is under fire for an editorial that many readers felt opposed data sharing in clinical research. The editorial was authored by Dr. Drazen and a deputy editor, Dan Longo, MD. Perhaps the most controversial statement in the editorial was this: "There is concern among some front-line researchers that the system will be taken over by what some researchers have characterized as 'research parasites.'" These were people who used data from another study, though they were not involved in it, for their own ends, according to Drs. Drazen and Longo. The editorial triggered fierce criticism, "probably more than for anything else the Journal has done in many years, according to ProPublica. It even spawned an opposing editorial, "#IAmAResearchParasite" in Science and led Nobel Prize winner Barry Marshall, DSc, to voice opposition. Many saw Drs. Drazen and Longo's statements as detrimental to data sharing and the scientific process.
2. It has recently voiced unpopular opinions on conflicts of interest. In particular, the Journal ran a series of articles that said conflicts of interest in medicine and research are overblown, according to the report. Former NEJM editors took issue with this, writing in The BMJ, "Judges are expected to recuse themselves from hearing a case in which there are concerns that they could benefit financially from the outcome. Journalists are expected not to write stories on topics in which they have a financial conflict of interest," they wrote, according to the report. "Yet Rosenbaum and Drazen seem to think it is insulting to physicians and medical researchers to suggest that their judgment can be affected in the same way." Interestingly, as ProPublica notes, Dr. Drazen has his own conflicts of interest with the pharmaceutical industry, which caused him to recuse himself from editing or selecting articles related to those conflicts for two years. He has also loosened NEJM's policy on conflicts of interest, allowing authors to write editorials or review medical literature relating to products if they had received no more than $10,000 from a single company, according to the report.
3. The organization is also accused of being too opaque. In particular, criticisms have compared the journal to The BMJ, which changed its policies and now requires underlying data be published with clinical trials. The BMJ also allows comments on all articles, rather than allowing editors to regulate discussion. Critics of NEJM say it has been rigid on transparency improvements. Additionally, it has been criticized for its dismissive responses for challenges to certain studies and its corrections process.
4. Lastly, the publication is criticized for its imperial attitude toward change and challenges. "They basically have a view that … they don't need to change or adapt. It's their way or the highway," Eric Topol, MD, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, Calif., told ProPublica. He also said, "Most people are afraid to say anything about the New England Journal because they're afraid they won't get something published there," adding, "That's part of this oppression."
5. Dr. Drazen defended NEJM in an interview with ProPublica. He said the publication aims to be accurate first and foremost, and some editorials are meant to be controversial to spark conversation, according to the report. He said NEJM publishes protocols and statistical analyses for all clinical trials, and also said the publication contacts authors whenever errors are found in studies and their responses are analyzed by statistical reviewers. Lastly, he did not feel the concerns that have been raised recently are out of the norm from any issues that have been raised in the past, according to the report.
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