Tuesday, November 27, 2012

Politics in Major Medical Journals

Medical journals aren't what they used to be.  Just ten short years ago, medical journals were places to report scientific study, interesting cases or clinical updates and reviews.  They were, for the most part, about science and discovery. 

Now, there is a dramatic shift of scientific content in our journals to politics and policy.

No where is this more evident than the much-heralded and widely read New England Journal of Medicine.  (The Journal of the American Medical Association (JAMA) is not too far behind either.)

As an example, I was struck by this week's New England Journal of Medicine article titles:

"Use of ADHD Medication and Criminality" (an observational study)
"Mammography Screening for Breast Cancer" (complete with poll)
"The Future of Obamacare" (Perspective)
"Lessons from Sandy" (Perspective)
"Drug Policy for an Aging Population" (Perspective)
"Intravenous Immune Globulin — How Does It Work?" (Review article)
I decided to look just 10 short years ago and compare what article titles existed in the New England Journal of Medicine from the week of November 21, 2002.  Here are the article titles from that issue:
"Transient Ischemic Attacks" (Perspective)
"A Controlled Trial of a Human Papillomavirus Type 16 Vaccine"
"Glycoprotein-D–Adjuvant Vaccine to Prevent Genital Herpes"
"Extended Transthoracic Resection Compared with Limited Transhiatal Resection for Adenocarcinoma of the Esophagus"
"Normal Vision despite Narrowing of the Optic Canal in Fibrous Dysplasia"
"Specialty of Ambulatory Care Physicians and Mortality among Elderly Patients after Myocardial Infarction"
Perhaps the shift from science to politics in our major medical journals is an brief aberration, but I don't think so.  I have noticed this phenomenon and expressed my concerns in 2006.  The trend has only continued to grow: even our presidential candidates for the last election had postition papers published in the New England Journal of Medicine just before the election.


But the reality of politics and policy determining how medicine is practiced remains front-stage in medicine as cost and new structural concerns dominate health care.  Medical questions, research and inquiry are increasingly second fiddle to health care political white papers.  Adding to this lack of  reporting of scientific discovery in major medical journals are the multiple rapid-fire, diverse portals for publication that exist for doctors and researchers these days thanks to the explosion of specialty publications and the Internet's impact on information delivery to doctors.  As a result, there is a fierce media race underway to keep doctors eyes focused on these antiquated journals' content as doctors increasingly migrate away from print to electronic content.  

If a major scientific journal like the New England Journal of Medicine decides to focus on policy instead of medicine, I suppose that's okay.  That is their prerogative.  But perhaps now that politics and policy have grown to such an extent in a major medical journal like the New England Journal of Medicine, the editorial board of this journal (and the others of similar political bents) should consider changing their name from the New England Journal of Medicine to the New England Journal of Perspectives.

At least then our young doctors of tomorrow will fully comprehend what they're getting.



Ryan Madanick, MD said...

Interesting points, although I'm not sure I completely agree. Consider that maybe we (as a profession and general community) have tended to stay too focused on reading and publishing the best science of medicine that we have failed to take so many other aspects of our profession into account. So much so that others have done it around us. You may be right, that this was done to keep readership around, but most journals include various commentaries and opinion pieces (a quick scan through Science or Nature shows a focus on recent news as well). Comments on current affairs in NEJM are not necessarily new either. 100 years ago this month (Nov 14, 1912) 2 editorials were entitled: "Relations of Hospital and Medical School" & "The Red Cross in the Balkan War". Granted, not politics, but still policy was part of their publication even back then to some extent.

Anonymous said...

There is an alternative, one that I found many years ago to be quite effective in avoiding the political side of NEJM articles. I simply stopped reading it. I can find the same or better medical articles without the political overtones in many other journals and throw-away medical newspapers

Seerak said...

The world in which we haved lived in the West these past several generations used to be one where concern with politics was an option, one that a person could ignore at little to no risk to himself - because there were constraints on government that reassured him that government could be trusted not to become a danger.

Compare with life for the rest of history before that . Politics was not an option at all - it was a life or death matter. It was necessary to devote large proportions of one's resources to political matters, for reasons of plain survival. You've had it good with your current sovereign? You'll want to know who succeeds him if he gets ill, or is assasinated. You had to stay abreast of power balances and struggles lest you get caught endorsing what turns out to be the losing side (there's no abstaining from *that* "vote"). You'll have to watch out in case someone who has it in for you gains the sovereign's ear. Last but not least, you'll be very lucky not to have to participate in at least one war in your lifetime.

We are slowly transitioning back to that - to an era when politics is life or death and which commands great slices of time and resources once spent on productive effort. These magazines are a sharply visible indicator for this illiberal trend.

This is not progress. That those primarily responsible for that trend are the sort who operate under the flag of "progressive" is a big clue to why it's happening with little real opposition.