The Boston Medical And Surgical Journal
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''The New England Journal of Medicine'' (''NEJM'') is a weekly
medical journal A medical journal is a peer-reviewed scientific journal that communicates medical information to physicians, other health professionals. Journals that cover many medical specialties are sometimes called general medical journals. History The first ...
published by the Massachusetts Medical Society. It is among the most prestigious
peer-reviewed Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work (peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. Peer review ...
medical journals as well as the oldest continuously published one.


History

In September 1811, John Collins Warren, a Boston physician, 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. 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. The journal was published quarterly. In 1823, another publication, the ''Boston Medical Intelligencer'', appeared under the editorship of
Jerome V. C. Smith Jerome Van Crowninsfield Smith (July 20, 1800 – August 21, 1879) was an American physician, author and politician, serving as the fourteenth mayor of Boston, Massachusetts from 1854 to 1855.''Mayors of Boston: An Illustrated Epitome of who ...
. 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, merging the two publications to form the ''Boston Medical and Surgical Journal'', and shifting from quarterly to weekly publication. In 1921, the Massachusetts Medical Society purchased the ''Journal'' for US$1 () and, in 1928, renamed it to ''The New England Journal of Medicine''.


Logo

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''.


Notable articles

Notable articles from the course of ''The New England Journal of Medicine'' history include: * In November 1846,
Henry Jacob Bigelow Henry Jacob Bigelow (March 11, 1818October 30, 1890) was an American surgeon and Professor of Surgery at Harvard University. A dominating figure in Boston medicine for many decades, he is remembered for the Bigelow maneuver for hip dislocation ...
, a Boston surgeon, reported a breakthrough in the search for surgical anesthetics with the first uses of inhaled ether in 1846. This allowed patients to remain sedated during operations ranging from dental extraction to
amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...
. "A patient has been rendered completely insensible during an amputation of the thigh, regain consciousness after a short interval," Bigelow wrote. "Other severe operations have been performed without the knowledge of the patients." * In June 1906,
James Homer Wright James Homer Wright (April 8, 1869 – January 3, 1928) was an early and influential American pathologist, who was chief of pathology at Massachusetts General Hospital from 1896 to 1926. Wright was born in Pittsburgh, Pennsylvania. In 1915, he ...
published an article that described how he stained and studied
bone marrow Bone marrow is a semi-solid tissue found within the spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It is composed of hematopoietic ce ...
with descriptions of what are now known as megakaryocytes and
platelets Platelets, also called thrombocytes (from Greek θρόμβος, "clot" and κύτος, "cell"), are a component of blood whose function (along with the coagulation factors) is to react to bleeding from blood vessel injury by clumping, thereby ini ...
. * In October 1872, a lecture by Charles-Édouard Brown-Séquard was published that proposed the then-revolutionary idea that one cerebral hemisphere can influence both sides of the body. The neurologist would go on to describe what is now known as the Brown-Séquard syndrome. * In June 1948, Sidney Farber reported promising results in treatment of early childhood leukemia. Based on anecdotal evidence that children with acute leukemia worsened if they were given folic acid, he worked on blocking folic acid metabolism. His team gave 16 infants and children with
acute lymphoblastic leukemia Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruisin ...
a folic acid inhibitor, aminopterin—10 showed improvement by clinical and hematologic parameters after three months. In his article, Farber advised receiving the results cautiously: "It is again emphasized that these remissions are temporary in character and that the substance is toxic and may be productive of even greater disturbances than have been encountered so far in our studies," he wrote. "No evidence has been mentioned in this report that would justify the suggestion of the term 'cure' of acute leukemia in children." * In November 1952, cardiologist Paul Zoll published an early report on resuscitation of the heart. "The purpose of this report is to describe the successful use in 2 patients of a quick, simple, effective and safe method of arousing the heart from ventricular standstill by an artificial, external, electric pacemaker," he wrote. "For the first time it was possible to keep a patient alive during ventricular asystole lasting for hours to days. This procedure may prove valuable in many clinical situations." * In February 1973, ''NEJM'' published the first report of polyp removal using a colonoscope and introduced a procedure during screening to reduce cancer risk. The authors reported on 218 patients, from whom they removed 303 polyps (at one or more procedures per patient). * A letter published in the ''NEJM'' in 1980 was later described by the journal as having been "heavily and uncritically cited" to claim that addiction due to use of opioids was rare, and its publication in such an authoritative journal was used by pharmaceutical companies to push widespread use of opioid drugs, leading to an addiction crisis in the U.S. and other countries. * In December 1981, two landmark articles described the clinical course of four patients—first reported in the CDC's June 1981 Morbidity and Mortality Weekly Report—with the disease that would come to be known as
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
. * In April 2001, Brian Druker et al. reported a targeted therapy for
chronic myelogenous leukemia Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a cancer of the white blood cells. It is a form of leukemia characterized by the increased and unregulated growth of myeloid cells in the bone marrow and the accumulat ...
. Based on the knowledge that BCR-ABL, a constitutively activated tyrosine kinase, causes CML, the authors tested with success an inhibitor of this tyrosine kinase in patients who had failed first-line therapy. The finding helped begin the era of designing cancer drugs to target specific molecular abnormalities. * In October 2020, the journal published an editorial, signed by all 34 editors, in which they condemned the Trump administration's handling of the COVID-19 pandemic saying that "they are dangerously incompetent" and that "they have taken a crisis and turned it into a tragedy." This is the first time ''NEJM'' has ever supported or condemned a political candidate and only three other times in history has an editorial been signed by all the editors. *In April 2021, Carhart-Harris et al. demonstrated that in the pharmacological treatment of major depressive disorder, there was no significant difference in
antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
effects between the
psychedelic drug Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary states of consciousness (known as psychedelic experiences or "trips").Pollan, Michael (2018). ''How to Change Your Mind: What the New Science o ...
psilocybin and the SSRI escitalopram after six weeks. Significant doses of psilocybin were only administered twice in the six-week period, while escitalopram was taken daily. This was the first time psychedelics and SSRIs were compared in the treatment of depression.


Social media

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. 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. In 1998, online publication extended to include the full text of all its articles from 1993 forward. Since its launch, ''NEJM'' has added to its site: * Videos in Clinical Medicine, peer-reviewed educational videos to teach procedures requiring skilled techniques and specialized physical examination. * Interactive Medical Cases, which mimic a clinical encounter by presenting the patient's history with results of the physical examination and laboratory and radiographic tests. Multiple-choice questions throughout test the taker's knowledge. * NEJM Archive, the entire collection of the journal's published material.


Influence

The
George Polk Awards The George Polk Awards in Journalism are a series of American journalism awards presented annually by Long Island University in New York in the United States. A writer for Idea Lab, a group blog hosted on the website of PBS, described the award ...
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." 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, ranking it first of 153 journals in the category "General & Internal Medicine". 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. 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.


Specialty journals

In 2022, NEJM set up a new sub-journal, NEJM Evidence. NEJM Evidence is a monthly digital journal featuring original research. It focuses on clinical trials and decision making.


Ingelfinger rule

''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". 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". The rule was first described in a 1969
editorial An editorial, or leading article (UK) or leader (UK) is an article written by the senior editorial people or publisher of a newspaper, magazine, or any other written document, often unsigned. Australian and major United States newspapers, suc ...
, "Definition of Sole Contribution", by
Franz Ingelfinger Franz Joseph Ingelfinger (August 20, 1910 – March 27, 1980) was a German-American physician, researcher and journal editor. He served as Chief of Gastroenterology at Evans Memorial Department of Clinical Research, part of Boston University Schoo ...
, the editor-in-chief at that time. A number of medical journals have similar rules in place.


Vioxx correction controversy

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. According to
Richard Smith Richard Smith may refer to: Arts and entertainment * Richard Penn Smith (1799–1854), American playwright * Richard Smith (silent film director) (1886–1937), American silent film director * Richard Smith (screenwriter), Scottish screenwriter, ...
, the former editor of the ''
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'', 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''.
Merck Merck refers primarily to the German Merck family and three companies founded by the family, including: * the Merck Group, a German chemical, pharmaceutical and life sciences company founded in 1668 ** Merck Serono (known as EMD Serono in the Unite ...
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." 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. The journal was publicly rebuked for its response to the research issues in editorials appearing in publications including the ''British Medical Journal'' and the '' Journal of the Royal Society of Medicine''.


Open access policy