Making News at NEJM

Turns out there’s more to the process of deciding which studies to publish in top medical journals than simply peer review and the selections of sage editors. At the New England Journal of Medicine, editors conducted around a half-dozen informal polls in the past year to help them assess the worthiness of a particular research question, according to Editor-in-Chief Dr. Jeffrey M. Drazen.

Dr. Jeffrey M. Drazen (Sherry Boschert/IMNG Medical Media)

A case in point: When considering the study “Early vs. Late Parenteral Nutrition in Critically Ill Adults,” the editors knew that most ICUs in the United States don’t start parenteral nutrition for a week, and the study results supported this “late” start (New Engl. J. Med. 2011;365:506-517). So, was this a question that really needed to be answered?

Rather than rely on intuition or American self-absorption, the editors used an editorial intern who worked for the journal to do an informal survey by calling ICU doctors around the world. To their surprise, they found that ICUs in Australia, New Zealand, and most of Europe start parenteral nutrition earlier than in the United States, he said in a discussion at the annual meeting of the American Thoracic Society.

“Since we have more readers outside the U.S. than in the U.S., we figured this was something that was important to publish,” said Dr. Drazen, professor of medicine at Harvard University, Boston.

“I think it has a message for ICU interventions in general. Most of the things that we reasoned based on physiology – the physiology tells you that you need to provide these calories in order for the body to heal – may be wrong,” he added. “It’s hard to take the kind of physiology that we’ve learned in animals and translate it clinically to humans. We really didn’t test these questions one at a time.”

The journal sifts through 5,000 submissions to publish around 200 original research articles each year. “We take the job seriously,” and sometimes an informal poll helps the process, he said. The parenteral nutrition study didn’t seem to be so important at first, but “It turns out that we were wrong.

“We like to make decisions based on information rather than guessing,” Dr. Drazen said. “It should be the same when treating patients.”

–Sherry Boschert (on Twitter @sherryboschert)

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Filed under Family Medicine, Hospital and Critical Care Medicine, IMNG, Internal Medicine

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