Ingelfinger soul-searching on the New England Journal of Medicine’s 200th birthday?
The NEJM was born in 1812 — as the impossible-to-remember New England Journal of Medicine and Surgery and the Collateral Branches of Science — and stories have been appearing about the milestone in various news outlets since January. The journal also has its own commemorative site.
On Connecticut’s WNPR today, in the second in a two-part series on the occasion, I was interviewed about the journal’s legacy, and not surprisingly, the reporter picked out a comment I made on the artificial news pegs reporters assign to medical news:
Science doesn’t work every week. It doesn’t happen in these punctuated episodes once a week or once a month when the journal comes out. It happens in a continuum. And by allowing journals complete control, essentially, over when something can be written about, you are perpetuating this really false idea that science happens when something gets published. It’s just not true.
Also not surprisingly, current NEJM editor-in-chief Jeffrey Drazen defended the journal’s use of the Ingelfinger Rule, which was of course invented there by former editor Franz Ingelfinger in what some say was a well-intentioned effort to prevent researchers from bypassing peer review and publishing results in the mass media.
It was a passage in a piece in this week’s issue of NEJM, however, that caught my eye for its unvarnished honesty:
By the late 20th century, journals needed to compete not just with each other but with newspapers and other media. As Franz Ingelfinger noted in 1977, “Medicine has become the stuff of headlines.” New topics drew further attention to medical journals — debates about health policy and national medical insurance, malpractice, special interest lobbying regarding particular diseases, and interest in health education. The growing market in medical news attuned journal editors to their content’s “newsworthiness.” In 1969, the Journal articulated this relationship in its Ingelfinger Rule, a policy against publishing anything that had already appeared elsewhere. Other journals followed suit. This rule, combined with embargo policies, has led to a carefully choreographed production in which medical journals and the popular press work cooperatively and competitively to influence the news cycle.
The piece goes on to refer to mimeographs as “new media,” which is hopefully intentionally funny.
There’s a lot for embargo watchers to focus on the above paragraph, notably the admission that yes, the NEJM uses the Ingelfinger Rule and embargoes to create a “carefully choreographed production…to influence the news cycle.” The language also suggests that the popular press is cooperating, which is something else worth noting. After all, embargoes are an agreement between two parties, and they wouldn’t have any power if journalists stopped agreeing to them. Researchers’ perceptions of the Ingelfinger Rule, of course — that it prevents them from speaking to the press at all, which isn’t true — make it difficult to imagine just how reporters would consistently break free of Study of the Week Disease.
So perhaps on the occasion of its 200th birthday, the world’s most powerful medical journal could use its bully pulpit to explain how they actually use the Ingelfinger Rule, as Nature has, for example:
…communicate with other researchers as much as you wish, but do not encourage premature publication by discussion with the press (beyond a formal presentation, if at a conference).
In other words, as long as you don’t go out of your way to seek media attention, you’re fine. Not an ideal approach, from my point of view as a journalist, but I can see it’s a justifiable compromise.
Or maybe NEJM just did explain how they use the Ingelfinger Rule: They just use it to influence the news cycle.