Project House Newsletter

STRATEGIES - VOLUME 6 NO 1 WINTER 1996

Should You Try for The New England Journal of Medicine?

Our product's landmark study is just what medical news headlines are made of. What could be better than publication in The New England Journal of Medicine? Everyone, from the principal investigator to the director of marketing, likes the idea, but chasing the dream may cause more problems than you bargained for.

A sterling reputation

The revered publication, established in 1812 as The New England Journal of Medicine and Surgery, is the oldest continuously published medical journal in the world. From its early days, the journal communicated breakthroughs; the use of ether for anesthesia first appeared in its pages. After its purchase (for one dollar!) by the Massachusetts Medical Society in 1921, NEJM maintained the proud editorial standards that have put it at the pinnacle of medical prestige. Any study NEJM prints is wrapped in the aura of its reputation--a strong appeal to researchers and marketers alike.

Over 230,000 subscribers pay to have NEJM delivered to their homes or offices. This number is fully five to six times greater than that claimed by any other medical journal.

Not least among the reasons you'd want your study to appear in its pages is the high probability that the information will be picked up by the popular press and even gain exposure on television newscasts. Publicity like that can sway today's health-conscious consumers at the same time as it reminds physicians of your product.

A series of hurdles

The New England Journal of Medicine receives 4,000 unsolicited manuscripts each year. Those not immediately rejected are filtered through a review process, drawing on the expert judgment of 17 physician editors. The article may be ruled out at that point or sent to two peer reviewers for scrutiny.

Only 8% to 10% of all articles submitted to the journal make the final cut. Reasons for rejection vary. The reviewers might feel that pivotal trial data for a "me-too" drug--another antibiotic, for example, or another antihypertensive--lack news value. They may be skeptical of the data or trial design or may find the article poorly written. If the two reviewers disagree between themselves, the manuscript may be sent to other reviewers.

As time goes by

The only publishing decision made quickly at NEJM is to reject a manuscript that's beyond repair. That decision, say the editors, could take only 2 weeks. Decisions on articles with potential for publication take a few weeks longer, and the peer-review process adds roughly another 6 to 8 weeks. A positive decision--provisional acceptance--usually means that the paper is returned to its author for revision. A reviewer may disagree with a discussion point, request different statistical treatment, make editorial changes, or demand additional data. A firm acceptance can take another 6 weeks to 6 months. Rejection at that point is still a possibility, which could set your publication and promotional plans back by months.

From submission to publication may take as little as 6 months or as long as 2 years. Articles that get mixed reviews, stir up disagreement among the editors, or need extensive rewriting take longest. Unfortunately for authors who want to be first with breakthrough data, the submission date doesn't appear on the published article.

Alternatives exist

If you think your trials may not pass the stringent review of The New England Journal of Medicine or you need your results out fast--other vehicles may be better choices.

Other peer-reviewed journals often target a single specialty audience, Antimicrobial Agents and Chemotherapy, for example, targets infectious disease specialists. Some peer-reviewed journals are more demanding than others. In general, publications sponsored by the leading society in a specialty, such as the AHA's journal Circulation, are well regarded and have high standards for acceptance. Unfortunately, their review process may take just as long as that of NEJM. And, since these journals are often sent automatically to all dues paying members of the society, real readership may not be as wide as the subscriber list suggests.

The New England Journal of Medicine Answers Questions

Q. Is there any way to shorten the time to publication?
A. Not really, but excellent articles containing important new information may come out more quickly than others.

Q. Does writing style count?
A. Yes. NEJM has high standards for all facets of a paper: content, tightness of the research, and writing quality.

Q Will an article be delayed so that another of a similar nature can be published with it?
A. An article won't be held until a related one comes in. If two similar (but not overlapping) papers are submitted at the same time, one may be held so that they can appear in the same issue.

Q. Are unsolicited review articles ever accepted?
A. NEJM does consider and sometimes publish such articles.

Q. Does prior publication, for example, in the lay press, always preclude publication in NEJM?
A. That's left to the discretion of the Editor-in-Chief. The decision can vary, sometimes depending on how much of the paper was disclosed.

Q. Is presentation at a meeting considered "prior publication"?
A. It depends on the meeting, the presenter, and how much of the paper was presented. Presentation at an AMA meeting might be less problematic for subsequent publication. Plans for presentation should be outlined in the cover letter that accompanies submission of the article.

Q. Are there categories of articles NEJM wouldn't consider?
A. No. Articles containing original research are published most, but NEJM will consider anything that's well written and judged to be of interest to its readership.

The Journals Cardiologists Read Most*

Journal	No. of subscribers	% of articles accepted	Accepts unsolicited reviews?	Typical time to publication
Circulation	24,000	19%	Yes	8 mo from submission to print
Journal of the American College of Cardiology	31,000	23%	Yes	10 - 12 mo from submission to print
New England Journal of Medicine	179,000 US 234,000 Total	8% - 10%	No	8 - 12 mo from acceptance to print
American Journal of Cardiology	32,000	19%	No	6 mo from submission to print
American Heart Journal	10,800	35%	Yes	8 - 12 mo from submission to print

* Survey results, 1995 AHA meeting

Pay for print journals, such as Current Therapeutic Research, usually don't focus on a single specialty. Because authors pay by the page for their articles, the scientific integrity of such journals may be questionable. Their great advantages are their high acceptance rates and short lead times to publication.

Journal supplements, underwritten by a sponsor, carry a clear statement of sponsorship. The sponsor often can recommend a reviewer--usually a symposium chairman or other respected individual acceptable to the journal. A responsible reviewer makes sure that acceptance of the manuscripts isn't just a rubber stamp process. A journal supplement can be bound into the regular issue that's mailed to the subscriber list, so your article appears with other articles in the issue. Some journals print supplements as freestanding publications to be mailed to the journal's subscriber list, and others print special issues to be mailed to a list supplied by the sponsor. The latter type--which shows up unexpected in the recipient's mail--may not be as highly regarded and often isn't indexed in the National Library of Medicine database.

Throw away journals are sent to physicians free of charge. They're supported by advertising and sales of reprints. Some are completely written by staff writers, but others accept original research articles. Many, such as Postgraduate Medicine, have wide readership and are indexed in the National Library of Medicine database.

* Requires Adobe Acrobat Reader - If you don't already have it, download the Free Version.

About Us | Services | Newsletter | Contact Us | Home