BROOKE GLADSTONE:
Elsevier is the largest journal publisher, but the title for the oldest continuously published medical journal in the world belongs to The New England Journal of Medicine, which celebrates its 200th birthday this year. Unlike Elsevier, The New England Journal of Medicine makes taxpayer-supported research freely available only six months after publication. The government requires that it be made free after a year, and Journal Editor-in-Chief Dr. Jeffrey Drazen says that's not all his journal gives away.
DR. JEFFREY DRAZEN:
If you sign in from one of the hundred poorest countries in the world, as defined by the World Bank, our servers automatically recognize you as a fully paid subscriber. The other thing that we do is that whenever we publish something that we believe has an immediate public health impact — articles about H1N1 Flu, about the SARS epidemic, we put that information up for free from day zero.
BROOKE GLADSTONE:
Cast your mind back to 1812. The Journal was being delivered on horseback. What was medicine like back then?
DR. JEFFREY DRAZEN:
So there were big differences. We didn't have the germ theory of disease. We thought that infection, which was common, was caused by miasma, bad air. And it was Louis Pasteur that proved that that was wrong in the 1860s. If you needed to have a tooth pulled or a leg amputated because it has been hurt in an accident, we had no anesthesia.
BROOKE GLADSTONE:
Bloodletting was - a popular treatment. And, in fact, The New England Journal for a while was a big proponent, right?
DR. JEFFREY DRAZEN:
The Journal was a proponent for a lot of things that have turned out to be wrong. I think that the key thing about The Journal's editors over 200 years is that we took the current science and asked what were the data to support it. And back then, people had clinical experiences that said that bloodletting worked. But over time, it became pretty clear that this was probably making people worse, and it dropped off the page.
BROOKE GLADSTONE:
What do you think the biggest mistake The New England Journal of Medicine made? Was it pathologizing homosexuality or supporting Nazi style eugenics?
DR. JEFFREY DRAZEN:
It's impossible to know. There [LAUGHS] are some pretty bad things. The editors were against the admission of women to medical school. So I think the key thing is to recognize you've made a mistake and to make progress. And we've tried to do that too.
BROOKE GLADSTONE:
How have the standards for medical journals changed, I mean, in terms of the structure of peer view and that kind of thing?
DR. JEFFREY DRAZEN:
So in 1812, if you go back and read through our archives, one of the physicians who was also a subscriber would write in and tell you about his experience, and people would then comment on whether they agreed or disagreed with it. In the late 1800s, early 1900s people reported big effects, the first x-ray, the first treatments of infections with antibiotics, effects that were so big that we didn't need statistics.
Then in the late 1940s, early 1950s, people started to look for things with smaller effects, the effect of streptomycin on tuberculosis. And those trials, because not everybody was prevented from getting polio or not everybody was cured from tuberculosis, had to be placebo controlled. We say, okay, you've got to prove to me, as the editor, that it's really your treatment that's made the difference.
BROOKE GLADSTONE:
What do you think is the biggest achievement of The Journal?
DR. JEFFREY DRAZEN:
What's been reported in The New England Journal? The first treatment in a remission of childhood leukemia in 1948, lumpectomy in breast cancer, 1981, the first identification of GRID, gay-related immune deficiency, which we know is HIV-AIDS, 1981. Just a few of the hundreds of things that we now take for granted in medicine, because they were reported, adopted by many physicians, found to help patients get better and then continuously used.
Actually, The Journal doesn't make achievements. We publish them. But when you ask a doctor, without any prompting, what do they believe is the most likely source of medical truth, they name The New England Journal of Medicine.
BROOKE GLADSTONE:
I actually like the cure for cholera that The New England Journal championed back in 1832, 100 drops of laudanum mixed with nearly as much of the essence of peppermint in a wine glass and filled with brandy. I could use some of that right now.
DR. JEFFREY DRAZEN:
[LAUGHS] Right - in fact, if you add a lot of the laudanum and brandy, you don't really need the peppermint.
BROOKE GLADSTONE:
[LAUGHS] Dr. Jeffrey Drazen is the editor-in-chief of The New England Journal of Medicine. Dr. Drazen, thank you very much.
DR. JEFFREY DRAZEN:
Bye, Brooke.
