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Keeper of the Journal

Guiding a venerable weekly into the Information Age

How does a medical journal that published its first issue six months before the War of 1812 stay young? Jeffrey Drazen, A68, has some expertise in that area. For the past ten years, he has edited The New England Journal of Medicine, which numbers among the world’s preeminent health science publications. It has been a challenging decade, one marked by upheavals in the publishing world and by revelations that drug companies were suppressing key information in articles. And from it all, Drazen’s weekly journal has emerged with renewed relevance—in tune with the digital era, engaged in public health issues—and with its integrity intact.

Drazen, a dapper Harvard-trained pulmonologist who wears bow ties to work and builds grandfather clocks at his home in suburban Winchester, hardly looks the part of a technological innovator. But he has led the push for digital offerings such as PowerPoint slide sets, podcasts, and clinical how-to videos. Especially popular are interactive case studies that take physicians through a case, asking them what tests to prescribe and how to treat the illness. “We’ve had up to forty thousand people working on the cases,” Drazen says.

The immediacy of online publishing has allowed Drazen to thrust the journal into the center of international public-health crises by offering up-to-the-minute data. In 2003, when the deadly SARS respiratory epidemic broke out, postings of blood counts, fever curves, and x-ray results guided practitioners around the world. Within a week, the SARS page had been viewed 250,000 times.

Since then, the journal has been on the forefront of reporting during the outbreak of the H1N1 flu virus and in the aftermath of the Haitian earthquake. “In Haiti, there were physicians on the ground who reported on what they saw and what they learned,” says Drazen. One physician, for example, wrote about treating Haitian amputees, while another issued a plea for long-term housing, wa-ter, and food supplies. “We hope others learned from what they found,” Drazen says.

And thanks to the two-way communication enabled by the Web, the past year’s debate on health-care reform raged not just in Washington but also on the journal’s website. Physicians from the political right, left, and center weighed in at healthcarereform.nejm.org, opining on questions like “What role should physicians have in controlling medical costs?” and “Do you favor taxing sugar-sweetened beverages as a way of helping to finance health-care reform and improving public health?”

“We tried not to take a stand,” says Drazen. “It kept changing day to day. We wanted to help inform.”

Drazen’s push into the digital realm has paid off. While print subscriptions slowly decline, he says, online subscriptions have grown fast enough to make up for the shortfall.

From his perch on the sixth floor of Harvard Medical School’s Countway Library, Drazen has guided The New England Journal of Medicine through another passage as well. Early in his tenure, the weekly was one of several prominent journals caught up in a storm over the publication of questionable studies conducted by pharmaceutical companies. The articles in question reported on the benefits of various drugs while ignoring studies that showed side effects and other adverse results. Peer review failed to detect the practice because the experts reviewing the articles were not privy to the unfavorable studies.

In response, Drazen led the fight for public disclosure of all clinical trials. In 2005 he and the editors of other top medical journals agreed to require companies to register clinical trials at their outset. That meant researchers could no longer hide trials that failed to produce the hoped-for results—and peer review stood a better chance of working.

“The drug companies fought us tooth and nail,” Drazen says. They maintained that the initiative would harm competition and stifle innovation. But Drazen and the other journal editors stood their ground, and ultimately prevailed. “We’ve had high compliance rates, and now the Food and Drug Administration requires it,” he says. Today, the website www.clinicaltrials.gov, run by the National Institutes of Health, lists upward of ninety thousand trials.

Drazen, who grew up in suburban St. Louis, didn’t set out to be a medical journal editor, or even a doctor. His Tufts major was applied physics. In one freshman class, Erica Lawson, E68, caught his eye. They fell in love and were married a year after graduation. By then, he was studying at Harvard Medical School, finding a way to put his quantitative skills to work to heal the sick.

Drazen continues to practice—it’s just one more way in which he strives to keep his journal in step with the real world. He teaches respiration and physiology to Harvard medical students. He does rounds in the intensive care unit at Brigham and Women’s Hospital. He sees pulmonary patients at Boston City Hospital. And he devotes one day a week to his own research on respiratory function.

“If you aren’t involved in your community,” says Drazen, “it’s too easy to get into an ivory tower and forget what it’s like to practice medicine. It’s important to be immersed so you can remain relevant to physicians who research and are in practice every day.”

DAVID McKAY WILSON, of New York City, writes for university magazines and the New York Times.

 
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