Let's all Join the Massachusetts Medical Society

And make loadsa cash.

The New England Journal of Medicine (NEJM) is among the most influential medical journals, with a Journal Impact Factor of 96. Along with journals such as the Lancet, it is the home to industry publications, which dominate its research section. 

When JAMA set a requirement for independent statistical analysis for industry-funded trials in July 2005, they published significantly fewer RCTs and industry-funded RCTs.  The beneficiaries of this policy included NEJM, whose proportion of industry publications rose to 56%.  There have also been concerns about NEJM's resistance to data sharing, which is crucial for independent verification of trial results, and its open resistance to dealing with conflicts of interest. 

Despite its emphasis on rigour, NEJM articles in Retraction Watch’s database number 25 retractions. 

The latest paper found that “ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements.” Cited 190 times.  A reader's comments prompted a re-evaluation of the data, as there were errors in the original data tables- so much for the peer review then.  This led CH to retract a meta-analysis on heart disease once the team realised the NEJM reference had been retracted. 

In 1996, the NEJM editors made it official journal policy that reviews and editorials could never be written by authors with financial COIs. However, in 2000, Jerry Kassirer and colleagues were replaced by Jeffrey Drazen, despite concern about his links to pharma—he only had ties with about 20 drug companies. 

As per NEJM policy, Drazen said he wouldn't ‘deal with any manuscripts involving these companies for 2 years from his last point of contact.’ As soon as the two years were up, Drazen performed a U-turn on the previous policy, allowing authors with “insignificant” financial COIs (defined as a de minimis level of <$10,000 per year from the industry) to write editorials and reviews. 

Industry-funded trials are more likely to publish favourable results that overestimate the effects in subsequent meta-analyses using primary outcomes that are more likely to yield statistically significant outcomes, such as less clinically relevant surrogates. Several NEJM published industry trials have been associated with substantial harms (think Vioxx, Rosiglitazone) due to underreporting of adverse events. 

Regarding Vioxx, the journal waited five years to publish concerns about the study’s findings. The  VIGOR Trial, published in NEJM in 2000, was found to have underreported adverse events, including heart attacks and deaths. Writing in the Journal of the Royal Society of Medicine, Richard Smith, former editor of the BMJ, lamented that  ‘It is clear, however, Jeff Drazen knew about these extra deaths long before the end of 2005. Indeed, the Wall Street Journal discovered that Drazen had been told about them in August 2001.

The bottom line, however, is that the NEJM did very well in the trials: Merck bought 900,000 reprints of the article for promotion at an estimated cost of between US $700,000 and US $836,000.  

That brings us to the NEJM's owner, the Massachusetts Medical Society (MMS), which is doing splendidly, despite all the issues.

The MMS, based in Waltham, Massachusetts, is a non-profit organisation with 24,000 members. It says it is a leading voice in health care policy, public health, and clinical medical education. Membership is for physicians and costs $450/calendar year, but new members benefit from a $200 discount, free for medical students.  

The independent, non-profit newsroom ProPublica Nonprofit Explorer pages report MMS revenues of $125,843,070 in 2023, with the majority of income from the NEJM: TTE estimates that subscriptions bring in a maximum of $11 million based on 24,000 members.    

The executive vice president's remuneration is £731k a year for 50% time, and the editor-in-chief of NEJM receives $416k for a half-time job.  Despite the conflicts, retractions and delays in responding to harm, the MMS is in fine shape with total assets of $282 million. If you want to get ahead, there's only one thing to do - to join the Massachusetts Medical Society.

This post was written by two old geezers who would not recognise $416k if it hit them in their faces despite their beards.

More readings: 

Jefferson T. Sticking to principles and anticipating outcomes. Journal of the Royal Society of Medicine. 2017;110(11):458-459. doi:10.1177/0141076817737972