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The Journal is within a dozen years of completing its second century of service to the medical community. Although it is considered one of the preeminent biomedical publications in the world, both biomedicine and publishing are changing rapidly. The Journal must evolve to retain its position of strength as it prepares to enter its third century. I will outline here some of the challenges facing the Journal and provide an overview of how I plan to meet those challenges. My proposals represent a vision, not a blueprint. We will develop a program that will steer the Journal on a course of change, but the method of implementation must be evolutionary. Rather than change abruptly, the look and feel of the Journal will evolve gradually.
Although many changes in medicine are coming, those that will have the greatest impact on medical practice and public health are advances in medical science. Thus, it is critical for the Journal to attract, review, and publish the most clinically meaningful scientific research. This is an important goal, and we are rededicating our efforts to achieve it. However, as medical science becomes more technically sophisticated, it is increasingly difficult for many health care professionals, especially those who have been out of an academic environment for any length of time, to read and understand many of the Original Articles published in the Journal. To help solve this problem, my predecessor recently instituted "This Week in the New England Journal of Medicine." This section contains a succinct summary of each Original Article, written specifically to help readers who are not actively working in a given field understand what the authors did and why they did it. In the coming months, we plan to expand the summary by adding a sentence or two explaining the reasons the editors decided to publish the article. We hope these summaries will help you understand what was on our minds when, guided by the valuable judgment of our dedicated volunteer reviewers, we decided to publish a particular article.
Among the advances in medical science that are likely to influence the practice of medicine in the next decade are those arising from the Human Genome Project and related research in genetics and genomics. This research is proceeding at such a pace that within 18 months a first draft of the entire human genome will be available. Many physicians have asked me how this advance in basic science will affect their clinical practice. To some, the impact may seem remote and of interest only to a handful of academics. I disagree. The information from the Human Genome Project will change the way we practice medicine. How will this occur? Within the next decade, a base-perfect rendering of the human genome will be available. However, it is not the base-perfect genome sequence, but rather the variants of this sequence, that will affect medical practice. DNA-sequence variants are estimated to occur in 1 of every 300 to 500 base pairs in the human genome.1 These sequence variants give rise to the tremendous diversity we recognize in, for example, human physical traits, susceptibility to disease, and responses to treatments. Already, medical scientists have discovered how key sequence variants influence conditions as diverse as cancer, hemostatic disorders, heart disease, and the response to antipsychotic treatments. This is just the beginning. In the coming decade, thousands of medically relevant DNA-sequence variants will be identified.
How will genomic information enhance the practice of medicine? It is well established that many diseases have a heritable component, but until now (except for conditions that follow a simple mendelian pattern of inheritance and phenotypic expression), we have been able to ascertain only a loose relation between the presence of a disease in a family and the presenting condition of a patient under evaluation. As the genetics of common and complex disorders such as obesity, hypertension, stroke, emphysema, and schizophrenia are dissected and reported, the results of genetic blood-test panels in which the DNA-sequence variants at the loci of interest are treated as risk factors will become available on an overnight basis. These panels should help physicians refine differential diagnoses and provide a scientific basis for the individualization of medical therapy. The Journal will do its best to find and publish the best science in this area. Furthermore, through appropriate review articles and summaries, we will present the information in such a way that all of our readers, especially physicians in practice, can appreciate the clinical value of these findings and use them to provide the best care for their patients.
Please be assured that we do not plan to turn the Journal into a genomics journal. We will still seek out, review, and publish the results of important clinical trials, therapeutic research, observational studies that provide novel insights into disease mechanisms, clinical epidemiologic studies, and interesting and biologically informative case reports. We believe that this mix of topics is what practitioners need to provide optimal care to their patients and what our academic audience needs to keep its research questions at the cutting edge.
As part of our dedication to front-line physicians, we will increase our commitment to the recently introduced Primary Care series, so that articles concerned with the day-to-day practice of medicine will eventually appear weekly. We will carry out a systematic review of the topics to ensure that the most common reasons for seeking medical care are covered on a three-to-four-year cycle. We understand that your time is precious, and we will make these articles easy to read; they will be short and well illustrated. Indeed, we are committed to expanding the illustrative material in the Journal, because we are convinced that it adds great value by helping to communicate complex concepts in an understandable format. If there is interest among our subscribers, we may develop an electronic data bank of Journal illustrations for teaching purposes.
In the past, the Journal has devoted just over 10 percent of its pages to issues of public policy in health care, public health, and ethics. The Journal 's Sounding Board articles, Special Reports, Special Articles, Legal Issues in Medicine articles, Health Policy Reports, and Occasional Notes have had a major impact on the public understanding of health policy and the links between medicine and public policy, the law, and ethics. These articles are a critical component of the Journal, and we will continue to give them as much space as they now fill. Our goal is to publish articles on health policy that reflect a spectrum of thought in this area, so that the Journal can serve as a forum for debate on the issues rather than be the voice of a single constituency.
The evolution of the Journal will occur in both its print and electronic versions over the next few years. We plan to add substantially to the electronic version of the Journal and to enhance the functionality of our Web site. We recognize that electronic information transfer is here to stay; we plan not only to keep abreast of the rapid pace of electronic information transfer that will characterize the coming millennium, but also to take a leading role in the use of electronic information technology in all facets of the Journal 's endeavors. As I begin my term at the helm of this august journal, my commitment is to provide you with the information you need to do your job in the best way possible. Look for the Journal every week in your mailbox or on your computer screen. We will keep you up to date as advances in medicine occur, and you and your patients will benefit.
Jeffrey M. Drazen, M.D.
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