Medical Journals and Molecular Medicine

“A revolution in the quality and efficiency of health care is in the making. The rational design of diagnostics, drugs, and vaccines made possible by molecular biomedical science, in conjunction with statistical methods designed to eliminate bias in the evaluation of these intervention, will dramatically change health care delivery by the turn of the century and beyond.” (1) The four major weekly medical journals are trying to cope with these polar changes. While they are doing well on the statistical side, drastically improving the quality of these efforts by emphasizing large-scale randomized clinical trials and meta-analyses, their coverage of the burgeoning field of molecular medicine is relatively meager. Using the molecular medicine database published in each issue of this journal it was found that less than 10% of the articles in the New England Journal of Medicine and The Lancet cover this important new area, while virtually nothing appears in the Journal of the American Medical Association and the British Medical Journal. This problem has been recognized recently in an editorial in The Lancet (2), which has raised several issues worthy of discussion in Molecular Medicine: the definition of the field, the role of clinicians, the potential over-selling of this relatively new discipline, and communication of molecular systems to clinicians and medical systems to non-medical investigators.

Scientific American’s pioneering Introduction to Molecular Medicine was devoted largely to genetic diseases. The Lancet’s definition, which was similar to that presented in the first issue of Molecular Medicine, included the basic science fields of immunology, biochemistry, genetics and molecular biology, but was also concerned with “the pathogenesis of disease at the molecular level” associated with “the designing of specific molecular tools for diagnosis, treatment and prevention.” The sine qua non for publication in Molecular Medicine is that the focus is molecular and that it deals with a specific disease. Suffice to say, therefore, that we conceive of Molecular Medicine as a medical journal devoted to the cutting edge of molecular science. Conversely, we realize that much of the literature of molecular medicine is produced by non-medically qualified scientists. Their work is fundamental to this field, and we are privileged to publish their papers in the journal and to welcome them as members and fellows of the Molecular Medicine Society.

The Lancet evinced concern for budding clinicians working with “nucleic acid fragments on gels rather than patients—sometimes earn[ing] them the dismissive label of ‘bar-code doctors’,” and for how this sort of training and experience could be integrated into a clinical career. We would reply, in the same way it has always been for clinical investigators working in both the laboratory and the wards. The problem today, however, is the competition afforded by the influx of scientists with MD/PhD and PhD degrees into biomedical research and their virtually full-time devotion to the laboratory (3).

The Lancet also raised the legitimate question of promising too much too soon, and cited Inder Verma’s excellent article “Gene Therapy: Hopes, Hypes, and Hurdles” in the first issue of the journal. Since Molecular Medicine’s view of the field goes beyond genetic diseases and gene therapy, it greatly increases both the scope and the opportunities. Given that, and knowledge of the power of this area of study, we do not believe that our hopes are unrealistic.

While The Lancet cited our statement at the launch of Molecular Medicine that molecular medicine provides a “common language and understanding among clinical groups”, it was legitimately concerned about clinicians’ understanding of the field. As a clinical investigator in that most arcane and complex field of biomedical research, immunology, I breathed a great sigh of relief when I realized, through the incomparable prose and pictures of Jim Watson’s books, that molecular biology is the simplest of all fields of medical research, its foundation essentially being that DNA makes RNA which makes proteins. We are considering the possibility of working with a major weekly journal to produce a step-by-step Watsonian series on Molecular Medicine for Clinicians. Conversely we might also do a series for non-clinicians in Molecular Medicine on molecular cardiology, neurology, gastroenterology, dermatology, infectious diseases, etc. In a series of efforts to improve communication we have introduced the structured abstracts pioneered by the medical journals, we also provide summaries describing the molecular rationale and the clinical purpose of each paper published in the journal. Reviews, like Inder Verma’s, are also provided. The particular challenge, however, is to avoid over-simplification.

We are pleased at The Lancet’s interest in molecular medicine and at the opportunity that they have afforded us to clarify our concepts of this fascinating, integrative, and potentially useful field of medical investigation.