Posts Tagged NEJM

Redesigning primary care in the USA

There’s a section in the November 13 edition of NEJM that’s currently gratis OA: Perspective roundtable: redesigning primary care, by Thomas H Lee, Thomas Bodenheimer, Allan H Goroll, Barbara Starfield, and Katharine Treadway, N Engl J Med 2008(Nov 13); 359(20): e24 [PubMed Citation] [HTML]:

U.S. primary care is in crisis. Primary care physicians must care for more and more patients, with more and more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. They must absorb increasing volumes of medical information and complete more paperwork than ever, as they try to function in a poorly coordinated health care system. As a result, their ranks are thinning, with practicing physicians burning out and trainees shunning primary care fields. In a roundtable discussion moderated by Dr. Thomas Lee, four experts in primary care and related policy — Drs. Thomas Bodenheimer, Allan Goroll, Barbara Starfield, and Katharine Treadway — explore the crisis, as well as possible solutions for training, practice, compensation, and systemic change.

[Video]; Transcript of video [PDF]; [Comments].

For some additional comments, see: The doctor is out? by Cervantes, Stayin’ Alive, November 18, 2008.

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Freely-accessible editorials about confidential peer review

The free full text is available for these editorials about the confidential nature of the peer-review process, and how it has recently been challenged:

Peer Review in the Balance, by Gregory D. Curfman, Stephen Morrissey, George J. Annas and Jeffrey M. Drazen, New England Journal of Medicine 2008(22 May); 358(21): 2276-2277. The first paragraph of this editorial:

For many years, the editors of the Journal have relied on peer review to ensure the scientific quality of the articles that we publish. Of the thousands of manuscripts submitted to the Journal each year, we publish about 1 in 20. To aid us in selecting those manuscripts, we seek advice from thousands of peer reviewers. Confidential peer review is a key component of our manuscript selection process.

Confidential review — or not? Donald Kennedy, Science 2008(22 Feb); 319(5866): 1009. The first paragraph:

At Science, We editors love our reviewers and know that our editorial colleagues elsewhere do too. After all, the process of scientific publication depends on the volunteer services of thousands of experts all over the world who willingly provide, without compensation, confidential and candid evaluations of the work of others. Because all of us in scientific publishing depend on reviewers, we’d better try to keep them at it, happy, and secure. But the following case, involving a lawsuit, a drug company, and the company’s assault on the confidential files of a journal, is a bad news story.

The outcome of this “bad news story” is discussed in the editorial in the NEJM. An excerpt:

[Judge] Sorokin’s ruling states that scholarly journals are entitled to the same protection of editorial confidentiality as journalists. The ruling also makes it clear that disclosure would be harmful not only to the Journal but also “to the medical and scientific communities, and to the public interest.”

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