Believe The Brown Journal

Although the New England Journal of Medicine (NEJM) now comes every week by mail without any cover, it used to come in a tan paper wrapper.

One day, as a colleague and I discussed a NEJM article, we discovered that each of us would let the NEJM stack up until the wrappers turned from tan to brown. Then, as with ripe bananas, it would be time to open them and digest the contents. Until the wrapper was brown, there had not been enough scientific scrutiny to trust claims made in the journal's articles.

On Monday November 11, the NEJM article on the use of a particular statin in a "low risk" population with satisfactory cholesterol levels but high CRPs (C-reactive Protein, a marker of inflammation) attracted a great deal of media attention. Experienced physicians will probably wait for several months before letting the article provoke them into prescribing the statin in question for the reasons promoted in the article. By the time the "brown journal" has matured in four or six months, the data will have been scrutinized carefully, appropriate questions will have been asked, biases will have been exposed, the drug company sponsor's biases will have been evaluated, the issue of possible conflicts of interest among the investigators will have been considered, and conflicting medical-scientific questions and issues will have been brought forward.

If you ask most young physicians about the "brown journal" they won't know what you are talking about. If they believe today's news, without paying attention to the information about the study that is still to come, they do you, the patient, no favor. And if you are dubious about my hypothesis, go to any medical library, take a ten year old journal from the shelf, read the drug advertisements, and ask yourself why those drugs disappeared and are no longer used.