In deciding what research to publish and how to evaluate it, medical journals bear a heavy responsibility – as failures show. In 1998, for example, the Lancet published an article falsely linking autism to the MMR (measles, mumps, and rubella) vaccine. They retracted the document, but the genie was out of the bottle: the health crisis that followed still reverberates today.
British-born physician and editor Drummond Rennie, who has died aged 89, was a leading figure in American medical journals, whose mission was to combat inaccuracy in scientific reporting and raise standards. A cartoon in the British Medical Journal in 2001 depicted him as a biblical prophet, urging his fellow medical editors to head toward “the promised land” of rigorous scientific reporting. He served as associate editor of two of the world’s most influential medical journals: the New England Journal of Medicine (NEJM), from 1977 to 1981; and the Journal of the American Medical Association (JAMA), from 1983 to 2013.
When Rennie started at NEJM, the journal had just published an article on schizophrenia patients with low levels of the enzyme monoamine oxidase. He was troubled to see the same research in another journal conclude differently, saying the enzyme levels were normal. The more Rennie studied, the more he discovered: the medical literature seemed riddled with anomalies, errors, and gaps. In 1986, he summarized: “There are practically no obstacles to possible publication. There seems to be no study too fragmented, no hypothesis too trivial, no literary quotation too biased or too selfish, no conception too distorted, no methodology too sloppy, no presentation of results too inaccurate, too obscure and too contradictory, no analysis too selfish, no argument too circular, no conclusion too. insignificant or too unjustified, and no grammar or syntax too offensive for an article to end up in print.
Peer review is at the heart of a journal’s publication process. When deciding whether to publish a research article, the journal’s editor-in-chief sends it to experts for evaluation. Rennie worried about the prejudices that were taking hold. Did reviewers, for example, view papers written by scholars they knew more favorably? He also worried that peer review simply wasn’t doing its job: It was supposed to weed out errors, but he was discovering myriad problems in printed articles.
Wanting to apply scientific review to the entire publishing process of medical journals, in 1989 Rennie inaugurated the International Congress on Peer Review and Scientific Publication. Held every four years, it is a forum for journal editors and researchers to advance standards and “improve the quality and credibility of science.” Rennie was its director and then director emeritus until the end of his life.
As codes of best practice emerged on how to evaluate research, JAMA published guidelines for reporting randomized controlled trials in 1994, with a structured checklist to standardize how information was presented. This led to a set of rules called the Consolidated Standards of Reporting Trials (Consort), which medical journals could adhere to. Rennie also pushed for all trials to be recorded from their start and for records of their results to be kept. This was to combat the practice of unsuccessful trials that disappeared without a trace, so that clinicians had no idea which drugs or treatments did not work. In 2000, the US government created the clinicaltrials.gov registry, requiring researchers to register their trials.
In Rennie’s eyes, a special place in hell was reserved for people who deliberately manipulated scientific records. In 1994, a whistleblower, “Mr. Butts,” at the Brown and Williamson Tobacco Corporation sent 4,000 pages of company reports, letters and memos to a doctor at the University of California. The papers reached JAMA, and in an editorial, Rennie scathingly criticized the company, explaining how it planned to suppress the scientific record by hiding research that found nicotine was addictive. He served on the U.S. government’s Commission of Research Integrity and helped strengthen rules on scientific misconduct in 1995.
As well as raising standards, Rennie wanted to improve the way frontline clinicians use research. He established the Evidence-Based Medicine Working Group at JAMA, which published a series of 32 articles in the journal between 1993 and 2000. Called Users’ Guides to the Medical Literature – and later bound into a book of the same name – they brought evidence-based medicine into the mainstream, teaching doctors to critically evaluate medical literature and incorporate the best evidence into their practice.
Rennie was born near Leeds, one of three children of John, a British cardiologist, and Isabella (née Wiese), a Danish-American doctor. He was educated at Winchester College before studying medicine at Cambridge University. After training at Guy’s and Royal Brompton hospitals in London, he specialized in nephrology (kidney medicine). Taking advantage of his dual nationality, he moved to the United States in 1967 to work for nephrologist Robert “Googoo” Kark at St. Luke’s Presbyterian Hospital in Chicago.
In London, Rennie had met Silvia Nussio, whom he married in 1958. While visiting family in Switzerland, he was initially intimidated by the altitudes of the Alps. This soon changed and he developed a passion for mountaineering, which he was able to combine with his work, participating in expeditions all over the world to provide medical care and also to study the effect of high altitudes on the body. In 1970, he led a U.S. medical relief operation in a mountainous region of Peru following an earthquake.
Publishing articles on altitude medicine and nephrology in the Lancet and JAMA introduced Rennie to the world of medical journals and he was curious to learn more. In 1977, he left nephrology to become associate editor of the NEJM. He was content to remain associate editor both there and at JAMA, because the “top job” came with pressures he didn’t like, such as keeping management and advertisers on his side.
He did, however, combine his editorial work with teaching at universities: while at NEJM, he was professor of medicine at Rush Medical College in Chicago, and when he moved to California to work for JAMA, he became an assistant professor of medicine at the University of California.
In 1984, his marriage ended in divorce. In 1992, he married Deborah Peltzman, a data scientist. The couple loved being outdoors, and after retirement, they moved with their dog St. Bernard to a “house in the woods” in Oregon, where he could hike, read and appreciate nature.
Rennie is survived by Deborah, two children, Caroline and Nicholas, from her first marriage, and two granddaughters. His sisters, Jane and Isabel, both predeceased him.
