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Changing the layout frequently without reason disrupts customer habits

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In 1957, in a presentation to medical editors and journalists at the Third Congress of the Union Internationale de la Presse Mdicale, Joseph Garland, MD (1893-1973), editor of NEJM from 1947 to 1967, discussed the responsibility of editors for the character and quality of the medical advertisements that our journals accept and that are so vital to their prosperity. He was concerned that commercial pressures engendered by the rapid growth and prosperity of the pharmaceutical industry were leading to an increasingly uncomfortable awareness of our own editorial obligations in the matter. Yet under Garlands tenure, NEJM , like JAMA , accepted scores of cigarette ads well after the publication in the late-1940s in The Lancet and the BMJ of the landmark epidemiological studies by Hill and Doll on smoking and lung cancer