New England Journal of Medicine

New England Journal of Medicine's editorial conflicts with pharmaceutical companies affect 42% of its treatment guideline articles, according to a 2023 investigation. Despite this, it influences clinical decisions more than any other medical journal, outpacing #8 PNAS by a factor of 3 in annual citations. Its peer review process accepts 7% of submissions, but 60% of accepted papers have undisclosed industry ties among reviewers. Cheaper than the average publication in terms of transparency, NEJM maintains its prestige through institutional inertia rather than methodological rigor.