Tweaking the BMJ redesign and fretting about alcohol

When the New England Journal of Medicine was redesigned in 1996 many readers didn't like the result. “I feel rather as if a beloved and dignified mentor just showed up in my classroom in an Armani suit coat, lime green pants, and a powdered wig,” said one reader. Almost half of those who wrote to the editor said they didn't like the changes, and he promised not to redesign the journal again.

We've been luckier, perhaps because we are not seen as being so dignified. Fifty eight people have written to congratulate us on the redesign. “With one fell swoop you have put right all the minor wrongs on the past,” said one. “More energetic than the old,” said another. Nobody wrote to say that they disliked the overall design, but three criticisms recurred.

Ten librarians wrote asking us to put the issue number on the front and to give more prominence to the bibliographical information. We have done this. Two people wrote regretting that we didn't make explicit on the cover our links with the BMA. We have added the words “British Medical Association.” Then, six people wrote to say that the cover looked “a bit empty.” We have not responded to this because we think that most people like the clarity, simplicity, and cleanliness of the cover. A readership survey has found that 18% of readers think the design much better, 42% slightly better, 25% neither better nor worse, 8% slightly worse, and 2% much worse; the rest didn't answer the question.

We have made other changes in response to our own reactions. The first page of “Views and Reviews” is redesigned; “Soundings” and “Personal view” come back as headings; and we have lightened up this final section by using more BMJ blue. We've also introduced blue boxes in many parts of the journal. Other changes are minor.

The “tweaked” journal raises a lot of difficult issues–including using the law to make women undergo caesarean section (pp 1183 and 1143) and (from England's chief medical officer) combatting poverty to improve the nation's health (p 1187)–but most difficult of all may be how to reduce the harm done by alcohol.

Authors from Australia have studied over 11 500 patients with acute myocardial infarction and over 6000 controls and concluded that risk of infarction is lowest among those who drink two alcoholic drinks daily, five days a week (p 1159). So, should we all drink that amount? No, suggests a study from Britain (p 1164), because any increase in average consumption is likely to be accompanied by an increase in the heavy drinking that damages people and families. You cannot have more drinking without more damage. That, says an editorial (p 1142), is what Denmark has discovered after promoting safe drinking.