Journal of clinical medicine research · 2026
From Discovery to Verification: A Thirty-Three-Year Analysis of Research Design in Three Leading General Medical Journals, 1992-2024.
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Chen Zhe, Gou Rei
Аннотация
BACKGROUND: Evidence-based medicine (EBM) has reorganized clinical research around a hierarchy favoring confirmatory designs over hypothesis-generating ones. Earlier analyses rested on single-year snapshots ending in 2008, so whether the shift continued, and at what rate, across the EBM era is unknown. We characterized 33-year trends in design profile and collaboration scale in three leading general medical journals.
METHODS: We conducted a repeated cross-sectional analysis of PubMed publication-type indexing for the New England Journal of Medicine (NEJM), The Lancet, and JAMA, 1992 to 2024, with numerator and denominator both restricted to the Journal Article publication type. We measured the annual proportion of journal articles tagged as Phase III trials (from 1993, when that tag was introduced), multicenter studies, randomized controlled trials and case reports, and authors per randomized trial. Trends were estimated by binomial generalized linear models (odds ratio (OR) per decade). The Phase III tag was validated against 132 articles.
RESULTS: The pooled share of Phase III trials rose from 0.15% in 1993 to 5.67% in 2024 (OR 2.79 per decade, 95% confidence interval (CI) 2.59 to 3.00; P < 0.001), and multicenter studies from 4.3% to 12.6% (OR 1.25; P < 0.001). The randomized-trial share rose more modestly, from 11.4% to 13.8% (OR 1.10; P < 0.001). Case reports fell in The Lancet (7.3% to 3.8%; OR 0.78) and JAMA (7.3% to 1.3%; OR 0.63), but not in NEJM (23.0% to 25.7%; OR 0.97; P = 0.08), where stability is accounted for by two standing features, the weekly Case Records and a single-page clinical image series begun in 1993. Case reports of three or more pages fell from 11.3% to 4.2% in NEJM (OR 0.71). Median authors per randomized trial rose from 5 to 10 in 1994-1998 to 19 to 23 in 2020-2024.
CONCLUSIONS: The leading general medical journals increasingly published large, multi-author, late-phase trials, while the substantive case report contracted in all three. The case report changed in kind, from a vehicle for novel observation to short pedagogical content carrying the same index tag. These trends are consistent with a structural shift from discovery toward verification, with implications for how new hypotheses enter the evidence base.
METHODS: We conducted a repeated cross-sectional analysis of PubMed publication-type indexing for the New England Journal of Medicine (NEJM), The Lancet, and JAMA, 1992 to 2024, with numerator and denominator both restricted to the Journal Article publication type. We measured the annual proportion of journal articles tagged as Phase III trials (from 1993, when that tag was introduced), multicenter studies, randomized controlled trials and case reports, and authors per randomized trial. Trends were estimated by binomial generalized linear models (odds ratio (OR) per decade). The Phase III tag was validated against 132 articles.
RESULTS: The pooled share of Phase III trials rose from 0.15% in 1993 to 5.67% in 2024 (OR 2.79 per decade, 95% confidence interval (CI) 2.59 to 3.00; P < 0.001), and multicenter studies from 4.3% to 12.6% (OR 1.25; P < 0.001). The randomized-trial share rose more modestly, from 11.4% to 13.8% (OR 1.10; P < 0.001). Case reports fell in The Lancet (7.3% to 3.8%; OR 0.78) and JAMA (7.3% to 1.3%; OR 0.63), but not in NEJM (23.0% to 25.7%; OR 0.97; P = 0.08), where stability is accounted for by two standing features, the weekly Case Records and a single-page clinical image series begun in 1993. Case reports of three or more pages fell from 11.3% to 4.2% in NEJM (OR 0.71). Median authors per randomized trial rose from 5 to 10 in 1994-1998 to 19 to 23 in 2020-2024.
CONCLUSIONS: The leading general medical journals increasingly published large, multi-author, late-phase trials, while the substantive case report contracted in all three. The case report changed in kind, from a vehicle for novel observation to short pedagogical content carrying the same index tag. These trends are consistent with a structural shift from discovery toward verification, with implications for how new hypotheses enter the evidence base.