Editorial

Redefining Medicine

    Subjects

    For more than two decades, Nature Medicine has been the prime venue for publication of outstanding work in the translational space. Now the journal’s scope is evolving to embrace the clinical research that meets the challenges and complexities of contemporary medicine.

    Nature Medicine launched in 1995 with a broad scope and the bold mission of bridging the gap that exists between researchers in the lab and clinicians at the hospital and to support the needs of the emerging discipline of molecular medicine.

    Over the years, the journal has been home to landmark research that has shed light on the mechanisms governing multiple aspects of human biology in health and disease. Seminal discoveries, such as the demonstration that neurogenesis happens in the hippocampus of the adult human brain, that leptin production is related to obesity in humans, that cancer cells follow a hierarchy akin to their normal counterparts and that the expression of PD-L1 in tumor cells drives immune evasion, were reported in our pages. As Nature Medicine matured, the journal also played a critical role in setting standards for preclinical studies. By promoting work that is sound and reproducible and that therefore has a fair chance to succeed in clinical trials, the journal fulfilled its original mission of reducing the distance between bench and bedside.

    Today, many of the lines separating basic and clinical research have blurred. Science and medicine now go hand-in-hand. Medical decisions are increasingly guided not only by the assessment of clinical manifestations of disease, but also by knowledge of the molecular basis of disease itself. In part, this is the result of amazing technological development that created the tools that were much needed to dissect the inner workings of human biology. In parallel, as the understanding of the basic biological processes underlying health and disease has improved, researchers have begun to apply these biological principles in the rational design of clinical interventions. Consider, for instance, how cancer treatment is being transformed by the understanding of the genomic landscape of cancer cells and more recently by the ability to unleash the immune system to fight tumors. On a different front, exciting advances in microbiome research, genome-editing technologies and stem cell biology are clearing the preclinical path and are moving on to testing in clinical settings, opening a window of opportunity for innovative interventions in humans.

    In order to continue to foster the progress of medicine, we at Nature Medicine feel that it is important for the journal to evolve to reflect the changes that are happening in the medical landscape. Our scope is broad, but the mission of publishing research that addresses the needs and goals of contemporary medicine unifies it. In that sense, the journal will continue to be a home to outstanding research that unveils new concepts of human biology, as well as for work that presents innovative technologies and robust preclinical bases of new therapeutic modalities for unmet clinical needs.

    Going forward, however, our main focus will be on exceptional clinical work in all its different flavors—from case reports that combine striking clinical observations with new biological findings to observational longitudinal studies that can drive the generation of new hypotheses for further interventional and mechanistic studies. We hope to nurture research spanning from small-scale first-in-human trials that bring new therapeutic modalities to the clinic to advanced trials that have the potential to change clinical practice. We also encourage submission of studies that apply advances of different ‘omics’ technologies to fulfill the promise of high-definition medicine, which is to tailor health recommendations on the basis of the biologic uniqueness of each individual.

    Examples of our new direction appear in this issue. The first study, from Kuhnen and colleagues (Nat. Med. https://doi.org/10.1038/s41591-018-0015-9, 2018), shows that a recently developed drug promotes durable weight loss in severely obese patients with leptin receptor deficiency in a phase 2 trial. In the second, Tutt et al. (Nat. Med. https://doi.org/10.1038/s41591-018-0009-7, 2018) report the results of the TNT phase 3 trial that identifies molecular determinants of response to platinum therapy in patients with triple-negative breast cancer. In the third, Shipp and colleagues (Nat. Med. https://doi.org/10.1038/s41591-018-0016-8, 2018) build on the power of genomics to provide a roadmap for a clinically actionable classification of diffuse large B cell lymphomas. As we move into the clinical space, we are taking additional steps in the editorial process to ensure that all clinical data reported in our pages have been properly vetted on statistical grounds. We are also working towards adherence to established recommendations for complete and transparent reporting of trial findings, as well as to good practices of ethically responsible sharing of data.

    Finally, we appreciate that contemporary medicine goes beyond just treating disease after it manifests. We consider part of our mission to promote research that advances the understanding of what being healthy means, of how humans age and of how local and global environments affect health and susceptibility to diseases.

    Along those lines, we are keen on studies that encompass the ability to model how diseases spread and how interventions halt disease spread. The development of technologies that impact human health is of high interest to us as well, including smart wearable devices and applications of artificial intelligence that may improve access to health care and that enable early diagnosis of disease.

    This is the beginning of a new phase for Nature Medicine. Our editorial team is eager to connect with current and new authors, as well as to actively engage with the translational and clinical communities. We hope that readers will find in our journal the excitement of new discoveries, opportunities for collaborations and a continuous forum for discussion of the science driving medical advances.