At the Helm of the World’s Most Influential Medical Journal

Physician Eric Rubin, M90, GBS90, has a lot going on. He directs a prolific lab doing groundbreaking work on tuberculosis at the Harvard T.H. Chan School of Public Health. He sees patients as an infectious disease specialist. And in September, he started another role: editor-in-chief of the New England Journal of Medicine, the oldest and most widely read general medical journal in the world.

Wearing that many hats isn’t a problem, he said, “because all those things are fun.”

“It's like when you’re a kid and you want to be a policeman or a fireman,” he said, “and I can be a policeman and a fireman. It’s like I never grew up.”

Rubin was raised in Brockton, Massachusetts, and studied biochemistry at Harvard before earning his M.D. and Ph.D. at Tufts School of Medicine and Graduate School of Biomedical Sciences. He talked with Tufts Now about his time at Tufts, the upside of acknowledging your mistakes, and the editorial challenge of conflicts of interest.

Tufts Now: When you graduated from Harvard, you went right into the M.D./Ph.D. Medical Scientist Training Program at Tufts. Did you always know you wanted to do research?

Eric Rubin: I always wanted to be a doctor, but I hadn’t really considered research until college, when I worked in a lab and I really liked it. I thought doing research as well as medicine would be great, but I didn’t actually apply to M.D./Ph.D. programs, because applying seemed like a lot of work. But Tufts was just starting its M.D./Ph.D. program. After I got into the Tufts School of Medicine, the new director of the M.D./Ph.D. program called me up and asked me to join the first class. I said, “Is there an essay involved?” And he said, “No.” I said, “Yes.”

The microbiology department where I did my Ph.D. was one of the best places to do a Ph.D. in the world, and remains that way. There’s just a terrific, nurturing environment for graduate students. Great, great faculty—many of whom are still there—and new ones they’ve added have maintained the ethos of that place. It really made an impression on me and helped shape my career.

You’ve been an author on more than 150 research papers. What’s one that stands out in your mind?

At Tufts, I decided to work on a problem that had been very difficult—figuring out how botulism works. Botulism is caused by a toxin. At the time, we had no idea what that toxin did. So I started working with it and quickly identified a function for the proteins that people hadn’t found.

I wrote it up as a paper and submitted it to Nature. It got very good reviews and came back with a few suggestions. Then I realized that something was wrong. In fact, the activity that I was measuring wasn’t due to the toxin that causes botulism, it was due to contaminants. They have nothing to do with botulism, but they have really interesting and novel mechanisms of action. And that’s what I spent the rest of my Ph.D. career on.

Is there a moral to that story?

The bottom line is that you’re best off doing things carefully and rigorously, even if you end up disproving your favorite hypothesis. In this case, the more exciting paper would have been to attribute what we found to the toxin that causes botulism—that would have gotten us into Nature.

But in fact, I think we learned a lot more, and learned about a class of proteins that turned out to be very important in cell biology, particularly in cancer cell biology. So it took us in a direction we hadn’t expected to go. But if we hadn’t been careful, we wouldn’t have noticed what the problem was.

You’ve been an editor at the New England Journal of Medicine since 2012, and you’ve had editorial roles at other journals since 2002. What’s fun about being an editor?

Seeing a lot of really interesting science, and being involved in helping to shape how that gets communicated—I think that’s exciting. At the New England Journal of Medicine, we make decisions collectively and meet all the time. And that means you hear about everything.

You hear all the best stories in medicine being presented by an expert in the topic. It’s amazing and so, so interesting. Learning about what’s going on in science and medicine has been great, and being able to work with incredibly smart people has also been fantastic.

You’ve said that conflicts of interests are among the most contentious issues that the journal deals with. What do you think can be done better?

We rely on our authors and reviewers and editorialists to be honest in their reporting and I think in the overwhelming majority of cases they are. When occasionally they aren’t, or they forget the conflicts that they have, sometimes people catch them on it. But we don’t have detectives going out there to check that what people said is true. We say, this is our policy we expect our authors etc., to live up to that and then put the burden on them. And I think it’s fair and I think that almost entirely works.

Then come the policy questions. How much of a conflict is a conflict? Right now, we have some very, very strict rules for our own editors. We don’t let them have any financial conflicts whatsoever. For our editorialists, we allow them to have rather minimal conflicts, although they help define what those are.

And for our authors, we essentially allow them to have conflicts as long as they disclose them. And I think that’s important. But what exactly should the limits be? If you’re going to write an editorial, which makes recommendations based on an original article that we published, how much can you be involved in that field? And I think that’s something that we have to continuously reevaluate.

The best experts oftentimes are conflicted. And so we’re constantly having to choose between people who might be the best authors and might make the most informed recommendations, and people who may be less informed but are unconflicted. So that means we have to draw a line somewhere and we will continue to think about where those lines should be.

Julie Flaherty can be reached at julie.flaherty@tufts.edu.