Health questions rarely arrive in the shape of a single discipline

Abstract

Consider a situation I meet routinely in my own geriatrics clinic. An older patient with five chronic conditions and eleven daily medications is, on its face, a pharmacological problem. Yet whether that patient is deprescribed safely depends on how the visit is reimbursed, how continuity is organized between hospital and community, how much time the physician has been allotted, and whether that physician is carrying the kind of sustained moral strain that erodes clinical judgement. Each of these can be studied rigorously on its own. None of them, studied alone, accounts for the outcome.

The existing literature handles this poorly — not through any failing of the journals concerned, but through the ordinary operation of disciplinary boundaries. Authors learn to frame a question so that it fits somewhere. The parts that do not fit are trimmed before submission, and what was trimmed is often the most interesting part of the work.

Nouprisma exists for that work.

We hold ourselves to several commitments. We will review across disciplines: every manuscript will be read by referees who can judge both the methods and the substantive field, rather than gatekept by a single discipline. We will be plural in method and strict in evidence: trials, econometric analysis, qualitative inquiry, implementation science, policy analysis, and evidence synthesis are equally welcome, and the standard in each case is whether the design can answer the question posed. And we will assess the work itself — on its rigour and its contribution, not on where its authors have published before or on any figure attached to their names. That commitment matters most for early-career researchers, and for authors working in health systems long absent from the international literature. Null findings and replications are welcome here.

The answer a single discipline returns is a beam of white light: it looks complete, and it looks like one thing. Only when it is separated can you see what it was made of. We intend this journal to be that place.

I invite colleagues to send us the research that has had nowhere to go.