It's terrible, so demoralizing for everyone involved. The AHRQ R36 was such a make or break award for students in health services research and health policy, nothing else like it to fill in the gap.

Better than most during the pre-supplement era! Especially when you had to use one of six precious citations.

JAMA supplements are strictly for methods, though. No additional results or discussion. Probably a good thing in the spirit of the letter, but doesn't get you out of "Well, have you tried doing it this way?" kind of comments.

I like them and agree with other people here that they have a good time and place, but I also think they get abused. People obscure methodological details and try to fit full papers into them.

So I don't quite understand the incentive structure here. I don't know if the goal is to somehow distort citation metrics, or to just try to pass off your letter as original research and hope no one notices.

The weird thing is that I don't think my employer or my peers would be particularly impressed that I sent a letter to a journal? If I went around saying I got published in NEJM, but it was just a reply to someone's article, people would be embarrassed on my behalf.

😬