NEJM's AI Policy: Dual Disclosure, ICMJE Alignment, and the NEJM AI Twist

NEJM's AI policy is grounded in the ICMJE recommendations, which most major medical journals follow. The ICMJE issued guidance in 2023 stating that AI tools don't meet authorship criteria and that their use should be disclosed. NEJM adopted this framework directly.

The ICMJE authorship criteria require that each author:

1. Made substantial contributions to conception/design or acquisition/analysis/interpretation of data

1. Drafted the work or revised it critically for important intellectual content

1. Approved the final version

1. Agrees to be accountable for all aspects of the work

AI tools can arguably contribute to criterion 2 (drafting), but they can't meet criteria 3 or 4. An LLM can't approve a final version with understanding, and it certainly can't be held accountable if problems emerge post-publication. That's why every Authorship/accountability journal, including NEJM, excludes AI from authorship.

NEJM's two-location requirement is more than Nature's one (Methods section) but less than Science's three (cover letter, acknowledgments, methods). Here's what it looks like:

In the cover letter:

"We wish to disclose that during preparation of this manuscript, we used Claude (Anthropic) for editing the Discussion section to improve clarity. The authors reviewed and verified all AI-edited content and take full responsibility for the manuscript."

In the manuscript (typically in the acknowledgments or a disclosure section):

"The authors used Claude (Anthropic) for language editing during manuscript preparation. All content was reviewed and verified by the authors."

The cover letter disclosure matters because NEJM requires the description in both places. If undisclosed AI use is discovered later, it raises questions about what else might not have been disclosed.

Here's where a comparison is useful. The NEJM Group also publishes NEJM AI, a journal dedicated to artificial intelligence in medicine. It might be expected to take a looser line on AI tools, but its editorial policy uses the same ICMJE-based wording as the flagship journal.

NEJM AI asks authors to disclose at submission whether AI-assisted technologies (such as large language models, chatbots, or image creators) were used to produce the submitted work, with a description in both the cover letter and the submitted work. Chatbots and other AI-assisted technologies cannot be listed as authors, and authors must review and edit all AI-produced material. NEJM AI's pages ask that AI use be disclosed; they do not encourage it.

This creates a useful comparison within the same publishing group:

The audiences differ. NEJM AI's audience consists of researchers who build and study AI systems, while the flagship NEJM's audience is broader: clinicians, epidemiologists, and clinical trialists who may or may not have AI expertise. The disclosure rule is the same in both.

NEJM doesn't list specific penalties for AI policy violations in its editorial policies, so how a case is handled is up to the editors.

What NEJM's pages do show:

• Disclosure at submission. The cover letter and the submitted work should describe the AI-assisted technologies used and what was produced.

• Image checks. NEJM says original, unprocessed image files may be requested by the editors at any time, and authors must disclose whether AI-assisted technologies were used at any stage of image processing.

• Retraction in practice. In April 2026 NEJM published the authors' retraction of an Images in Clinical Medicine item after the authors said they had used an AI tool to alter the image. The editor's note says authors are required to disclose any use of AI tools and any changes made to images.

NEJM and JAMA share similar positions: both allow general AI writing assistance and follow ICMJE guidelines. They differ on where the disclosure goes. NEJM asks for it in both the cover letter and the submitted work, while JAMA's instructions for authors put AI help with writing in the Acknowledgment section and AI used in the research in the Methods. The Lancet and Cell Press are more restrictive, limiting AI to readability only.

Before submission:

• Keep a record of any AI tool use during manuscript preparation. You'll need specifics for both disclosure points.

• Review all AI-assisted text carefully. NEJM's editors evaluate manuscripts at the highest level of scientific rigor. AI-generated text that contains factual errors or clinical inaccuracies will be caught during review.

The cover letter:

• Mention AI use prominently, don't bury it at the bottom.

• Be specific about which sections of the manuscript were AI-assisted.

• State clearly that all authors reviewed and take responsibility for the content.

The manuscript disclosure:

• NEJM asks that the submitted work describe the technologies used and what was produced, and its policy does not name a section. The acknowledgments or a designated disclosure section is a reasonable place. Check the current NEJM policy before submitting.

• Match the disclosure to what you wrote in the cover letter. Inconsistencies between the two documents would raise editorial concerns.

What to avoid:

• Don't use AI to generate clinical recommendations or treatment conclusions. For a journal whose audience includes practicing physicians, AI-generated clinical content carries patient safety implications that go beyond publication ethics.

• Don't assume NEJM AI is looser or stricter than the flagship journal. They're different publications, but their disclosure wording is the same.

• Don't skip the cover letter disclosure thinking the manuscript disclosure is sufficient. NEJM specifically requires both.

For non-native English speakers:

• NEJM's published policy does not prohibit AI language polishing. The disclosure requirement applies to it, and you remain responsible for the accuracy, integrity, and originality of the text.

Submitting a clinical manuscript to NEJM? A NEJM submission readiness check can help you verify that your paper meets the journal's standards, including proper AI disclosure formatting.

NEJM's moderate AI policy reflects the journal's institutional character: evidence-based, measured, and focused on accountability rather than prohibition. By grounding its policy in the ICMJE framework, NEJM ensures alignment with virtually every major medical journal that follows the same guidelines. And NEJM AI, the NEJM Group's AI-focused journal, applies the same ICMJE-based disclosure wording.

The practical takeaway is straightforward: use AI tools if they help your manuscript, disclose in two places, don't list AI as an author, and make sure every claim in your paper can withstand scrutiny from reviewers who expect the highest standard of evidence in medicine.

Comply proactively if:

• You used any AI tool (ChatGPT, Grammarly, Copilot) during manuscript preparation

• The journal requires AI use disclosure in the cover letter and the submitted work

• Your institution has its own AI use policy that may be stricter

Less concerned if:

• You used only conventional spell-checking tools that do not generate content (NEJM's policy concerns AI-assisted technologies used to produce the submitted work, such as large language models, chatbots, and image creators; ask the editorial office if unsure)

• Your use was limited to literature search or reference management (but citation of AI-generated material as a primary source is not acceptable)