Political Publications in Medical Journals: Should We Reconsider?

In June of 1993, standing proud, I entered through the hallowed gates of medicine as I recited a time-honored oath. For more than two millennia, students of medicine worldwide have made a similar pledge. We committed “to do no harm and commit no injustice.” We vowed to rise above borders and fickle winds of “current thought.” And we promised to be guided by a moral duty to always to do the right thing. It was crystal clear: the patients’ well-being is the priority. Among it’s various versions, the Hippocratic oath supercedes transient ideologies as an ethical ideal that supersedes the populism of the day by proclaiming the Golden Rule of medicine, placing the patient’s health and interest above all else.

The problems start when politics and science comingle. When we politicize, anoint, and revere one ideology or individual, we inevitably influence not only our colleagues but the public at large. How can we expect the medical community of warring nations to offer aid to the injured from the opposing side if one is clear on their righteousness and their opponents’ inferiority?

Physicians are granted respect for their intellect, guidance, and ability to think calmly within a storm. A generosity which extends to our journals. The lay believe in our peer-review process and quality controlled “science,” for which we have been recognized. They derive policy decisions, public health initiatives, and standards of care based on words from our journals. But just as easily, our syntax can be decontextualized to sway opinions.

While this has happened before perhaps, maybe we can unplug it from happening again. Most recently, a prestigious medical journal published a political opinion piece.¹ I question the value and benefit to our profession and the public at large. We already know that 50 percent of the population may be alienated by the offering. And we also know that the article likely will be taken out of context and insinuated to represent the medical community at large. And to publish it without a commentary or opposing viewpoint is unusual. Just in the last year more than 1,600 articles have been retracted and two of the world’s most respected medical journals, with an average impact factor of 67.54, published articles that were not up to the standard proposed to be upheld. Their abbreviated review resulted in the World Health Organization pausing studies and national policies being muffled. The main highways of social media, trusting in the proceedings, then decided to censor incongruent information.^2,3

If we struggle to eliminate bias completely, then perhaps, we can learn from the highest court of the land. The Supreme Court publishes the dissenting opinion, recognizing that thinking may differ, circumstances may change, and referencing an opposing point of view may be ripe for another time. Medicine, as well has been wrong or early to pass judgment; in fact, it is common. But our journals have a strong tradition of mitigating bias and defanging definitiveness. Most original articles today require authors to mention the limitations of a study or bias in an argument. This helps to alert the less discerning and perhaps spark another to do a follow up study. But acknowledging a flaw may have greater impact for the lay who are not trained to critically read. No argument or scientific theory is without a caveat. There should be little tolerance in our journals for articles that conflate associations as causative or make declarative statements such as, “it is conclusive” and, “the argument can now be put to rest.” We know in science rarely if ever is anything conclusive. Even Newton’s “laws” were overturned after 250 years.

While each is entitled a political opinion, perhaps it is better to sideline it from our peer-reviewed professional outlets. Political position pieces can and have been misused. And if it is felt important to politically opine, then perhaps allow an opposing view to be published in kind so that one coat of arms cannot be waved like a banner. We have a tradition of tempering bias in the scientific articles we release. Do we owe the same standard to the political opinions we unleash?

1. The Editors, Dying in a Leadership Vacuum. N Engl J Med 2020; 383:1479-1480

2. https://www.marketwatch.com/story/why-twitter-facebook-and-youtube-are-takingdown-hat-hydroxychloroquine-video-and-suspending-accounts-including-donaldtrump jr-that-shared-it-2020-07-28

3. I myself had a post removed in which I demonstrated my office’s use of betadine nasal rinses. I received a formatted note that it didn’t meet community standards even though I listed the references for the peer reviewed articles that supported betadine as a virucidal against covid.