The Fourth Estate in Medicine: medical journals and politics from 1797 to the present

The intertwining of medical journals and political concerns dates back to the very origins of the medical journal in the United States. Yet politics and political have been multivalent terms, warranting a careful dissection of their varied invocations. With a negative valence, they have been invoked to describe the bias brought in through political considerations or actions achieved by journal editors through political means. With a more neutral valence, they have referred to the relationship of the medical profession and its journals to issues of national political importance. And more fundamentally, they have served at the very center of debates over the proper boundaries of medical journal expertise and content. This article traces this typology and history through four key periods: the formation and development of the earliest US medical journal at the turn of the 19th century; considerations of medical journals and slavery in the immediate antebellum era; the consolidation of “political” power within JAMA and state medical societies (and their journals) in the first half of the 20th century; and the increasing concern over the proper domain and objectivity of medical journals in the late 20th and early 21st centuries.