A medical journal is supposed to be an unbiased and objective source of the latest and best medical information. Of course, since all journals (for now) are run by human beings the reality and the ideal are widely separated. Even so, you shouldn’t be able to tell the politics of the journal’s editor from its content. An article in the Washington Post reports the kind of problem that has characterized some of our best medical journals for decades. (Prestigious medical journals rejected stunning study on deaths among middle-aged whites)

A study by Angus Deaton and Ann Case that shows a large spike in the death rate for cohorts of middle class whites was rejected by both the Journal of the American Medical Society and the New England Journal of Medicine. Ordinarily such  a rejection would occasion little or no notice. Both these journals are highly selective and reject the vast majority of papers that are submitted to them. This is especially true of the NEJM. But shortly after the paper was rejected (it was subsequently published by the Proceedings of the National Academy of Sciences) Deaton was awarded the 2015 Nobel Prize in Economics.

Deaton went  public about the dual rejection; he thought that it was politically motivated because  “The research showed that the mortality rate for whites between the ages of 45 and 54 with a high school education or less rose dramatically between 1999 and 2013, after falling even more sharply for two decades before that.

“That reversal, almost unknown for any large demographic group in an advanced nation, has not been seen in blacks or Hispanics or among Europeans, government data show. The report points to a surge in overdoses from opioid medication and heroin, liver disease and other problems that stem from alcohol abuse, and suicides.” (Quotation from the Wapo article linked above)

I have no way of knowing if Deaton is correct that his paper was rejected because it was not politically correct or if just didn’t reach the very high standards of the NEJM. What I do know is that the NEJM has drifted so far to the left that it is now the medical equivalent of The Nation. This is an opinion, so browse the table of contents of the Journal and see if you come to the same conclusion. The titles of the articles published in the front of the book are enough to tell you which way it slants.

The leftward drift of the Journal started under the editorship of Arnold Relman and has continued even farther to port under the leadership of Jeffrey Drazen. Elite medical journals pretend to objectivity, but are as fully immersed in the culture of selective disinterestedness as the rest of the academy, of which they are a powerful cog. If you want to get a detailed description of how biased the NEJM and its like are read Thomas Stossel’s book Pharmaphobia: How the Conflict of Interest Myth Undermines American Medical Innovation. It’s about the relationship of the drug companies and the medical profession, but along the way it also gives an insider’s view of how really “unbiased” medical journalism really is. Stossel was the editor of the Journal of Clinical Investigation when I was on its editorial board.

Stossel’s medical and scientific credentials are compelling; he’s a professor of medicine at Harvard and has been elected to the National Academy of Sciences. Yet his views of medicine and how it should be organized are diametrically opposed to those of his coevals at the highest ranks of the medical elite. Thus, the only way he can dealt with is to be ignored.

I can’t think of a profession whose leadership is so removed from the views and concerns of its rank and file as is medicine. So is it possible that Deaton and Case’s paper was rejected because the distressed group it described wasn’t part of a favored ethnic set? Yes. Is it certain that such was the case? No. But that it is well within the confines of probability is damning.

When it sticks to medical science, the NEJM is the best journal of general medicine in the world. But it seems to think that every problem in the world is a medical problem, eg war. So it easily goes astray. The obvious solution to this sort of medicalization of all of human existence is to turn the pages at the beginning of each issue and head straight for the real medical content.