The Art and Science of JAMA, Then and Now

This transcript has been edited for clarity.

Hello and welcome. I'm Dr George Lundberg and this is At Large at Medscape.*

Many of you may know that I had the great privilege of being the editor-in-chief of JAMA (the Journal of the American Medical Association) from 1982 to 1999. Many people have told me personally, and some in writing,[1] that my editorship rescued JAMA from being a lightly regarded "house-organ" and made it into a great medical and public health journal. Obviously, I like hearing that, but I decided to examine that claim for any validity.

JAMA was begun in 1883, so in 1983 we had the remarkable opportunity to plan and carry out a centennial celebration, a 100-year birthday party. The party was held on the pages of the journal and it lasted 1 full year.

Using the number of times an article had been cited along with expert opinion, we chose the 50 best articles in the 100-year history of JAMA and republished them chronologically in sequence each week. Accompanying each article was a perspective by a living expert who described why the article was or was not a landmark article.

Turns out that JAMA published:

  • "The Etiology of Yellow Fever," by Walter Reed in 1901;

  • Simon Flexner's "The Transmission of Acute Poliomyelitis to Monkeys" in 1909;

  • "The Etiology of Scarlet Fever," by George and Gladys Dick in 1924;

  • Perrin Long's "The Treatment of Meningococcic Meningitis with Sulfanilamide" in 1937;

  • Mahoney and colleagues' "Penicillin Treatment of Early Syphilis" in 1944;

  • the Jonas Salk paper "Considerations in the Preparation and Use of Poliomyelitis Virus Vaccine" in 1955;

  • Hammond and Horn's "Smoking and Death Rates" in 1958;

  • Albert Sabin's "Live, Orally Given Poliovirus Vaccine" in 1960; and

  • Henry Kempe's "The Battered Child Syndrome" in 1962.

You will find all of these and more, with the expert perspectives, in the book, Fifty-One Landmark Articles in Medicine: The JAMA Centennial Series.[2]

Not too shabby a record for a casually "disregarded" journal. One of the many things we can take credit for from 1982 to 1999 is the development of theme issues, to serve many purposes, and we turned it into its own impactful art form.[3]

We played out many theme issues over time. Note that the cover art uniquely signaled the theme issue topic. (Not so for the usual weekly cover art.) Theme issues included:

  • Prevention of Nuclear War;

  • Boxing and Brain Damage (on the cover, George Bellows' Dempsey & Firco 1923 Bout);

  • Gun Violence (Rene Magritte's The Survivor—the shotgun is the only survivor);

  • Peer Review (Magritte's Eye Peering);

  • Tobacco (Van Gogh's Skull With Burning Cigarette);

  • Sports Medicine (one of "The Rowing Pictures" by Thomas Eakins);

  • Caring for the Uninsured (Jamie Wyeth's Kalounna in Frogtown—the quintessential uninsured child);

  • HIV/AIDS (blank cover, signifying all of the art that was not created because of AIDS); and many others.

By far the all-time leader in focusing upon the art and humanities in medicine, JAMA published great cover art and accompanying great art essays for more than 40 years. Under the leadership of the one and only M. Therese Southgate, MD, JAMA educated hundreds of thousands of physicians on sensitive human intricacies. Three hundred of those covers and Southgate cover stories are available in three volumes titled The Art of JAMA.[4]

Other than those obviously high-impact landmark articles, how does one measure the quality of published science, then and now? Poorly.

The usual journal approach, although deeply flawed, is the impact factor. The impact factor is the number of citations (published in some 12,000 journals in a current year) to articles published by that journal during the previous 2 years, divided by the number of articles published by that journal in those same 2 years.

When I arrived as editor-in-chief in 1982, JAMA's impact factor was about 3. When I departed in 1999, it was nearing 20. I fretted over the rapid rise in the impact factor because I considered JAMA to be a journal with an educational purpose to improve patient care, not only one that published research articles to be cited by other researchers, which is what the impact factor actually measures.[5]

Alas, that form of "bean counters," the impact factor cheerleaders, won. In 2017, the JAMA impact factor was 47. Must be a lot of citable science out there.

So much for the science; what about the JAMA art now? Well, beginning in 2013, the covers look just like all plain vanilla journals, listing the articles on the cover. Boring. Deep inside, one can find "Poetry and Medicine" and "The Arts and Medicine." The staff does try hard. Diligent readers may strive, find, and enjoy it. Cover "art" has survived for JAMA theme issues, more or less. Or more likely, cartoon sketches.

So, there you have it: The science and art of JAMA, then and now. Life is short; art is long. C'est la vie. Rest in peace, good friend, Terry Southgate. We love you. We miss you.

That's my opinion. I'm Dr George Lundberg and this is At Large at Medscape.

*This column is based in part on lectures given at Grand Rounds at Highland Hospital in Oakland, California, on November 16, 2018, to pre-med students and faculty at the University of Alabama on April 11, 2019, and to the "Little Learners" doctors' education club, Saratoga, California, on April 23, 2019.

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