“Why are Medical Journals so dull?” A Potted History of Tedium in Medical Journalism
In 1958, the endocrinologist Richard Asher wrote a provocative article for the British Medical Journal lamenting the lacklustre and boring style of the modern medical journal: “Medical Journals are dull; I do not think there is any doubt about it” the doctor declared. Asher complained of the drab and colourless design of journals and the endless articles they contained that were tediously long and authored by those who “have nothing to say, and they do not know how to say it”. [1] Despite the acid humour, Asher was voicing genuine concerns about the readability of medical journals. The problem, as he saw it, was that the coldly impersonal and obscure language of modern science was making medical writing unintelligible; doctors were vanishing from their own narratives only to be replaced by reams of diagrams, tables and esoteric, anonymised ramblings.
Cartoon from an 1883 issue of Punch. Wood engraving by Charles Keene. (Wellcome Library, London)
Anxieties like Asher’s, about the literary merits of journalism, were not new among doctors. That medical periodicals could be dry, dreary and under-read was a perennial discussion point in the nineteenth century. In 1823 when the medical weekly the Lancet was first published by the surgeon Thomas Wakley, it caused a flurry of controversy by upturning the traditional style of the medical journal.[2] Wakley’s unauthorised publication of the lectures of high-profile hospital surgeons provoked the wrath of the medical elite, while his exposés of medical scandals and sharp-tongued tone attracted immediate attention from practitioners across the country as well as the wider public. Wakley’s journalistic strategy was risky, and the informal style of the Lancet was used by its detractors to denigrate it. One rival journal criticised the Lancet’s approach as little more than a ploy to attract more readers, opining that “where one reader attends to a dry record of facts, ten we know will be gained by embellishings”.[3] But Wakley was banking upon a demand among practitioners and students for a journal that provided something more than the staid case reports and long-winded communications which the existing medical monthlies and quarterlies were filled with. It was a risk that paid off, with the Lancet outselling its rivals in the first half of the nineteenth century.
Nonetheless publishers and editors remained acutely aware of the risk of losing readers with unappealing content. It was well understood that the lifestyle of the medical practitioner was not one that left much room for reading. Many doctors struggled to make a living, meaning that purchasing medical literature was hardly a priority for most. Often practitioners simply did not have the time to read due to the demands of their work. Thus the editorials of new medical journals frequently made claims to entertaining, easily digestible content suited to the needs and desires of the overworked doctor. When the London Medical Circular began in 1852, for example, its editor hoped only that the journal would “form pleasant and useful reading for an occasional half-hour”, believing most doctors did not wish to waste the limited reading time they had with “the perusal of a voluminous paper”.[4]
By the end of the nineteenth century there was a growing industry in popular health journalism, with a wave of new titles on sanitation and domestic hygiene flooding the literary market. These journals were more closely aligned with the dynamics of contemporary journalism than the medical weeklies, many embracing the trend towards light, readable and entertaining literature suitable for the increasingly literate populace. Publications like The Hospital, which had an audience drawn from both the medical profession and the public, criticised the Lancet and British Medical Journal for their publication of complex and overly long articles; the more lively tone of the popular journals was making the medical weeklies vulnerable once more to accusations of dullness.[5] In 1883 Punch published a caricature (above) which tells us something about the way in which medical journals were perceived by the public; a man at a club is reading the Christmas edition of the Lancet much to the disappointment of his friend. Entitled ‘”Depressing!” the man’s friend encourages him to put the journal down and enjoy a game of Pyramids instead. Partaking of medical literature, its pages filled with death and disease, was being ridiculed as a rather gloomy way to spend one’s time.
Who and what are medical journals for? And what duty do medical journals have to make their content readable and entertaining? Discussions about the role scientific journals have historically played in the circulation of knowledge have not left much room for the question of readability. But journal audiences were not untouched by the need for well-written content. In medicine at least, this has long been an issue, and one that draws out other lines of inquiry, from the ways in which time-poor, overworked doctors access information, to the manner in which medical periodicals have been influenced by broader trends in journalism. With the shift in the last few years towards open access models of publishing and large repositories of pre-print manuscripts, the role of the scientific journal is coming under renewed question.[6] Richard Smith, former editor of the British Medical Journal has argued that journals connected to associations (such as the British Medical Journal is) should forget altogether about focusing on original research, of which many members may have limited interest, and instead on producing a “cheap and cheerful publication that will entertain their members so that they are pleased to receive and read it”. [7] A number of medical journals now have patients involved as contributors, editors and peer-reviewers, and this also has implications for their tone and content.[8] The literary style of the medical journal is not simply an aside to the ‘real deal’ of journal content, but can actively shape the ethos, audience and financial fortunes of a publication.
[1] Richard Asher, “Why are Medical Journals so Dull?”, British Medical Journal 2 (1958):502-503.
[2] Michael Brown ‘”Bats, Rats and Barristers’”: The Lancet, Libel and the Radical Stylistics of Early Nineteenth-Century English Medicine’, Social History 39 (2014): 189-209.
[3] “Hospital Reporting,” London Medical Gazette 1 (1828): 697. As quoted in Carin Berkowitz, Charles Bell and the anatomy of reform (Chicago and London: University of Chicago Press, 2016): 84.
[4] “Address to the Reader,” London Medical Circular 1 (1852): 1.
[5] “The Hospital to its Readers,” The Hospital 22 (1897): 2.
[6] Aileen Fyfe et al, Untangling Academic Publishing: a history of the relationship between commercial interests, academic prestige and the circulation of research (2017) https://zenodo.org/record/546100#.WS_uQ-vyuUk.
[7] Richard Smith, “The death throes of national medical journals,” BMJ Opinion (March 2nd 2016).
[8] Richard Smith, “The trouble with medical journals,” Journal of the Royal Society of Medicine 99 (2006): 115-119.
