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Should journals mix medicine and politics?

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:0-g

The Inseparability of Medicine and Politics

Medicine and politics are obligatory companions, as inseparable as
tea and biscuits. Although academic reactionaries and purists may argue
that medicine should not be tainted by political agendas, rarely has this
been, or is it, reality. (1)

Medicine--as practiced in times and regions as diverse as pre-
Christian Hippocrates, Freud’s Vienna or Massachusetts’s Back Bay--invokes
relationships, all of them illustrating a political connectedness to
governing authorities.

When I hear fellow Pennsylvania physicians speak of politics in
medicine, the substance often reflects those controversies that attract
media scrutiny and hefty emotional responses: Fee-for-service vs. managed
care reimbursements, Darwinian evolution vs. creationism, stem cell
research vs. right-to-life arguments, clean needles for IV drug users vs.
moral objections, and/or financial support for AIDS prevention and
treatment vs. financial resources allocated elsewhere. However riveting
are those arguments, it is the day-to-day interrelationship of politics
and medicine---those that border on the mundane—that cement the
relationship. The existence of that bond makes the case, at least for me,
that our relationships to, and with, governing bodies are fundamental to
medicine and therefore critical to medical reporting. (2)

In psychiatric medicine, the evolution of this interrelationship,
particularly as it pertains to 19th and 20th century U.S. federal and
state policies, is highlighted by involuntary commitment,
deinstitutionalization, Federal, State and private sector funding sources,
psychiatric epidemiology and pharmacoepidemiology(3).

As is true of both psychiatric and non-psychiatric medicine, our
profession in Pennsylvania is licensed by authorization of the Department
of State. The Secretary of State is an official appointment of the elected
Governor. The regulatory oversight and management of conduct for
practitioners of the healing arts (including medicine, dentistry,
veterinary, podiatry, nursing, etc) is defined by Pennsylvania Code
(applicable laws of Pennsylvania) as well as federal and local/community
standards. Similar laws and standards define the compensation for our
services from federal programs (Medicare), federally-subsidized state
programs (Medicaid) and from private insurers who are under State and
Federal licensing and regulation.

Medical practitioners prescribe within the directives and guidelines
of the Federal Drug Enforcement Agency (DEA) and, where applicable,
individual state agencies that monitor controlled substances. (Not all US
states have separate registries for controlled substances; Pennsylvania is
one that does not.)

Like its counterparts in the UK(MHRA, NPSA; others), our
pharmaceutical and therapeutic prescribing habits have Federal watchdogs,
including the U.S. Food and Drug Administration, multiple collateral
advisory committees and Federally-funded programs that assist the process
of research and information dissemination (National Institute of
Health/National Institute of Mental Health/Substance Abuse and Mental
Health Services Administration: NIH/NIMH/SAMHSA; others.)

The American Psychiatric Association (APA) and its collaborative
organizations devote a prodigious effort to legislative and political
agenda. The current APA website’s Homepage highlights three “front and
center” advocacy items: Endorsement of recent Congressional passage of an
$83 million dollar ‘Suicide Prevention Bill’, and two subsequent links to
the APA Advocacy Action Center and APAPAC, both sites that promote
lobbying efforts on behalf of APA’s constituency. (4)

Oversight regulation, advocacy and legislative agendas, investigatory
and legal mandates underscore medicine’s inseparable coexistence with
politics. With issues of medical record confidentiality, academic
research freedoms, parity, tort reform, the involuntary commitment of
individuals, the duty to warn, the continued evolution of Lyndon Johnson’s
Community Mental Health Act of 1965 or George W. Bush’s New Freedom
Commission’s recommendation to screen American’s youth for psychiatric
disease, psychiatry is as much about legal and political agendas as it is
about mental illness and mental health.

Whether the issues pertain to psychiatry or non-psychiatric medicine,
it is crucial for journals to discuss political trends and counter-trends
in medicine---just as it is expected that they deliberate the epidemiology
and pathophysiology of heart disease, cancer or schizophrenia. Medical
journals and physicians would be well served, I believe, by confronting--
not denying--the issues and the political forces that shape them.


1. Krakauer, E. Yale J Biol Med. 1992 May-June; 65(3):243-9.

2. Abbasi, K. Should journals mix medicine and politics?BMJ 2004; 329: 0-g

3. Center for Mental Health Services, Mental Health, United States 2000.
Manderscheid, R.W. and Henderson, M.J., eds. DHHS Pub No. (SMA) 01-3537.
Washington, DC: Supt. of Docs., US Govt. print. Off., 2001)

4. American Psychiatric Association Homepage, (Accessed 11.05.04)

Competing interests:
None declared

Competing interests: No competing interests

10 November 2004
Stefan P. Kruszewski, M.D.
Addiction Psychiatrist
Harrisburg, Pennsylvania USA