Why The New England Journal of Medicine’s COVID Leadership Editorial is so Extraordinary


US COVID Task Force (White House photo)

Two weeks ago, on my way out the door after a typically long day at work, I confessed to a colleague that, like my patients, I was feeling the pressure of our impending Presidential election. Our government’s response to COVID-19 has been consistently inadequate from the get-go. Without a change in leadership, I complained, our country was destined to remain stuck in a rabbit hole. With flu season breathing down our necks, I have been feeling unduly pessimistic about what the next few months have in store- particularly as the country braces for a third surge in COVID cases. 

My colleague, who is an active and passionate member of a local state medical society, agreed politely and then shared her own frustration. She began by proudly acknowledging  that her group had done much in advocating for more resources for patients and doctors during the pandemic. 

Yet, she voiced disappointment that her medical society leadership was strangely muted when calling out specific politicians whose policies have so calamitously contributed to 220,000 deaths in the U.S. in the past nine months. In mentioning this grievance, she brought up an unwritten rule in medicine: It is ok to criticize a public health policy but not the administration from which it originates.

Ironically, two days later, several colleagues reached out to me with a hot-off-the press editorial from the New England Journal of Medicine (NEJM), asking if I had yet seen it. I must confess that the sudden influx of messages took me aback. Never in my 30-plus years as a physician have multiple doctors simultaneously been so moved to send me a medical opinion piece marked as an ASAP communication.

The normally cautious tone and bland opening paragraph to which I’m accustomed from a medical journal editorial was notably absent. This one was different and immediately caught my attention:

“Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.” 

Such a lead-in would not have surprised me if it had come from the Wall Street Journal, CNN, or the Seattle Times. But seeing the NEJM stake out an opinion so boldly suffused with direct implications in the political realm was utterly new territory. The 34 editors further took the current administration to task for its “astonishing” failure to respond to the Coronavirus pandemic, writing that “this election gives us the power to render judgment” of current U.S. leadership.

The novelty of this development was not lost on the New York Times, which pointed out that the world’s leading medical journal has never condemned or supported a political candidate, making the editorial a first in the publication’s 208-year history. The NY Times further emphasized that they, too, took special notice of the bold and direct editorial language used by the NEJM, despite the latter’s article withholding direct mention of the President by name.

Despite claims to the contrary by the President, the U.S. has performed worse than many other developed nations in dealing with the pandemic. The journal’s editors write: “The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2,000.” Another powerful point of comparison is the country of South Korea, which had much higher rates of travel to and from China when the Coronavirus initially emerged. 

I found myself cheering the NEJM authors for further pointing out that instead of turning to experts in the field of infectious diseases, public health and policy administration government leaders had relied on “…uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.” 

Although the editorial did not directly instruct their readership to cast a vote for Joe Biden, it came razor close: “When it comes to the response to the largest public health crisis of our time; our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

The final point made in the condemnation of the current administration’s efforts to control COVID-19 touched on evolving social tensions that the pandemic has highlighted. An outbreak that has disproportionately affected communities of color “has exacerbated the tensions associated with inequality.” In so writing, the editorial squarely aligned themselves with the Black Lives Matter movement, as so many healthcare workers (“white coats”) have already done following the deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor.

The NEJM article follows on the heels of a very new trend of medical journals speaking plainly in the political arena. Last month, a Scientific American editorial endorsed a candidate for the first time in its 175-year history: “We urge you to vote for Joe Biden, who is offering fact-based plans to protect our health, our economy and the environment.” And the influential British journal, The Lancet, called on Americans to make Trump a one-term president back in May. 

All three journals took stands against Trump without referring to political parties. Laura Helmuth, the editor-in-chief of Scientific America magazine, told NPR that the editorial purposefully avoided doing so in an attempt to be inclusive for its readers. In a similar vein, the NEJM editorial states, “Truth is neither liberal nor conservative.”

These developments are especially gratifying because early in the pandemic, medical journals—including the NEJM—rushed to publish articles of dubious quality and without the usual fact-checking that is so important in advancing medical progress. It seemed they were jumping over each other to get the latest observations around COVID-19 to their readers for the notoriety it would garner them. When this happened, the journals broke a sacred trust to carefully vet material that invariably shapes the care we offer our patients. 

These three recent editorials are a return to honestly—telling it like it is—and accepting the consequences that some traditionalists would be unhappy mixing medicine with politics. These editorials remind us of our responsibility to find a middle ground and—when necessary—to oppose not just the policy, but the architects behind the policy.

David Aboulafia, M.D.
David Aboulafia, M.D.
Dr. Aboulafia is a member of the Division of Hematology and Oncology at Virginia Mason where he has worked for three decades. He is a Clinical Professor of medicine at the University of Washington and a principle investigator for the National Cancer Institute funded group The AIDS Malignancy Consortium. He has a career-long interest in HIV as well as the link between certain viruses and cancer.


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