Throughout its 208 year history, the New England Journal of Medicine has remained completely impartial. The world's most prestigious medical journal has never endorsed or condemned a political candidate.
In an editorial signed by 34 editors who are US citizens (an editor is not) and published on Wednesday, the magazine said the Trump administration reacted so badly to the coronavirus pandemic that it " took a crisis and turned it into a tragedy. ”
The journal did not specifically endorse Joseph R. Biden Jr., the Democratic candidate, but that was the only possible conclusion, other scholars noted.
The editor-in-chief, Dr. Eric Rubin said the damning editorial was one of only four in the journal's history to be signed by all editors. The editors of N.E.J.M. join another influential magazine, Scientific American, which last month endorsed Mr. Biden, the former Vice President.
Political leadership has failed Americans in many ways, which is clearly different from the responses of other countries' leaders, the N.E.J.M. said.
In the United States, the magazine said there was insufficient testing for the virus, particularly early on. There was insufficient protective equipment and a lack of national leadership on key measures such as mask-wearing, social distancing, quarantine and isolation.
There have been attempts to politicize and undermine the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention, the journal said.
As a result, there have been tens of thousands of "excessive" deaths in the United States – caused directly and indirectly by the pandemic – as well as immense economic pain and an increase in social inequality as the virus hit disadvantaged communities hardest.
Criticizing the Trump administration's rejection of science, the editorial wrote: "Rather than relying on expertise, the administration has turned to uninformed 'opinion leaders' and charlatans who cover up the truth and facilitate the spread of lies."
The unusually sharp editorial called for change: “When it comes to responding to the greatest public health crisis of our time, our current political leaders have shown that they are dangerously incompetent. We shouldn't favor them and allow the deaths of thousands more Americans by allowing them to keep their jobs. "
Scientific American had never endorsed a political candidate either. "The pandemic would weigh on every nation and system, but Trump's rejection of evidence and public health action was disastrous," the magazine's editors said.
The N.E.J.M. is, like all medical journals these days, inundated with papers on the coronavirus and the disease it causes, Covid-19. Editors have tried hard to balance efforts to insist on quality with a constant flurry of misinformation and misleading statements from the administration, said Dr. Clifford Rosen, magazine associate editor and endocrinologist at Tufts University in Medford, Massachusetts.
"Our mission is to promote and also educate the best science," said Dr. Roses. "We saw anti-science and bad leadership."
Increasing public health failures and misinformation would have ultimately taken a toll, said Dr. Rubin, editor-in-chief of the New England Journal of Medicine.
"It should be clear that we are not a political organization," he said. "But almost every week in our editorial office there was new outrage."
"How can you not speak in a time like this?" he added.
Dr. Thomas H. Lee, Professor of Medicine at Harvard Medical School and member of the editorial board of the journal, did not participate in the writing or voting on the editorial.
But "not to say anything specific at this point in history would be a cause for shame," he said.
Specialists who are not familiar with the N.E.J.M. applauded the decision.
"Wow," said Dr. Matthew K. Wynia, Infectious Disease Specialist and Director of the Center for Bioethics and the Humanities at the University of Colorado. He noted that the editorial did not specifically mention Mr Biden, but said it was clearly "an obvious call to replace the President".
There is a risk that such a deviation could damage the reputation of N.E.J.M. compromised for impartiality. While other medical journals including JAMA, Lancet and The British Medical Journal have taken political positions, the N.E.J.M. adequately addressed policy issues in a forum published in October 2000 in which Al Gore and George W. Bush answered questions about health care.
However, such a deliberate debate in today's atmosphere is hard to imagine, said Dr. Jeremy Greene, professor of medicine and medical historian at Johns Hopkins University.
The Trump administration has shown "a continuous, ruthless disregard for the truth".
"When we want a forum that is fact-based, it strikes me that no form of engagement can work," added Dr. Greene added.