How a quiet Quaker physician revolutionized evidence-based medicine and peer review at Annals of Internal Medicine
Imagine a world where your doctor's medical decisions relied more on tradition and authority than on rigorous scientific evidence. This was the reality of medicine in 1960 when J. Russell Elkinton took the helm of Annals of Internal Medicine. Over the next decade, this soft-spoken Quaker physician would quietly revolutionize how medical knowledge was created, evaluated, and shared, laying the groundwork for what we now recognize as evidence-based medicine1 .
His editorial leadership didn't just change a journal—it transformed the very foundation of how doctors distinguish fact from fiction in medical practice.
Born into a prominent Quaker family that had been in the Philadelphia region since 16732
Joseph Russell Elkinton wasn't a flashy revolutionary. As a Professor of Medicine at the University of Pennsylvania, he understood the needs of both clinicians and researchers. What few realized at the time was that this unassuming physician would fundamentally reshape one of medicine's most prestigious journals and leave an indelible mark on how medical science advances.
To appreciate Elkinton's impact, we must understand the medical publishing landscape he inherited. Prior to his editorship, the Annals and similar journals operated very differently:
Previous editor Maurice Pincoffs had reviewed most submitted manuscripts himself, occasionally consulting with associates at the University of Maryland2
Decisions relied heavily on the knowledge of a small circle of local experts
Medical authority often trumped scientific evidence in clinical decision making6
Journals primarily functioned as one-way communication channels
This approach reflected the broader medical culture of the time, where clinical practice was historically viewed as the "art of medicine" with expert opinion, experience, and authoritarian judgment forming the foundation for decision making6 . The use of scientific methodology and statistical analysis remained rare in clinical medicine, creating a significant gap between research and practice.
Elkinton's most transformative innovation—one he insisted upon before accepting the position—was the right to send all submitted papers to be reviewed by expert consultants throughout the country2 . This simple but radical idea created the foundation for modern peer review as we know it today.
Elkinton created an Editorial Board consisting of specialists in various fields of internal medicine who acted as advisors on editorial matters2
Rather than relying on local colleagues, he built a nationwide network of expert reviewers
Each submission underwent rigorous scrutiny by multiple independent experts before publication decisions
The system ensured that research was evaluated on its scientific merit rather than the author's reputation
This external peer review model represented a seismic shift from the previous insular approach. It meant that a cardiologist in California might review a paper from a New York endocrinologist, with a Boston statistician evaluating the methodology.
This cross-pollination of expertise dramatically improved the quality and reliability of published research.
| Innovation | Before Elkinton | After Elkinton's Reform | Impact |
|---|---|---|---|
| Peer Review System | Primarily internal review by editor and local associates | National network of expert reviewers across specialties | Higher quality publications, reduced bias |
| Reader Engagement | Limited feedback mechanisms | "Letters and Comments" section added2 | Lively scientific dialogue, immediate critique |
| Editorial Structure | Single editor making most decisions | Editorial Board with specialized advisors2 | Broader expertise in decision-making |
| Production Quality | Variable format and layout | Standardized trim size format2 | More text per page, improved readability |
While Elkinton wasn't directly involved in laboratory experiments, his work ensured that the research published in Annals met the highest scientific standards. Modern medical research relies on specific reagents and materials to ensure reproducible, valid results. Here are key components from typical research methodologies during Elkinton's era that remain essential today:
| Reagent/Material | Function in Research | Example Applications |
|---|---|---|
| Dimethylsulfoxide (DMSO) | Solvent for compounds4 | Drug solubility studies |
| Fetal Bovine Serum | Cell culture growth supplement4 | Growing human cell lines |
| Formaldehyde/Paraformaldehyde | Tissue fixation4 | Preserving cellular structure |
| Trypsin-EDTA | Detaching adherent cells4 | Cell passage and harvesting |
| L-Glutamine | Cell culture nutrient4 | Supporting cell growth |
| Antibiotic/Antimycotic | Preventing contamination4 | Maintaining sterile cultures |
Elkinton understood that robust scientific progress required more than just improved article quality—it needed vibrant scholarly conversation. To achieve this, he introduced a "Letters and Comments" section that enabled contributors greater opportunity to respond and engage with their colleagues2 . This innovation transformed the journal from a static repository of knowledge into a dynamic forum for scientific debate.
| Aspect of Journal | Pre-Elkinton Era | Post-Elkinton Era | Significance |
|---|---|---|---|
| Circulation | ~24,000 in 19599 | Steady growth maintained | Widened reach of quality medical evidence |
| Review Process | Local consultant review2 | National expert peer review2 | Higher quality evidence for clinicians |
| Reader Interaction | Limited feedback mechanisms | Active "Letters and Comments" section2 | Fostered scientific community |
| Production Quality | Conventional printing | Standardized format, increased content2 | More efficient knowledge dissemination |
This section became one of the journal's most popular features, embodying Elkinton's belief that science thrives through open dialogue and constructive criticism. It created what we now recognize as the essential feedback loop of scientific progress, where publication is the beginning rather than the end of the knowledge refinement process.
When Elkinton retired in 1971, he left a transformed publication that had set new standards for medical journalism. His innovations created the template not just for Annals but for medical publishing broadly:
His national expert review system became the model for all major medical journals
The letters section created a template for ongoing scientific conversation
His leadership demonstrated the importance of keeping editorial functions separate from financial administration2
His reforms accelerated medicine's shift from tradition-based to evidence-based practice
The reforms Elkinton implemented came at a crucial historical moment, as medicine was beginning to embrace what would later be formalized as evidence-based medicine (EBM). The critical appraisal techniques and rigorous evaluation standards he championed in the pages of Annals anticipated the formal EBM movement that would emerge in the 1990s6 .
Elkinton's quiet revolution demonstrated that how we evaluate and disseminate medical evidence matters as much as the evidence itself. His editorial road—the phrase used in a contemporary tribute8 —created the pathway that modern medical publishing still travels today. By insisting on rigorous peer review, encouraging scientific dialogue, and maintaining integrity amid financial pressures, he ensured that clinicians everywhere could trust what they read in the pages of Annals—a legacy that continues to benefit patients and doctors alike.
Though J. Russell Elkinton passed away in 2002, his vision for honest, rigorous, and collaborative medical science has never been more relevant. In an age of information overload and questionable sources, the standards he established for medical publishing serve as a crucial bulwark protecting the integrity of medical science and the patients who depend on it.