For many years I assumed that Steinbeck's high calling to those who would be writers was directed not at me but at those whom we conventionally regard as creators of literature—novelists, essayists, historians, surely poets and playwrights, possibly journalists. I was slow in my enlightenment that perhaps also he was speaking to me, and others like me, whose predominant literary production has been writing articles, chapters, reviews, and texts for medical purposes. Could it be that even in that sterile, regimented world of medical literature, those of us who write are held to the same high calling that Steinbeck requires? And could it also be that in that world, the pen is mightier than the scalpel?
The writers of medical literature in all its forms inform those who use the scalpel, the pharmacopoeia, and everything else in the arsenal of the modern practice of medicine. Whether medical literature is mightier is less important than understanding that medical literature is fundamental, necessary, and powerful. Its promulgation is not to be taken lightly.
If literature is as old as speech, certainly medical literature is as old as the practice of medicine. And medical literature has not been promulgated by the timid, isolated elect “singing their litanies in empty” clinics. The history of medical writing is replete with practitioners, investigators, and observers who have proclaimed their convictions, unapologetically and with certainty. Consider Hippocrates, Moses Maimonides, Sigmund Freud, William Osler, Abraham Flexner, James Watson, Francis Crick, C. Everett Koop, David Kessler, Jerome Kassirer, and many others who buck customary practice and speak up.
I believe that the commission of the medical writer is quite similar to Steinbeck's view of the obligations of writers of conventional literature. The writer of medical literature is charged not only with describing and exposing the many deficiencies and malfunctions of mind, body, and spirit. The medical writer must also maintain undisputed integrity; objectivity in the thwarting of bias; and faithfulness in declaring and celebrating humankind's ability to understand, prevail, and behave compassionately–all for the purpose of improvement of the human condition.
Is it too foolish to speculate how the medical literature might change if we all adhered to Steinbeck's admonition and each person who wrote a medical article, book chapter, editorial, or commentary first asked how the finished product would improve the health and welfare of humankind? No doubt the volume of journals and texts would diminish. Complications would certainly be introduced into the academic promotion process. And, given the extent of biased and unreliable reporting in medical journal articles currently,1 we might be able to believe what we read.
Perhaps we in the health professions cannot go so far as Steinbeck in drumming out of our membership writers who do not passionately believe in the perfectibility of humanity and whose writing is not for the ultimate purpose of improvement of the human condition, although we try to nurture those characteristics in our students. But wouldn't it be simply wonderful, and think of the improvement in the world's medical literature, if Steinbeck's admonition flashed across our minds—or maybe our computer screens—each time we set pen to paper or touched the keyboard?
Gregory L. Eastwood, MD
1Chan A-W, Hrobjartsson A, Haahr MT, Gotzsche PC, Altman DG. Empirical evidence for selective reporting of outcomes in randomized trials. Comparison of protocols of published articles. JAMA. 2004;291:2457–65.