A Quick Historical Review of ACP’s Early Journals

Annals of Medicine

The publication and distribution of medical knowledge was one of the central goals envisioned by the founders of the College upon its creation in 1915. With the conclusion of the First World War, around 1919, the Councillors of The American College of Physicians decided to publish a medical journal, “in the interests of American Medicine.” April 1920 marked the debut of the Annals of Medicine. Intended to be published quarterly, at $10.00 for a yearly subscription, Annals of Medicine offered articles from leading medical writers and a section for Abstracts from the Current Literature. 

The first issue contained a list of both ACP members and members of the American Congress on Internal Medicine current to that period. The central article of the first issue, “The Field of Internal Medicine,” was authored by the College’s first president: Reynold Webb Wilcox. The journal was also filled with photos of ACP officers and Convocation events, which was held in Chicago on February 20, 1920.

Annals of Clinical Medicine

Unfortunately the journal was canceled after its first volume. According to ACP historian William Gerry Morgan, such an endeavor was ultimately “too ambitious for a young and struggling organization.” The College’s next journal, Annals of Clinical Medicine, began publication in July of 1922 as the “official publication” of the College and the American Congress on Internal Medicine (which merged with ACP in 1926). This bimonthly publication was published for the College by the Williams and Wilkins Company of Baltimore. The original design of this journal was to have each yearly volume consist of approximately 600 pages and cost $6.00 for an annual subscription in the United States; $6.25 in Canada, Mexico and Cuba; and $6.50 everywhere else. College members were offered a discounted rate of $5.00 annually. 

Beginning with Volume 2 in July of 1923, College members in good standing were offered the journal free of charge. The price structure for subscriptions changed the following year in 1924, as nonmembers in the United States, Canada, Mexico and Cuba had their rate raised to $7.00, while the subscription rate in other countries was now $7.50. By its third year, the Annals of Clinical Medicine had become successful enough to have evolved into a monthly publication; year-long volumes were now over 1,000 pages. A concerted effort was made to forge the Annals of Clinical Medicine into a journal that would address all the potential needs of internal medicine physicians. Articles were not simply geared to issues of internal diseases, but towards those areas where internal medicine intersected with other branches of practical medicine. 

Friction had developed between the Editor’s office and the Williams and Wilkins Company by 1924. This was mostly due to the publishing contract, which the College came to view as being almost totally in favor of the Williams and Wilkins Company. The Board of Regents directed Executive Secretary Edward R. Loveland to survey the publishing contract in May of 1926. 

Annals of Internal Medicine

The College was eventually able to have the contract with the Williams and Wilkins Company legally terminated. As a result, the College could neither publish their journal nor call a journal the Annals of Clinical Medicine, as that title was the copyrighted property of the Williams and Wilkins Company. The leadership of the College chose the name Annals of Internal Medicine for it next publication, which began July 1, 1927. Ninety-two years later, this publication has not only developed into the leading journal for internal medicine but has become one of the most influential medical journals in the world.  

A Quick Historical Review of Annals of Internal Medicine

The dissemination of medical knowledge has been an essential goal of the American College of Physicians since its founding in 1915. Throughout the years, this value has been actualized most directly by the publication of the Annals of Internal Medicine, which was founded on July 1, 1927. Although this was the College’s second medical journal, it was the first to be directly published and managed by ACP. The journal was printed by the Ann Arbor Press, which was conveniently located near the home of Annals’ first Editor, Dr. Aldred Scott Warthin. The initial circulation of volume one of Annals of Internal Medicine was 1,903 copies per month. The financial and business aspects of the journal were managed by ACP Executive Secretary, Edward Loveland. By 1931, circulation had risen to 3,093; and by 1940 circulation it had reached 5,022 copies per month. Even throughout the Great Depression circulation steadily increased each year. As the number of subscribers grew so did the size of each issue.

One of the primary focuses of the journal was to publish the most “noteworthy” lectures and papers presented at the College’s Annual Session. During its early years, the Editor of Annals often had to solicit contributions to fill each issue. Eventually as the journal became more established and respected the situation was reversed; and the percentage of editorial rejections greatly increased. In 1928 the College’s Board of Regents (BOR) passed a resolution that “advertisement of articles or preparations” that had not been previously approved by the Council on Pharmacy and Chemistry of the American Medical Association could not be published in Annals. Initially, Annals was a financial liability for the College, but by the late 1930s the increased revenue from advertising enabled the journal to produce a surplus.

Maurice C. Pincoffs becomes Editor

In May 1931, Aldred Scott Warthin died, and was replaced by Dr. Carl V. Weller, the Chairman of Pathology at the University of Michigan, who served as Interim Editor until January 1933. He was replaced by Maurice C. Pincoffs, Professor of Medicine and Head of the Department of Medicine of the Medical School of the University of Maryland. As a result of the new Editor of Annals no longer living near Ann Arbor, the College switched printers and selected the Lancaster Press, located in Lancaster, PA.

Under the editorship of Dr. Pincoffs, the Annals of Internal Medicine began to publish more original clinical studies.This greatly reduced the prominence of papers from the Annual Meeting. These changes resulted initially from developments in medical science happening in the 1930s, but later on were also influenced by the experience of military doctors during the Second World War. In 1936 the BOR approved the creation of the position of Assistant Editor. This was both a response to the increasing size of the journal, along with the rising editorial work involved with each issue. Paul Clough, Associate Professor of Medicine in the University of Maryland, was selected for this position.

In 1937, Dr. Pincoffs approached the BOR’s Annals Committee to discuss a situation that led to a new policy. The Editor had been inundated with requests from various organizations to publish special issues in honor of various outstanding medical scholars, which is known in academic circles as a Festschrift. Dr. Pincoff believed that serving as a medium for the publication of such materials would be “inappropriate” for Annals. The Committee developed a policy that Annals would not organize or sponsor a Festschrift, but allowed the Editor discretion in publishing suitable material taken from such volumes. In taking this course of action, the Annals of Internal Medicine became the first American medical journal to adopt such a policy.

World War II

A few months after the United States entry into the Second World War, Dr. Maurice Pincoffs, the editor of Annals, was called into active service with the Army. On Dr. Pincoffs’ recommendation, Assistant Editor Dr. Paul Clough became Editor for the duration of Dr. Pincoffs’ military service. Dr. Clough appointed Dr. Hansley Barker of Baltimore as Acting Assistant Editor, with both taking office on May 1, 1942. With so many members serving in the military (over 20 percent) or having to take on additional responsibilities as a result of the war, a concern rose that there might be difficulty in obtaining appropriate contributions for publication. Annals Acting Editor Dr. Clough gathered enough suitable materials to enable Annals to publish through the first few months of 1943 without incident. Dr. Clough also used some issues of Annals to publish papers presented at regional postgraduate meetings. Although the College canceled all Annual Meetings for the duration of the war, regional and educational meetings continued.

As a result of the war, the College’s cost for the printing of Annals by the Lancaster Press increased by 10 percent per issue in 1942. As members who were serving in the military had their fees waived, there was concern that Annals might have a significant decrease in subscription revenue. But such concerns proved immaterial as the Army and Navy increased subscriptions for military hospitals, and many members in the armed services, despite their wavier from dues, continued to pay the full subscription costs. In order to comply with federal restrictions on paper during wartime, the size of Annals volumes had to be reduced slightly. While initially there was concern about the quality of articles available for publication during World War II, the volume of contributions was significant enough to alleviate any concerns. There was occasional difficulty in publishing the journal on time due to shortages brought on by governmental regulations during wartime and labor troubles.

By the end of 1945, the circulation of Annals exceeded 7,500, which was more than double that in the previous decade. Advertising rates had also increased by 45 percent over the same time period, and Annals subscription income was estimated to be over $53,000.00 ($736,106.00 in 2019 USD). By early 1946 Dr. Clough, Acting Editor of Annals, announced that Dr. Pincoffs was discharged from the Army and after a short period would be returning as to his post as editor. During his army service Dr. Pincoffs was decorated twice for bravery in combat and exceptional meritorious service. He was awarded the Legion of Merit with Oak Leaf Cluster and was appointed Chief Consultant in Internal Medicine to the Surgeon General for the Pacific Theatre of Operations. By 1948 Annals was again being published without delay, as wartime paper shortages were no longer an issue.

The postwar economic boon and the prestige of Annals had enabled further production and revenue development, such as using heavier coated paper and raising advertising rates by 16 percent. The Committee on the Annals of Internal Medicine was dissolved and replaced by an Editorial Board. In June 1954, with the completion of Volume 40 of the Annals of Internal Medicine, the first cumulative index of the journal was prepared and distributed to College members and requesting subscribing libraries. When Dr. Pincoffs first became Editor of the Annals of Internal Medicine it was a small publication, occasionally struggling during the worst depression in American history.  By 1959 the circulation of Annals was nearly 24,000 and it was regarded as the best medical journal in its field in the world.

Joseph Russell Elkinton becomes Editor

1960 ushered in a major change for both the Annals of Internal Medicine and the American College of Physicians. In 1958, Dr. Maurice Pincoffs, the editor of Annals since 1933, announced to the Board of Regents (BOR) that he wished to retire by August of 1960. All through those years Dr. Pincoffs kept his editorial office in Baltimore, while the journal's business management was maintained at the College in Philadelphia. The College's BOR decided that the editorial office should be brought into the headquarters, and as a result, only suitable candidates from the Philadelphia region were interviewed. Dr. Joseph Russell Elkinton, professor of medicine at the University of Pennsylvania, became the new Editor of Annals in October of 1960. Dr. Elkinton was the scion of a prominent Quaker family who had been in the Philadelphia region since 1673. At the same time, ACP Executive Secretary Edward Loveland retired and was replaced by Dr. Edward C. Rosenow, Jr., under the new title of Executive Director of the College. Dr. Rosenow was responsible for the financial management of Annals. Though they consolidated the publishing activities of Annals in the Philadelphia headquarters, the Board of Regents continued the policy of keeping editorial functions separate from the financial administration of the journal.

Peer Review

The Committee on Publications was formed to oversee the operation of Annals and other College publications. An Editorial Board consisting of specialists in various fields of internal medicine was created. This board, whose members were nominated by the Editor of Annals, would act as advisors on editorial matters. During his time as Editor, Dr. Pincoffs had reviewed most of the submitted manuscripts himself, occasionally seeking consultation from associates at the University of Maryland. Prior to accepting the editorship of Annals, Dr. Elkinton he had insisted on the right to send all submitted papers to be reviewed by expert consultants throughout the country. A "Letters and Comments" section was added to the journal, enabling contributors a greater opportunity to respond and engage their colleagues. In 1970 the College contracted with R.  R. Donnelley and Sons of Chicago to take over printing responsibilities. The shift to a standardized trim size format enabled both increased advertising and more text per page. Following Dr. Elkinton's retirement, Dr. Edward Huth was named Editor of the Annals of Internal Medicine in July of 1971.

In 1968 new regulations adopted by the Internal Revenue Service (IRS) allowed taxation of income derived from advertising in the journal of a non-profit institution. An exception was given only if  the advertising was directly related to the "exempt purposes” for which the organization had received the designation of a "charitable or educational institution." As a result, the IRS imposed federal income taxes on the net advertising revenues of Annals. The College paid the additional taxes, but in 1972 ACP filed a lawsuit to refund those income taxes paid for the year 1968-69, amounting to $376,977, claiming that the regulations under which the taxes were imposed during this period were invalid. Congress had enacted a new law, effective in 1970, which essentially approved the regulations previously adopted by the IRS. For this reason, success with additional claims was doubtful. From 1968 to 1972 the College paid $801,550 in federal taxes on income derived from advertising in Annals. Further lawsuits attempting to recover taxes paid by the College would continue until 1986.

Edward Huth becomes Editor

Dr. Edward Huth had become Assistant Editor of the Annals of Internal Medicine in 1960 and Associate Editor in 1965. When he became Editor in 1971, he continued his predecessors’ commitment to excellence while bringing his unique literary flair for writing to the journal. Dr. Huth would in time become the leading expert on “style and structure” in medical writing, eventually publishing four books on the subject, including the Style Manual for the Council of Biology Editors. He also played a central role as a member of the International Committee of Medical Journal Editors, for the creation of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (URM) in 1979. The URM standardizes the ethics, preparation and formatting of manuscripts submitted for publication by biomedical journals. The URM is followed by over 1,100 scientific journals and the National Library of Medicine.

Annals’ 50th Anniversary in 1977 ushered in a period of technological and editorial development. Editorial staff began to verify the bibliographic references of all submitted articles for accuracy by examining the original source material. In July 1978 Dr. Huth appointed Associate Editors to aid in the selection and review of materials to be published in the journal. Annals also began complying with Uniform Requirements for Manuscripts Submitted to Biomedical Journals. By 1979 the Editor had also added a statistician to the staff and had a computer database created to list all eligible individuals available to review manuscripts. This database grew to 3,500 reviewers by 1982. In 1984 Annals’ Editors began having bibliographic references verified online by MEDLINE. The College also reached an agreement to allow Bibliographic Retrieval Services (BRS) on-line access to full text of Annals articles.

ACP continued its lawsuit against the U.S. Federal Government attempting to recover taxes paid by the College on Annals advertising revenue. In 1977 the Claims Court held that the advertisements were not substantially related to the organization's tax-exempt purpose and that the income was therefore taxable. On petition the Courts of Appeals for the Federal Circuit reversed the ruling, stating that the advertisements helped to educate the journal’s readers and were therefore substantially related. On January 21, 1986 the case eventually reached the U.S. Supreme Court, which unanimously held that the advertisements in this particular case were not "substantially related" to the medical journal's educational purposes. As a result, the College had to pay taxes on the profits it earns from the advertisements in Annals. This landmark case is often referenced in law school classes throughout the United States. This ruling has affected all journals published by nonprofit organizations.

Innovations and Structural Changes

The late 1980s brought several innovations and structural changes to the Annals of Internal Medicine. 1987 marked the beginning of Annals’ publishing structured abstracts. The July 1, 1988 issue of Annals inaugurated the journal becoming a twice-monthly publication along with placing the issue’s table of contents on the front cover. In 1989 The American College of Physicians moved its headquarters from 4200 Pine Street to its current location at Independence Mall West, Philadelphia. This enabled the publishing activities to be combined in one division.  Dr. Edward Huth, the Editor of Annals since 1971, retired in June 1990, and was replaced the following month by Drs. Robert H. Fletcher and Suzanne W. Fletcher. The Fletchers were general internal medicine physicians and clinical epidemiologists. Before becoming editors of Annals, they served on the faculties of medicine and epidemiology at McGill Medical School and the University of North Carolina, Chapel Hill. 

In 1991 Annals began to offer as a supplement ACP Journal Club, and the following year the first Spanish edition of Annals was launched. In 1992 an article in the journal critical of pharmaceutical advertising leads to a decline in such advertising in Annals. As a result, the College’s Board of Regents again reiterated their support of independent editorial judgment for the Annals of Internal Medicine. In 1993 the Fletchers accepted appointments at Harvard Medical School and resigned from their Annals’ editorship. Edward J. Huth returned as Interim Editor until a permanent editor could be found. At the same time, ACP’s publishing activities were reorganized into two divisions: Annals and Publishing.

Dr. Frank Davidoff was named Editor of Annals in 1995. Prior to his editorship, Dr. Davidoff was active in basic molecular pharmacology and advanced clinical research. During his editorship he published research on the changes to manuscripts resulting from peer review and editorial processes. Dr. Davidoff also noted an increasing number of papers submitted to Annals coming from Europe and Japan. He fulfilled a request of the Cochrane Collaboration and the National Library of Medicine to review all previous issues of Annals published since 1948 to identify reports of randomized clinical trials. In 1996 Annals’ editors announced the introduction of a more extensive policy on the disclosure of conflict of interest issues. During this period the journal also adopted the new guidelines of the Consolidated Standards of Reporting (CONSORT) to alleviate the problems arising from inadequate reporting of randomized controlled trials.

Hal Sox Becomes Editor

In 2000 the Annals Web site (www.annals.org) was launched. In June 2001 Dr. Davidoff retired as Annals’ editor was replaced the following month by Dr. Harold C. Sox. Before becoming Annals’ editor, Dr. Sox did clinical research on the application of decision analysis in selecting and interpreting diagnostic tests. He was a Professor of Medicine (Clinical) at Stanford University School of Medicine and Professor and Chair, Department of Medicine, Dartmouth Medical School.  Dr. Sox also served as a Regent of the College, chair of several ACP committees and in 1998-1999 President of the College. Dr. Sox introduced a new element to Annals’ clinical research articles, context notes. These notes summarize the place of the reported study in current medicine, serving as an editorial comment on a particular paper. Dr. Sox also sought to attract more original research articles, reports on quality improvement, clinical policy and articles advocating evidence-based medical decision-making.

Upon Dr. Sox’s retirement in July 2009, Dr. Christine Laine became the Editor of Annals and a Senior Vice President at the American College of Physicians. Dr. Laine is the youngest editor in the history of Annals of Internal Medicine, where she has served on the editorial staff since June 1995. Prior to joining Annals editorial staff, Dr. Laine received her medical degree from State University of New York at Stony Brook, and completed residency training in internal medicine at The New York Hospital (Cornell University), and a fellowship in general internal medicine and clinical epidemiology at Beth Israel Hospital (Harvard University). Laine earned a master of public health degree at Harvard University and served as an Assistant Professor, Division of Internal Medicine at Jefferson Medical College (Philadelphia) where she split her time between research, teaching, and clinical practice.