The Future of Annals

Annals of Internal Medicine is the principal “voice” of internal medicine. My challenge as its new Editor will be to help move Annals from its present level of excellence to new heights. The word “help” is correct because the task is enormous and will involve many people, including, of course, not only the superb Annals editors and staff but also our readers and authors. The crystal ball is cloudy (as usual), but I see four different outlines for an Annals of the future: as science and scholarship, as clinical medicine, as a medical publication, and as an institution.

Perhaps more than any other medical discipline, internal medicine is identified with science [1]. Science is cognitive, involving accurate observation and clear description, hypothesis generation, data gathering and interpretation, and the creation of theory. But science is also a state of mind: skeptical, open, balanced, respectful of evidence, thorough, always on the alert for bias. In this broad sense, good science is good science whatever the subject: biomedical, epidemiological, psychosocial, political-economic. The core value of Annals has rested largely in the quality of its science. Today's scientific knowledge in medicine is good, but there is a great deal of room for deeper understanding; for, as Lewis Thomas has said, “The only solid piece of scientific truth about which I feel totally confident is that we are profoundly ignorant about nature” [2]. (Who, …