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August 2, 2000

Human Rights in the Biomedical Literature: The Social Responsibility of Medical Journals

Author Affiliations

Author Affiliations: Ms Flanagin is Managing Senior Editor, JAMA.

JAMA. 2000;284(5):618-619. doi:10.1001/jama.284.5.618

The number of articles on human rights published in biomedical journals has increased substantially during the last decade. This reflects an increasing involvement of physicians and other health professionals in the documentation of the health consequences of violations of human rights,1,2 improvements in the quality of articles on human rights, and the willingness of journals to publish these articles.

MEDLINE defines human rights as "the rights of the individual to cultural, social, economic, and educational opportunities as provided by society (eg, right to work, right to education, and right to social security)."3 The term human rights was formally introduced into the MEDLINE lexicon in 1973. Previous indexing for this term was included under civil rights.3 Although the MEDLINE definition does not specifically address each article of the Universal Declaration of Human Rights,4 it encompasses the main issues of freedom, justice, and peace, and is further supported by 9 medical subject heading (MeSH) categories and a long list of conceptual coterms. The MeSH categories listed under human rights are child advocacy, civil rights, consumer advocacy, freedom, patient advocacy, social justice, women's rights, privacy, and right to die.3

MEDLINE indexes 4000 of 15,000 journals in medicine, nursing, dentistry, veterinary medicine, health care systems, and preclinical sciences, which are published in 70 countries. Citations to 400,000 articles are added annually to this database, which contains 10 million records of articles dating back to 1966.5 In the MEDLINE database of 4000 journals, 29,235 articles have been published on human rights between 1966 and 1999. There were 135 human rights articles indexed between 1966 and 1969. Beginning in 1975, however, there have been steady increases in the number of human rights articles, with more than 9000 published during the last 5 years (Figure 1).

Figure. Human Rights Articles Published in Biomedical Journals, 1966-1999 (N = 29,235)
Image description not available.
Letters and editorials were included in this definition of articles. All of the articles were indexed in MEDLINE under the term human rights.

The focus of these articles reflects the changing attention biomedical journals and the biomedical community have given specific human rights–related topics over time. The top 5 human rights coterms in the MEDLINE database in order of descending frequency are medical ethics, torture, world health, public health, and refugees.6 Medical ethics and public health as they relate to human rights have been given considerable attention since 1966, with 4429 articles on human rights and medical ethics and 5101 articles on human rights and public health indexed between 1966 and 1999. Beginning in the 1970s, journals began to address the issue of torture. MEDLINE indexed 186 articles on torture and human rights between 1970 and 1999; 8.6% of these were published during 1970-1979, 37.6% during 1980-1989, and 53.8% during 1990-1999. In the late 1970s and 1980s, biomedical journals began publishing articles on refugees and human rights. Two such articles are indexed for the years 1970-1979, 12 for 1980-1989, and 80 for 1990-1999.

The types of human rights articles also have evolved over time. Editorials and letters, which typically herald current opinion and debate, are the most common. More than 2900 editorials and letters on human rights are indexed collectively in MEDLINE from 1966-1999; 74% of these were published during the 1990s. Review articles are important because they assemble, summarize, and often evaluate available information on a specific topic, and clinicians often use review articles to guide clinical decisions.7 In the 1970s, 33 review articles on human rights were indexed in MEDLINE, reflecting the emergence of human rights as a subject worthy of appraisal. During the last 10 years, the number of review articles addressing human rights increased substantially with more than 1700 reviews indexed in MEDLINE between 1990 and 1999. Thus, human rights has become formally accepted into the biomedical literature as a subject demanding regular updates, summaries, and critical evaluation.

Perhaps because of the challenges and difficulties in conducting research on human rights topics, the majority of published studies involve case series, observational studies, and surveys. However, the number of clinical trials, although relatively small, is increasing. During the 1970s, 11 clinical trials or articles about clinical trials related to human rights were indexed in MEDLINE. In the 1980s, 22 clinical trials, including 2 randomized controlled trials, were indexed, and in the 1990s, these numbers increased to 37 and 25, respectively. Thus, 2 decades after human rights emerged as a formal entity worthy of review, it is increasingly recognized as a subject that requires systematic evaluation and scientific investigation.

The biomedical literature on human rights reflects an evolving interest among the biomedical community from one of awareness and recognition of a problem that some considered out of the realm of conventional medicine and public health to that of promoting improvements in clinical practice and research involving human rights. Medical journals have played an important role in this transformation by publishing articles that expose violations of rights to freedom, justice, and peace; highlight the importance and relevance of human rights to medicine and health; describe and evaluate methods of prevention and control of human rights violations as well as effective interventions and therapies for survivors; and report research that supports the emerging science of human rights.8,9

The editors of JAMA recognize that THE JOURNAL has a "social responsibility to improve the total human condition and to promote the integrity of science."10 As a result, we will continue to publish an annual theme issue devoted to the subjects of human rights, violence, and inhumanity. Again, we call for manuscripts that address the prevention, deterrence, and control of violence and violations of human rights as well as optimal therapies and interventions for both survivors and perpetrators.11 Next year's issue is scheduled for August 1, 2001. Manuscripts received by January 30, 2001, will have the best chance for publication in that issue. Please follow THE JOURNAL's Instructions for Authors12 for information about manuscript preparation and submission.

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