The history of medical writing as a profession

Medical writing developed from medical texts and physician-authors into a distinct profession with paid editors, professional associations and organised training. Its history includes the people who built editorial services and the widening of those services beyond physician journal editors.

From medical texts to a distinct profession

By 2009, medical writing had existed for thousands of years but had become a distinct profession only during approximately the preceding century, combining elements of medicine and writing while remaining separate from both medical practice and the humanities. ¹ Recovering a coherent history helps establish a professional identity and lets new writers join a tradition rather than merely take a job. ^{2, 1}

Medical writing and scientific publishing developed through these ages and events. ³

• Antiquity: Thoth, Egypt’s ibis-headed god, was the mythical inventor of writing and patron of physicians; Apollo, Greek god of rhetoric and the arts, gave healing to his favourite son Asclepius.
• The great medical texts: the Papyrus Smith described diseases by presentation, treatment and prognosis in 1700 BCE; the Ayurveda described India’s healthcare system in 900 BCE; the Moabite Mesha Stele of 850 BCE was the first text known to use punctuation; Hippocrates wrote 70 books in 460 BCE; and China’s Nei Ching, the Yellow Emperor’s book of medicine, reflected centuries of practice in 300 BCE.
• The great physician-writers: Celsus wrote the eight-volume De Re Medica in AD 20; Galen wrote 500 books in 170; Al-Razi wrote the ten-volume Kitab Al-Mansuri on Greek medicine in 885; Taddeo Alderotti’s Consila contained the first modern case histories in 1300; Guy de Chauliac, physician to Pope Clement VI, wrote the Inventarium sive Chirurgi Magna, which was the most complete scholarly surgical book to that date in 1363; Vesalius’s De Humani Corporis Fabrica contained more than 600 woodcuts of human dissection in 1542; and the Accademia dei Lincei’s Gesta Lynceorum became the first scientific-society publication in 1609.
• Formalised medical writing: the Journal des scavans and Proceedings of the Royal Society began as the first scientific journals in 1665; Christiaan Huygens plotted expected survivors by age in a hypothetical population of 100 in 1669, perhaps the earliest graph; the New England Journal of Medicine began as The New England Journal of Medicine and Surgery and the Collateral Branches of Science in 1812 and became the oldest continuously published medical journal; Pasteur added a Methods section in 1859, essentially creating introduction, methods, results and discussion; Max Brödel established the first academic medical-illustration department at Johns Hopkins in 1911; the Mississippi Valley Medical Editors Association was founded in 1940 and became AMWA in 1948; the International Committee of Medical Journal Editors introduced the Uniform Requirements for Manuscripts Submitted to Biomedical Journals in 1979; and the Consolidated Standards of Reporting Trials statement for randomised trials began the reporting-standards movement in 1997.

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Paid editors and the first associations

During much of the nineteenth century, medical journalism combined society journals, proprietary journals of varying legitimacy and advertising-driven tabloids, alongside established journals such as the New England Journal of Medicine, founded in 1812, and JAMA, founded in 1883. ^{4, 5} Journal editors formed the American Medical Editors Association at the AMA’s 1869 meeting to promote editing as a distinct medical specialty, with AMA founder Nathan S. Davis as its first president. ^{4, 6} By the turn of the century it had hundreds of members, including internationally recognised editors, and leading journals published its proceedings; some editors became paid part-time or full-time professionals. ^{4, 6}

Its positions diverged from the AMA’s: it criticised the business practices of George Simmons and Morris Fishbein and advocated a cabinet-level national health department that the AMA opposed. ^{4, 6, 7} An American Medical Editors and Authors Association appeared between 1928 and 1932, possibly as a continuation of the earlier body, although accounts conflict. ^{8, 6} The earlier editors’ association survived the First World War but not the Great Depression. ⁴

Fishbein later disparaged it as a trade organisation concerned with postage and advertising rather than standards, although he became a strong supporter of AMWA, founded its Chicago chapter and served as president in 1958. ^{4, 7} Accounts date his Distinguished Service Award to 1956 or 1962. ^{9, 4, 7}

Maud Mellish Wilson and the author’s editorial office

Maud Mellish Wilson was an early influential author’s editor whose work helped establish Mayo Clinic’s editorial standards and reputation, and probably the craft of author’s editing. ¹⁰ Born Annie Maud Headline in Minnesota in 1862, she trained as a nurse while auditing medical lectures, graduated in 1887 and became a children’s-hospital superintendent. ¹¹ She married surgeon Ernest Mellish in 1889, assisted his operations and began editing his papers after their return to Chicago in 1893. ¹¹ After his death in 1905, she organised Augustana Hospital’s library and edited manuscripts for Albert Ochsner, who recommended her to William Mayo. ^{11, 12} She joined Mayo Clinic in 1907 to develop its library and edit scientific publications. ^{11, 13}

The initial library comprised three small bookcases, some journals and staff-owned books, while publications by the Mayo family were reportedly stored in a coal bin. ¹⁴ She organised the papers, acquired missing volumes and built holdings to more than 4,000 volumes within a few years and 40,000 by her death in 1933. ¹⁴ She helped design the library for the Clinic’s 1914 expansion with pathologist Louis B. Wilson, whom she married in 1924. ¹⁴

Asked to improve articles whose writing fell below the standard of the clinical work, she led the editorial office and the Division of Publications established in 1914, heading the division until 1926 and continuing to edit until 1933. ^{15, 10} The division added four photographers, deliberately recruited from among women, and two medical illustrators, and she designed a centralised system for registering, editing, submitting, revising and tracking manuscripts. ¹⁵ From 1909 until her death, no Clinic manuscript left without meeting her standards; authors who refused revision could publish without Clinic support. ¹⁵ Editors noticed consistently sound, well-prepared manuscripts, a reputation recalled by an Annals of Internal Medicine editor in the early 1990s. ¹⁵ In one anecdote, Charles Mayo returned from a trip, admired an edited manuscript and initially failed to recognise his own work. ¹⁵

In 1909 she began the Collected Papers of Mayo Clinic, selecting important papers from 1905 onwards, and edited at least one volume annually until 1933, representing more than 6,000 articles. ¹⁶ The first volume had 686 pages and the fifteenth, published in 1924, had 1,420; the series reached 60 volumes before ending in 1969. ^{16, 17} These collections increased professional visibility when physicians and hospitals generally considered advertising improper. ¹⁶

Her division began daily Clinic Bulletin meeting summaries in 1919, narrowed them to apparently weekly grand rounds in 1926 and adopted the Proceedings of the Staff Meetings of the Mayo Clinic title in 1927. ¹⁸ A separate account dates the weekly Proceedings from 1926. ¹³ The publication became the separate monthly peer-reviewed Mayo Clinic Proceedings in 1964. ¹⁸

Her book The Writing of Medical Papers appeared in 1922, with editions in 1925 and 1929, combining grammar, style, article preparation, journal abbreviations, proofreaders’ marks and publication practices. ^{19, 13} Seven of its twenty chapters addressed grammar and usage and thirteen addressed preparing the scientific article, with concise rules at each chapter’s end. ¹⁹ It was among the early popular guides to preparing medical articles. ^{19, 20}

She became an honorary Clinic faculty member in the late 1920s, and the Clinic closed for her funeral in 1933; William Mayo considered her its fourth founder alongside himself, his brother and their father. ²¹ Richard Hewitt succeeded her as head of the Division of Publications; the Walter Alvarez biography dates his AMWA presidency to 1955, while the Maud Mellish Wilson biography gives 1957. ^{17, 22, 23} Charles Roland later became the first director of the Clinic’s biomedical communications department, although accounts place its creation in 1964 and his appointment in 1969. ^{17, 24}

Harold Swanberg and AMWA’s foundation

William Harold Swanberg was born in Philadelphia in 1891, earned his medical degree in 1916 and became a radiologist, medical writer and editor. ^{25, 26, 27} His first monographs, The Intervertebral Foramen in 1914 and The Intervertebral Foramina in Man in 1915, preceded graduation and supplied early photomicrographs and anatomical descriptions, first in cats and then humans. ^{28, 29, 27} The studies disproved the chiropractic theory that pressure on nerves explained disease, yet remained standard chiropractic works for decades. ^{28, 29}

After military radiology training, he opened the Quincy X-Ray and Radium Laboratories in 1919, published extensively on radiotherapy and invented an applicator for treating gynaecological cancers. ^{30, 6, 27} He organised the Adams County Medical Society in 1923, served as librarian for thirty years and initiated its bulletin, later the Quincy Medical Bulletin, which continued until 1970. ^{30, 6, 29} His Radiologic Review began in 1924, became the Mississippi Valley Medical Journal in 1939 and Clinical Medicine in 1960, continuing until 1978. ^{30, 5, 27} He became the Mississippi Valley Medical Society’s first secretary-treasurer in 1935 and held that office until 1961. ^{27, 6}

On 25 September 1940, Swanberg brought together six physicians in Rock Island, Illinois, to form the Mississippi Valley Medical Editors Association, supporting state and local journal editors and improving medical writing. ^{31, 32, 33, 34, 35, 36, 27, 37, 6, 38} Its first annual meeting was in 1941, but paper shortages prevented publication of the proceedings; the second meeting’s papers appeared in the Mississippi Valley Medical Journal in 1942. ³⁶

War-related travel restrictions interrupted meetings between 1942 and 1948, and only 42 members remained when interest waned. ^{39, 40} The anniversary chronology specifies no meetings from 1943 through 1947. ^{41, 42} Swanberg proposed a national organisation with broader territory and subject matter, open to medical writers rather than only editors, with a new constitution and the name American Medical Writers Association. ^{41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 39} Morris Fishbein supported the 1948 meeting with a two-hour medical-writing course. ^{39, 40}

The renaming occurred at Springfield, Illinois, in September 1948: the detailed anniversary chronology and biographies give 29 September, while the poster abstract gives 28 September. ^{51, 52, 53, 54, 39, 40, 31} The renamed association accepted nonphysicians working in editorial or business roles in medical publishing, libraries and foundations, according to its founder’s biography. ⁴⁰ Another account dates broadened eligibility to 1951, while a 2015 recollection describes roughly thirteen initial years of physician-only membership with some sponsored exceptions. ^{55, 56}

Swanberg served as secretary-treasurer from 1940 to 1960 and was described by peers as essential to the association’s founding and survival during its lean early years. ^{27, 9} He published a 236-page history of its first twenty-five years in 1965; a planned second volume was never written. ^{27, 57, 58} He remained active until his death in 1970, aged 79. ^{57, 58} His daughter Nancy taught medical writing at Baylor College of Medicine and became an AMWA fellow in 1963; his son William also worked in medical editing. ^{25, 26, 59}

Across his career, Swanberg founded five organisations, three educational foundations and three journals, each of the journals lasting fifty years. ^{60, 61, 57}

Early programmes and growth

Swanberg set nine goals for AMWA, with all but one achieved in his lifetime and all successes achieved by volunteers until Lillian Sablack became its first paid executive director in 1973. ^{39, 62}

1. Publish a bulletin: the Mississippi Valley Medical Journal became its publication in 1948; the Quarterly Bulletin began in 1951 and became the AMWA Journal in 1985; the AMWA Newsletter began in 1970 and Medical Communications in 1972, absorbing the newsletter in 1978 and merging into the Journal in 1986.
2. Start regional chapters: membership grew from 42 to 1,254 in 1958 and more than 1,800 in 1965, with nine US chapters and one in Mexico City; the 2022 account reported more than 4,000 members in sixteen North American chapters.
3. Bestow awards: the Distinguished Service Award first went to Swanberg in 1952 and took his name in 1962; the Honor Award recognised contributions to medical literature; both originally included gold medals, discontinued in 1963; a journalism award recognised general, specialist and research, state, county or city, controlled-circulation and other journals.
4. Establish fellowships: recipients included editors Morris Fishbein, George Simmons and Joseph Garland; clinic founders Karl Menninger and Alton Ochsner; Frances Kelsey, who prevented US thalidomide marketing; and Michael, Lois and Selma DeBakey.
5. Begin a manuscript editing service: from 1952 until at least 1965, members could obtain line-by-line critiques of manuscripts of up to 5,000 words for journals that paid authors no fees; the service excluded library research, bibliographies, selling manuscripts and ghostwriting and charged by word count.
6. Establish college degree programmes: an Educational Committee cofounded by Swanberg and Richard Hewitt in 1951 worked with educational institutions, foundations and companies to develop medical-writing and editing curricula.
7. Offer a travelling lectureship: Jacques Gray delivered 37 lectures at East Coast medical centres and pharmaceutical companies from 1955 until his death in 1961, funded by his employer Parke, Davis & Company.
8. Exhibit at professional meetings: Swanberg created a recruiting exhibit shown in Havana in 1956 and at US meetings, and AMWA published 20,000 copies over two editions of the eleven-chapter A Group of Papers on Medical Writing.
9. Nurture sustaining memberships: in 1965, 26 sustaining members paid annual support fees, almost all major pharmaceutical companies whose AMWA members often held senior posts.

^{63, 40, 64, 65, 57, 66, 67, 68, 23, 69, 70, 62}

The first chapter, Metropolitan New York, formed on 18 January 1956; fellowships were established by constitutional amendment in 1951 and first awarded in 1952, and bylaws followed in 1961. ^{71, 72, 73, 74, 75, 76, 77, 78, 79}

The editing service handled more than 375 manuscripts in its first five years; one account describes Swanberg administering it while a journalism professor edited, and another identifies doctoral student Theodore Peterson as the first editor, with 600 manuscripts after almost six years. ^{23, 67, 7} In 1957, fees rose from $4 to $5 for the first thousand words and from $3 to $4 for the next thousand; a later advertisement charged $5 per thousand words. ^{23, 80, 68, 7} Swanberg also created what may have been the first registry of freelance writers and editors, later including salaried people, helping launch freelance medical writing. ^{59, 37, 81, 23}

During the 1950s, the constitution excluded members of Communist or Fascist parties; this amendment was removed a few years later. ^{37, 81}

A wider profession

By the 1960s, physician-editor members were retiring without replacements, threatening the association’s survival. ^{82, 58} Harold Laufman, president in 1968–1969, and Charles Roland, president from 1969, helped change the bylaws so any member in good standing could become president; previously an MD was required. ^{83, 24} Swanberg opposed allowing nonphysicians to hold office and appears to have cast the only vote against the change. ^{37, 58} Eric Martin became the first nonphysician president in 1970 according to the later biographies, or in 1971 in the 2009 pioneer account. ^{82, 58, 84} Gerald McKee became the first president without a doctorate in 1976 and Virginia Eicholtz the first woman president in 1977. ^{55, 84, 44, 43}

After thalidomide, more complete and standardised regulatory documentation increased demand for writers, alongside growth in pharmaceutical marketing, continuing education and scientific publications. ^{85, 58} Martin, Arnold Melnick, Milton Schiffrin, Bill Nelligan and Lillian Sablack reorganised AMWA, developed a workshop-based curriculum and attracted regulatory writers, publication specialists and later agency and CRO employees. ^{82, 58} Schiffrin’s reputation attracted members and sponsors, Nelligan provided space, clerical support and executive-director funding for two years, and Sablack brought administrative order. ^{82, 58} This training of full-time writers helped establish modern medical writing as a profession. ^{85, 86}

Martin drafted the first code of ethics, dated as approved in 1973 by the pioneer account and chronology but as authored in 1978 by his biography. ^{84, 87, 88, 89} Edith Schwager began Dear Edie in 1978 and helped prompt a move away from smoke-filled meetings. ^{84, 50, 49}

The association’s milestone chronology records these developments. ³¹

Year	Milestone
1940	Annual meetings
1951	Rewritten constitution and not-for-profit incorporation
1952	Fellowships
1952	Affiliation with the American Association for the Advancement of Science
1956	Local chapters
1961	Bylaws
1972	Specialty sections
1973	Code of ethics
1975	Freelance directory
1979	Core curriculum and certificate programme
1979	Annual conferences
1986	AMWA Journal
1994	Biomedical Communication: Selected AMWA Workshops
1998	Website
2003	Position Statement on the Contribution of Medical Writers to Scientific Publications
2007	Webinars, including the tenth-edition AMA Manual of Style update
2009	Expanded certificate programme
2009	History Project and Written Memories initiative

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The position statement was prepared by Cindy Hamilton and Mary Royer on behalf of a task force and became a benchmark for other organisations. ⁸⁴ Membership accounts for 2010 give more than 5,600 members in twenty chapters in the poster and more than 5,300 in the president’s address. ^{31, 36} In 2015, membership spanned 38 countries, predominantly the United States with a strong Canadian contingent, and included pharmacists, nurses, veterinarians, biologists, epidemiologists, journalists and teachers as well as physicians. ^{90, 80}

Changes in writing practice and employment

One physician’s recollection described a gradual move away from jargon-heavy articles, recalling Walter Alvarez’s possibly 1930s JAMA submission being returned because a layperson could understand it. ⁹¹ Alvarez also resisted editors substituting technical terms for ordinary language, with Maud Mellish and Richard Hewitt supporting him. ²²

At the end of the 1970s, one clinical writer hand-tabulated case reports, calculated statistics and handwrote reports for a typing pool, where revisions required retyping pages or whole documents. ^{92, 93} Another recalled magnetic-card typewriters replacing correction fluid and repeated retyping. ^{94, 95} The clinical writer considered that collecting, analysing, interpreting and communicating data had given him a broad perspective that later specialisation narrowed; his colleague recalled that technological change also brought gains. ^{96, 97}

The FDA’s 1988 guideline supplied outlines for clinical study reports and integrated safety and effectiveness summaries; ICH E3 in 1995 provided a global report structure and encouraged templates for other documents, and the Common Technical Document offered a common submission structure and electronic format for the US, EU and Japan. ⁹⁵ In 2015, a past AMWA president observed fewer permanent pharmaceutical-company positions and more CRO employment, independent contracting and business ownership than when he and a colleague joined in 1986 and 1994. ^{98, 99, 100} This shift required the association to serve people responsible for their own development. ^{100, 101, 102, 103}

EMWA’s formation and independence

Medical writing was virtually unknown as a recognised profession in Europe in 1985. ¹⁰⁴ European attendees at AMWA meetings saw the value of training, qualifications, standards and professional community and discussed a European association in the late 1980s. ¹⁰⁵ Another account traces the idea to a London lunch after Mike Matthews and Stephen de Looze met at AMWA’s 1986 San Francisco meeting. ¹⁰⁶

Accounts differ about the preliminary meetings: one places fourteen representatives of nine European companies at Loughborough’s Quorn Grange Hotel on 11 October 1990; another places the Alderley Park meeting on that date, followed by Loughborough and an informal Belgian meeting, possibly at Rixensart. ^{107, 106, 108} Jane Wynen, Ceara Roche and colleagues in the SmithKline vaccine group helped advance the initiative. ^{106, 109} By April 1991 more than 75 people had expressed interest, and a steering committee circulated a questionnaire about establishing the association. ¹⁰⁷

The first formal meeting took place in Brussels on 21 February 1992 with 32 attendees, from seven countries in one account and nine in another, and presentations but no workshops. ^{107, 106, 110} After debate, 24 of 29 voted to become an AMWA chapter, using its structure and administration to help the new group develop. ^{107, 106} Jane Wynen became president and Geoff Hall vice-president; AMWA’s board approved the chapter in March 1993. ^{107, 106}

Affiliation later became contentious: 85% of dues went to AMWA, approval for European workshop leaders and content was lengthy and could require US conference delivery, registration forms arrived after workshops had filled, and European degree equivalence was questioned. ¹¹¹ Although AMWA’s infrastructure and experience favoured remaining a chapter, attempted compromises failed. ¹¹¹ Growing conferences made volunteer-only administration impractical, and following the 1997 Edinburgh conference EMWA appointed professional management and changed from chapter to affiliate status, keeping its funds and approving its workshop leaders. ¹¹¹ The twenty-fifth-anniversary account dates independence to 1997, while the later Swanberg biography gives 1998. ^{110, 108}

From 1998, EMWA incorporated as a company limited by guarantee, moved its funds from a treasurer’s personal account and established its own education committee and certification programme over two years, with the AMWA relationship then formally ending. ¹¹² Membership rose from 240 in April 1999 to 260 in May and 350 by April 2000. ¹¹² By its twenty-fifth anniversary it exceeded 1,000, with twice-yearly meetings, more than 130 active workshops, spring symposia and a professionally managed head office. ^{110, 113} The 2023 Swanberg biography described members from almost forty countries, twelve outside Europe. ¹⁰⁸

Its first twenty-five years included these accomplishments. ¹¹⁰

1. Five-year plans reflecting members’ needs.
2. Professional management and a headquarters move from Switzerland to the UK.
3. Representation through Good Publication Practice, the CORE Reference and the joint professional-writing statement with ISMPP and AMWA.
4. Executive-committee expansion to public relations and conferences.
5. An educational committee managing workshops.
6. An expanded, modernised website.
7. A social-media team.
8. The Geoff Hall Scholarship for new writers.
9. Financial stability.
10. Webinars.
11. The Freelance Forum.
12. A professionally produced journal with a full editorial board and open-access features.
13. Reach beyond Europe and relationships with other professional organisations.
14. The Expert Seminar Series and special interest groups.
15. The Internship Forum.

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EMWA established the Nick Thompson Fellowship at Montpellier in 2001, with Art Gertel and Geoff Hall among its first recipients. ¹¹²

AMWA and EMWA became major training associations whose members also taught in academic programmes, trained employees and wrote hundreds of professional articles and books. ¹¹⁴