CAMBRIDGE, Mass. — The old crusaders are getting just a little creaky: Dr. Arnold S. Relman, 88, has a hearing aid and the hint of a tremor; Dr. Marcia Angell, 72, osteoporosis and arthritic hands. But their voices are as strong as ever.

Colleagues for decades, late-life romantic partners, the pair has occasionally, wistfully, been called American medicine’s royal couple — as if that contentious Tower of Babel could ever support such a topper. In fact, controversy and some considerably less complimentary labels have dogged them as well.

From 1977 to 2000, one or both of them filled top editorial slots at The New England Journal of Medicine as it grew into perhaps the most influential medical publication in the world, with a voice echoing to Wall Street, Washington and beyond. Many of the urgent questions in the accelerating turmoil surrounding health care today were first articulated during their tenure.

Or, as Dr. Relman summarized one recent afternoon in their sunny condominium here, Dr. Angell nodding in agreement by his side: “I told you so.”