Saturday, May 20, 2006

Fired CMAJ editor rants in NEJM

Politics versus science, editorial independence versus accountability

Dr. John Hoey wants editorial independence. Maybe he should start a blog. In the May 11 on line edition of the New England Journal of Medicine (NEJM) he recounts his dismissal as editor of the Canadian Medical Association Journal (CMAJ) and the related shake up that resulted in additional dismissals and resignations, virtually decimating the journal’s editorial staff.

Although a confidentiality agreement prevents both sides from divulging details there were known to be repeated clashes between the editors and the owners of the Journal, the Canadian Medical Association (CMA). By most accounts it’s about not only editorial independence but also politics and the mixing of scientific content with journalism.

It all came to a head with the Journal’s publication of articles in March and December of 2005 about how Canadian pharmacists question and counsel women seeking behind the counter access to levonorgestrel (Plan B). The articles were highly critical of the Canadian Pharmacists Association (CPA) which, apparently getting wind of the December story before publication from one of the reporters, complained to the CMA and responded in the journal thusly.

The March editorial asserted that counseling by pharmacists makes women “fair game for unwanted questioning and unsought advice — at their own expense” and characterized involvement by pharmacists as a “lingering paternalism.” The response from George Murray, president of CMA, made these points: “Imagine the outrage if the Canadian Pharmacists Association (CPhA) were to suggest that doctors should not ask a woman her name if she is asking for EC, or that they not be paid for the service they provide. Further, for CMAJ to suggest that the information a pharmacist collects is not kept confidential is irresponsible. Any information provided is private, secure and confidential, which would not be the case if the product was available in a convenience store or supermarket.” And this: “CMAJ's position flies in the face of the medical professions' recognition of the importance of collaborative, interprofessional practice where physicians and other health care providers have a clearly identified and valued role.”

But there are larger questions. First, is political content appropriate for a scholarly medical journal? I would disagree strongly with Dr. Hoey and argue that it is not. Such politicization occurs in the form of opinion pieces under the guise of “scientific journalism” or in less transparent forms of editorial mischief such as publication bias or the acceptance of tainted articles. How does this pollute science? For example after example read Steve Milloy’s Junk Science Judo. On page 46 he writes: “When faced with alarming ‘news’ about a new health threat (especially one that might benefit some third party), keep the slow, steady ho-hum scientific method in mind. Boring? Sure. Tedious? You betcha. Slow and deliberative? Be grateful.” It’s dangerous to mix science with public debate. Sure, science can and should inform such debate, but it should never be the other way around, and the lines of demarcation should be clear. Political discourse should not influence science. The doing and the reporting of science should be pure, pristine and sterile. Once scientific results are released from scholarly journals public debate can then be played out in other more appropriate venues.

I like the way Milloy characterizes the process of science. Tedious. Boring. Ho-hum. But Hoey takes a different view. In the May 11 NEJM piece he writes “The ability of an editor to edit depends to an important degree on the editor's own outlook and self-assurance (often mistakenly interpreted as arrogance).” (My translaton: The ability of an editor to edit depends to an important degree on the editor’s own agenda). He goes on with “An eager propensity to poke a stick into something or somebody is also useful. It is a characteristic so widespread, at least among the editors I have known, members of the ICMJE and others, that it may be essential. But the defining characteristic of an editor is quixotic idealism, a characteristic that makes publishers nervous.” Hmmm. An eloquent defense of the eternal right of journal editors to function as loose cannons.

Hoey seems to have a double standard concerning politics in medical journals. Apparently it’s OK for the editors but not for the journal owners. That untenable position is articulated in this paragraph from the May 11 article: “The notion that politically sensitive topics can be expunged from a medical journal is folly. It is also irresponsible. Physicians and their patients must have faith that professional journals facilitate a discourse unencumbered by the economic and political interests of their owners.”

Scholarly medical journals should, of course, avoid all political agendas, no matter whose. The problem can take various forms. An editor may have a political bent which the journal owners dislike, perhaps the case at CMAJ. Equally dangerous is an editorial agenda in lockstep with that of the owners, apparently the case at the Journal of American Physicians and Surgeons (JPANDS). Orac recently touched on this problem in connection with a controversial JPANDS paper purporting to demonstrate a link between mercury containing vaccines and autism. (Note that the Association of American Physicians and Surgeons opposes mandatory vaccination). The JPANDS example may be extreme but it’s nevertheless illustrative of what can happen when a medical journal cozys up to political interests. Such political affiliation has cost JPANDS a great deal in credibility as illustrated by this article by Terry Krepel (caution: ad hominem attacks here). Ironically, Hoey’s defenders seem to invoke the credibility argument in defense of more political content.

The debate about mixing journalism and politics with scholarly reporting of science was played out a few years ago in the British Medical Journal (BMJ) when that journal decided to emulate Cosmopolitan. The announcement from the pages of the January 5 2002 issue read: “The BMJ might be on a long march from being like Brain, a forbidding, research based journal, to Cosmopolitan, a magazine full of froth and colour. The trick is deciding how fast to go. Most current BMJ readers would be appalled by a BMJ that was like either Brain or Cosmopolitan, but some--- those who regret what they see as a constant "dumbing down" in our culture--- would like a journal more like Brain, while others longing for more accessibility and readability want something closer to Cosmopolitan. Today the BMJ introduces a few changes that take us closer to Cosmopolitan.” If readers wanted a dumbing down, BMJ did not disappoint. (Its heavy content of pseudoscientific fluff has earned it a venerable place on Quackwatch’s list of non-recommended periodicals).

Of course no discussion of medical politics and editorial mischief would be complete without mention of the George Lundberg incident at the Journal of the American Medical Association (JAMA). Briefly, an 8 year old study on whether oral sex is generally perceived as “sex” was suddenly selected for publication just in time to influence public debate on allegations surrounding President Clinton. Not surprisingly, Hoey and others, in the February 23 1999 issue of CMAJ weighed in with: “General medical journals are not just a repository of science….” and statements such as “policy makers, among others, crave the contributions of ‘science’” (it’s rather telling here that the authors put the word science in quotation marks). It goes on with “Moreover, it is na├»ve to think that scientific inquiry is conducted on a rarefied plane free of values and political perspectives in the first place.”

Wow. Let’s parse that statement. First, what is meant by “values?” Basic values such as scientific integrity and honesty, as well as ethical dealings with research subjects, are essential. But I would submit that “political perspectives” have no place in scientific inquiry. (Imagine the howls of indignation if that same statement was made by a Big Pharma leader with the phrase “money interests” substituted for “political perspectives).”

Finally, what about editorial independence? A reasonable view would be that journal owners should hire the editors and then let them do their job unencumbered. But just what is the job of an editor? Most would agree that it is to critically review submitted manuscripts and impartially select those that withstand rigorous scrutiny in order to ensure high scientific quality. Yes, journal owners must let editors do their job. But what is a journal to do when editors fail that job and create a conflict of interest by straying into the political arena? Nothing, apparently, according to Dr. Hoey. Dr. Hoey seems to be asking for more than editorial independence. He wants complete freedom from accountability.

Background: An expose by Michael Fumento on the tainting of science by politics as played out in medical journals.

1 comment:

Tim Lambert said...

The "expose" you cite by Fumento has some problems. Relying on Fumento is, in general, a bad idea.