not so proud…

Posted on Monday 25 May 2015

This is a follow-up to the last post [a narrative…]. I wrote Dr. Angell who pointed me to this editorial in the NEJM:
by Marcia Angell
The New England Journal of Medicine. 1999 341:752.

This week I succeed Jerome P. Kassirer as editor-in-chief of the Journal. Kassirer’s highly successful tenure was cut short after eight years when the Massachusetts Medical Society, which owns and publishes the Journal, decided not to renew his contract. Most observers were baffled by the decision, since the Journal was obviously flourishing under Kassirer’s superb leadership. In a joint announcement on July 25, Kassirer and Jack T. Evjy, president of the society, referred only to “honest differences of opinion between Dr. Kassirer and the Medical Society over administrative and publishing issues.”

Behind this oblique explanation lay a long-standing struggle between Kassirer and the society’s leadership over the latter’s ambitious plans to expand its role as a medical publisher, both in print and on line, by launching and acquiring new publications, repackaging the Journal’ s content for consumers, and entering into joint arrangements [“cobranding”] with various information-based commercial enterprises. Kassirer privately questioned the wisdom of many of these ventures, but what he strongly opposed in his capacity as editor-in-chief was the use of the Journal’s name to promote products for which he and his staff had no responsibility. To him, these activities threatened the Journal’ s credibility. To the society’s leadership and publishing staff, such leveraging not only was good business practice, but also furthered the society’s educational mission.

There were other, related disputes between Kassirer and the Journal’ s owner. The society for some time had talked of moving the Journal’ s editorial offices from the present location in Boston to the society’s headquarters in suburban Waltham. Kassirer resisted such a move, primarily because he felt it would lead to the incorporation of the Journal’ s staff into the larger organization and thereby threaten the Journal’ s quality and independence. There was also some concern that editorial autonomy might be eroded.

It is no secret that the other Journal editors and I were dismayed by the society’s decision to let Kassirer go, and that we shared many of his concerns about the use of the Journal’ s name to promote other products. The society’s action precipitated a crisis unique in the Journal’s 187-year history. There was even talk of a mass resignation by the editors, an event from which the Journal might never have recovered. Faced with the possibility of irretrievably damaging the Journal, both the society and the editors drew back from the brink. After intense discussions between the society’s leadership and the editors, Evjy and I issued a joint statement on August 4, which read, in part, as follows:
    The Massachusetts Medical Society and Dr. Marcia Angell, Executive Editor of the New England Journal of Medicine, are negotiating the terms of an agreement by which she will become interim Editor-in-Chief. We are committed to ensuring that the NEJM maintains its special position as the world’s pre-eminent medical journal. To that end, we have agreed on the following three principles:

  1. The Editor-in-Chief and her staff will continue to enjoy complete editorial independence and be fully responsible for content and editorial policy. The Editor-in-Chief will continue to confer on important editorial matters with the Society’s Committee on Publications and keep it informed, but neither that committee nor any other agent of the Society will have authority over content or editorial policy.
  2. The Editor-in-Chief will have authority over the use of the name, logo, and content of the New England Journal of Medicine, in print or any other form. Consumer versions of the content will also be subject to her approval or that of her staff. There will be no use of the name, “The New England Journal of …” for other products, as, for example, “The New England Journal of Cardiology.” Neither the logo nor the name of the NEJM will be used on other products or in marketing them, without the approval of the Editor-in-Chief, although such products may be identified as coming “from the publishers of the New England Journal of Medicine.”
  3. The Society recognizes the unique status of the NEJM within its publishing division and understands the concerns about moving the editorial offices to Waltham. No decision about moving has yet been made and none will be made without the full and active involvement of the Editor-in-Chief and her staff. In any event, no move will occur until the arrival of a permanent Editor-in-Chief.
  4. In view of our mutual commitment to these principles, we hope to reach rapid agreement on a detailed contract. [This has now been done.] In that case, Dr. Angell will serve as Editor-in-Chief until a permanent Editor-in-Chief assumes the post. Her present intention is to retire at that time. A blue-ribbon Search Committee, with representation from the professional editorial staff and the wider academic medical community, will be appointed as soon as possible.
The above principles provide a clear framework for a better relationship between the Journal and its owner, one that will permit the Journal to continue to thrive as the unique and independent institution it is. In agreeing to these principles, the leadership of the society recognized that the Journal, while legally its property, has a much broader “ownership.” For many in the academic research community, it is an invaluable and integral part of their professional lives; furthermore, much of the research published in the Journal is publicly funded, and its peer reviewers are all volunteers. The Massachusetts Medical Society bought the Journal for a dollar in 1921. Since then, it has for the most part exercised its stewardship with wise restraint and an awareness of the Journal’s larger constituency. I am optimistic that in the wake of the summer’s crisis, there will be a recommitment to this kind of stewardship. The society should take pride in such a resolution.

I’m not so proud of them as she apparently was back in the day…
    berit bryn jensen
    May 26, 2015 | 5:23 AM

    Love. There is love of truth and of people. There is lust for money. Greed. In the end it’s down to personal integrity, courage, ethics.
    Sir Iain Chalmers, co-funder of The Cochrane Collaboration, now coordinator of the James Lind Alliance, visited the Norwegian Knowledge Center’s weeklong seminar on evidence based medicine last friday. He pointed at greed as the wrecker of responsible, national health care for every citizen and trust in medicine, the greed of individual doctors contaminating the profession.

    Chalmers is on par with Loren Mosher, Marcia Angell, lovingly named Mrs Angel by her late husband Dr Relman, when they spoke on health care in Oslo a few years ago, and on how they were ignored and not consulted on policy matters by the Clintons after voicing their strong objections to the governing trend of cosy, mutually profitable industry-professional relations.
    Chalmers, Angell, Relman, Kassirer, Nardo, Goetzsche, Burstow, Whitaker deserve honour as non-corruptible men and women of love and integrity, keeping the public informed, always at a personal cost.

    I recommend rereading of Loren Mosher’s letter of resignation from the APA.

    May 26, 2015 | 6:52 PM

    Thank you berit bryn jensen for the link to Mosher’s letter of resignation. It is unbelievable to me that he knew all that in 1998 – in terms of relevance – itseems like it was written yesterday.

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