a hard pill…

Posted on Monday 7 March 2016

In case you don’t recognize the author of the BMJ blog below, he’s the former New England Journal of Medicine Editor who was fired in 1999 for upholding the principles that had made that prestigious journal great. As far as I’m concerned, Jerome Kassirer, his predecessor Arnold Relman, and his Assistant Editor Marcia Angell [later interim editor] are all three true heros of the realm. Early on, they saw what was coming and tried to warn us. And in Dr. Kassirer’s case, he lost his position for doing the right thing. Here’s my brief summary of that story if you don’t know it:
To his credit, Dr. Kassirer is still trying. Here he reports on what must be a painful déjà vu:
BMJ Blogs
4 March 2016

Earlier this week the Canadian Medical Association [CMA] fired the editor in chief of the Canadian Medical Association Journal [CMAJ], citing slipping journal revenue and declining reputation as a cause. The journal’s oversight committee [JOC] — set up in 2006 to safeguard the journal’s editorial independence against political and economic transgressions — negotiated with both the CMA and the CEO of the corporation that runs the journal, hoping that a compromise could be reached.

But now the JOC exists no more. Simultaneous with the firing of the CMAJ editor, members of the JOC were invited to attend a conference call where they, too, were dismissed. This act was a shocking breach of faith, in direct contravention of the processes that the CMA had put in place and repeatedly reaffirmed over the years. In an Orwellian form of logic, the CMA, having dismissed both the editor and the committee, asserted that it was strengthening and reaffirming editorial independence. Given that a new editor will report to the CMA Board or some other entity appointed by the board, it is difficult to imagine how a new editor’s independence could be preserved.

Journal oversight committees are no panacea, and there are circumstances that justify dismissing a journal editor, but the expertise of the JOC volunteers cannot be assailed. By design, it included a tenured professor of journalism with decades of experience as a professional journalist, a generalist physician who has spent 30 years in rural practice and founded a rural medicine journal, an academic clinical investigator with publishing experience for a national organization, a former dean of a medical school who had also been editor in chief of a cardiology journal and had served on the Pound Committee, and one American [myself].

Medical journals are no longer as profitable as they were when I was an editor of a major journal. Many young physicians no longer subscribe and they get their medical information online. Smartphones are rapidly overtaking many other information sources. Advertising revenues, which made up most of the profits in the past, have declined and online revenues have not kept up. If the CMAJ is not considered sufficiently profitable, CMA members have a choice, namely to support the journal from membership dues or not. But to expect the journal to publish high quality work, improve its web presence, and continue to comment on the critical issues facing Canadian medicine on a bare bones, depression-scale budget was never a realistic option.

Medical journals, like the scholarly exchanges of academia, are a public good. Whether journals are owned or operated by industry or medical societies, they share a tight bond with academia. Their editors are recruited from academia, their content is derived from the research and opinions of academic physicians, and academic institutions evaluate their faculty based on where their papers are published. Given these attributes, journal owners are expected to abide by some basic precepts: fairness, openness, and dedication to editorial independence. CMA members should question their allegiance to an organization that fires its journal editor when expedient, treats its professional advisors with disdain, and bends so readily to corporate and financial influences.
In a later section of his blog [also on-line], Dr. Kassirer documents yet an earlier version of this same scenario with this same journal. I know it’s not just a story about the Canadian Medical Association’s Journal, or even journals in general, but many other segments of medicine as well – like Academic Departments having trouble financing training and scholarship that sometimes ally themselves with the pharmaceutical and the medical device industry, or form commercial University Medical Enterprises, and sometimes end up legitimizing or even colluding with the very misbehavior that academic institutions are expected to guard against. The rationalizations are as monotonous as the misguided solutions.

So when I read a story as disheartening as this one, or write a paragraph as gloomy as that last one, I try to recall just how many Dr. Kassirers I’ve run across in the last several years. And I need to remember that tomorrow when I work in the clinic, I won’t even think about this kind of discouraging stuff except for the odd sneer at the new electronic medical records software running on a donated computer in my office. I’ll think about the patients, and the volunteers that work in the clinic, and I’ll come home tired and take a nap. And it won’t seem so dark as it does when I read an article like this one. But for this moment, it’s a hard pill to swallow. He’s definitely one of the good guys…
  1.  
    James O'Brien, M.D.
    March 8, 2016 | 12:38 PM
     

    “Medical journals, like the scholarly exchanges of academia, are a public good. Whether journals are owned or operated by industry or medical societies, they share a tight bond with academia. Their editors are recruited from academia, their content is derived from the research and opinions of academic physicians, and academic institutions evaluate their faculty based on where their papers are published. Given these attributes, journal owners are expected to abide by some basic precepts: fairness, openness, and dedication to editorial independence. CMA members should question their allegiance to an organization that fires its journal editor when expedient, treats its professional advisors with disdain, and bends so readily to corporate and financial influences.”

    He’s describing a Skinner Box that would not lead to that noble outcome he desires. Journal owners are making thirty percent plus profit margins and academics have hundreds of journals in which to publish shoddy work, so what’s the incentive to be selective and rigorous? All the carrots and sticks here lead to large volumes of worthless research being published. And it’s not just psychiatry or medicine it’s academia in general. Check out this study published courtesy of the US taxpayer for over 400K:

    http://phg.sagepub.com/content/early/2016/01/08/0309132515623368.long

    That is not an Onion parody or a prank. The lead author is associate dean and the University of Oregon.

    The relationship between academia and publishing companies has become very much like the relationship between government and lobbyists.

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