{"id":63930,"date":"2016-03-07T20:06:36","date_gmt":"2016-03-08T01:06:36","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=63930"},"modified":"2016-03-07T21:02:57","modified_gmt":"2016-03-08T02:02:57","slug":"a-hard-pill","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/03\/07\/a-hard-pill\/","title":{"rendered":"a hard pill&#8230;"},"content":{"rendered":"<div align=\"justify\" class=\"small\">In case you don&#8217;t recognize the author of the BMJ blog below, he&#8217;s the former <font color=\"#200020\">New England Journal of Medicine<\/font> Editor who was fired in 1999 for upholding the principles that had made that prestigious journal great. As far as I&#8217;m concerned, <font color=\"#200020\">Jerome Kassirer<\/font>, his predecessor <font color=\"#200020\">Arnold Relman<\/font>, and his Assistant Editor <font color=\"#200020\">Marcia Angell<\/font> [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&#8217;s case,  he lost his position for doing the right thing. Here&#8217;s my brief summary of that story if you don&#8217;t know it:<\/div>\n<ul><span class=\"small\">      <\/p>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/24\/a-narrative\/\">a narrative&hellip;<\/a><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/25\/57179\/\">not so proud&hellip;<\/a><\/div>\n<\/li>\n<p>      <\/span><\/ul>\n<div align=\"justify\" class=\"small\">To his credit, Dr. Kassirer is still trying. Here he reports on what must be a painful <em><font color=\"#200020\">d\u00e9j&agrave; vu<\/font><\/em>:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/blogs.bmj.com\/bmj\/2016\/03\/04\/jerome-p-kassirer-a-canadian-purge\/\" target=\"_blank\">Jerome P Kassirer: A Canadian purge<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#0033ff\">BMJ Blogs <\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">4 March 2016<\/div>\n<p align=\"justify\">Earlier this week the Canadian Medical Association [CMA] <a href=\"http:\/\/www.theglobeandmail.com\/news\/national\/critics-decry-canadian-medical-journals-orwellian-revamp\/article28960721\/\">fired the editor in chief<\/a> of the <em>Canadian Medical Association Journal<\/em> [<em>CMAJ<\/em>], citing slipping journal revenue and declining reputation as a cause. The journal&rsquo;s oversight committee [JOC] &mdash; set up in 2006 to safeguard  the journal&rsquo;s editorial independence against political and economic  transgressions &mdash; negotiated with both the CMA and the CEO of the  corporation that runs the journal, hoping that a compromise could be  reached.   <\/p>\n<p align=\"justify\">But now the <a target=\"_blank\" href=\"http:\/\/www.cmaj.ca\/site\/misc\/cmaj_joc.xhtml\">JOC exists no more<\/a>. Simultaneous with the firing of the <em>CMAJ<\/em> 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.&nbsp;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&rsquo;s independence could be preserved.<\/p>\n<p align=\"justify\">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].   <\/p>\n<p align=\"justify\">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 <em>CMAJ<\/em>  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.   <\/p>\n<div align=\"justify\">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.&nbsp;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.<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">In a later section of his blog [also <a target=\"_blank\" href=\"http:\/\/blogs.bmj.com\/bmj\/2016\/03\/04\/jerome-p-kassirer-a-canadian-purge\/#more-36283\">on-line<\/a>], Dr. Kassirer documents yet an earlier version of this same scenario with this same journal. I know it&#8217;s not just a story about the Canadian Medical Association&#8217;s Journal, or even journals in general, but many other segments of medicine as well &#8211; 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.<\/div>\n<p>  <\/p>\n<div align=\"justify\" class=\"small\">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&#8217;ve run across in the last several years. And I need to remember that tomorrow when I work in the clinic, I won&#8217;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&#8217;ll think about the patients, and the volunteers that work in the clinic, and I&#8217;ll come home tired and take a nap. And it won&#8217;t seem so dark as it does when I read an article like this one. But for this moment, it&#8217;s a hard pill to swallow. He&#8217;s definitely one of the good guys&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In case you don&#8217;t recognize the author of the BMJ blog below, he&#8217;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&#8217;m concerned, Jerome Kassirer, his predecessor Arnold Relman, and his Assistant Editor Marcia Angell [later [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-63930","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63930","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=63930"}],"version-history":[{"count":10,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63930\/revisions"}],"predecessor-version":[{"id":63940,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63930\/revisions\/63940"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=63930"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=63930"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=63930"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}