Who calls the tune at the Canadian Medical Association Journal?
CBC News Online | April 7, 2006
A witty cynic once observed that freedom of the press is reserved for those who own a press. The pity of it all, of course, is that it's true. Everyone has always known that the guy who owns the paper, or the guy who publishes it, is the ultimate boss.
It would be nice to think otherwise; indeed, one of the sustaining myths of our society is of the crusading editor who tells it as it is and who can do so because we all believe in the freedom of the press. But that is a myth, and everyone knows it.
That said, there is an exception. Scientific journals have long enjoyed a freedom ultimately unknown to other publications because they are dealing with scientific knowledge and discovery, the reporting of which must be free of even a hint of ulterior interest.
The exception to the rule?
To take the most obvious example, because medical journals are largely dependent on advertising by the pharmaceutical industry, they must avoid even the slightest suspicion that pharmaceutical companies dictate or even influence editorial policy. Such suspicions would leave those journals with no credibility.
The case was well put recently by Dr. John Hoey, then editor of the Canadian Medical Association Journal, which has been much in the news:
"Readers expect CMAJ editors to select content without interference, and authors expect their work to be judged without regard to the interests of any third party. Readers and news media who rely on our reporting need to know that our journalists are not subject to censure."
Several years ago, explaining the relationship between the American Medical Association and that organization's journal, Hoey wrote that the AMA does not own the journal in the usual sense but rather, "It is the custodian of it."
Of course they're free – or are they?
This is where the myth of the free and unfettered scientific journal falls thump on the ground.
In late February, Hoey and his senior deputy editor were fired following a series of events that included, in particular, a complaint to the CMA by the Canadian Pharmacists Association. In the turmoil of their departure, two full-time editors, two part-time editors and 15 of the 19 members of the editorial board have resigned.
The CMA has not yet explained why it fired Hoey and deputy editor Anne Marie Todkill, except to say that it was time for a "fresh" approach.
One of the surprises that emerged from the furor of recent months has been the high esteem in which the CMA Journal is held. The "impact factor" of the journal – the measure of the scientific importance of the articles it published – is the fifth highest of the world's general medical journals. Its impact factor has more than tripled in the decade in which Hoey was editor.
Among the medical journals that have spoken out recently in defence of Hoey and the CMAJ are the Lancet of the British Medical Association and the New England Journal of Medicine, two of the world's most respected medical journals. One of the CMAJ editorial board members who resigned to protest the firings was Dr. Jerome Kassirer, a former editor of the New England Journal of Medicine.
The core conflict
In retrospect, the apparent cause of the crisis between Dr. Hoey and the CMA seems insignificant – except that it seems to go to the core of that perennial potential conflict between a publisher and major advertisers.
The offending article was a news report by the CMAJ that the Canadian Pharmacists Association is advising its members to collect women's names, addresses and particularly personal information when the women order the so-called "morning-after pill," which is designed to prevent conception immediately after intercourse. The information included some aspects of the women's sexual history.
At the same time, the CMAJ reported that there was no requirement to collect such personal information for a non-prescription medication, and no apparent need, especially when it could be embarrassing for customers, particularly in the case of younger women.
In addition, journal reporters interviewed several privacy experts who raised security concerns about the information that pharmacists were being urged to collect. The journal talked with 13 women across the country who had bought the morning-after pill and asked them to report on how they had been treated by pharmacists.
When the pharmacists association complained to the CMA, the CMA in turn complained to Hoey about the survey.
One of the complications in reporting on the dispute is that staff at the journal must sign confidentiality agreements under which they are prevented from discussing internal matters.
In the past there have been a number of requests from the CMAJ and its staff for a written guarantee of editorial independence, as are provided at some other medical journals, but their requests were ignored.
Those requests have been repeated since the affair blew up first in December with the controversy over the pharmacist story. But the indications are that the CMA is no more inclined now than in the past to guarantee the editorial independence of its once esteemed journal.