We start a new series with this issue.
The Looking Glass
The Looking Glass will depict how others look at medical practice, its
practitioners, mental health workers and philosophers. It will also reflect on happenings in the world of Medicine and
We start with Medical Journals. The CMAJ...
CITATION: Singh A. and Singh S. (2006), A Look At CMAJ: A Misty Image
Indeed (The Looking Glass). In: What Medicine Means To Me, MSM, III:6, IV:1-4.
A Look At CMAJ: A Misty Image Indeed
The date: Feb 20, 2006. Medical publishing was rocked
by the sudden dismissal of the Editor In Chief of the CMAJ (Canadian Medical Association Journal) John Hoey, and
a Senior Deputy Editor Anne Mary Todkill. The Editor appointed in the interim, Stephen Choe and another Deputy Editor
Sally Murray, also resigned in a week's time, on 28 Feb to be precise. Along with them also went Jerome Kassirer,
former CMAJ editorial board member and a former editor of the New England Journal of Medicine (NEJM), appointed to
frame regulations or governance plans about editorial independence.
All these are well-respected professionals in the field of biomedical publication and there has
been a huge outcry, both in the medical as well as popular press, at their abrupt sacking.
If this were not enough, fifteen out of the nineteen members of the editorial board of the CAMJ
also resigned, precipitating a grave crisis. In the meanwhile, the CMA, in an attempt at damage control, appointed an interim
Editor, Noni Macdonald, along with an Editor Emeritus, Bruce Squires, who has been an earlier editor of CMAJ, and a
founder member of WAME. A retired Chief Justice of the Canadian Supreme Court has been appointed to chalk out a Governance
Plan for Editorial independence. Changes are also envisaged in the JOC (Journal Oversight Committee). The CMA President is
exhorting everyone concerned to move on, and has assured a policy of editorial independence. The atmosphere, at the time of
writing this, is combative and smoldering, and a distinct unease prevails.
Long Standing Feud
There has been a long-standing feud between the CMA, the organisation
that owns and tries to control CMAJ, and the Editor of CMAJ over editorial independence. John Hoey
has been asking for greater editorial independence since the journal, although belonging to the CMA, according to him, actually
belongs to the whole world of medicine and science, and is, really speaking, accountable mainly to them.
John Hoey, in nearly
a decade at the helm (he was hired in August 1996), has brought CMAJ from a modest
journal to one whose impact factor is today fifth in the world of general medical journals,
only less than that of the NEJM (38.6), JAMA (24.8), Lancet (21.7) and BMJ (7.0). He brought it from an impact factor of 1.6 in 1997 to an impressive 5.9 in 2004. (It has since
gone to 7.4 in 2005. See About CMAJ at: http://www.cmaj.ca/misc/about.shtml).
has happened with the CAMJ closely approximates what happened with JAMA in 1999 when George Lundberg, the editor for 17 years
(Jan 1982 onwards), and who brought it to scientific respectability, was summarily sacked by the executive vice-president
of the American Medical Association (AMA), E Ratcliffe Anderson, Jr., during the Bill Clinton oral sex episode. He was sacked
because he fast tracked an article on college students' perception whether oral sex constituted sex (Sanders and Reinisch, 1999). A predominant
section, 59%, felt it did not. Now this coincided with the Bill Clinton-Monica Lewinsky episode, for which the Republicans
wanted to impeach the President. And the publication of such a report in a prestigious Journal like the JAMA may have acted
to blunt the opposition. The AMA, which owns the JAMA, predominantly supported the Republicans. Such a fast track publication
by the powerful Editor was thought to be a political move by the Association Office bearers. Although, mind you, it was peer
reviewed and accepted for publication in a proper manner. But the fact that it was fast tracked to coincide with this episode
was enough to precipitate the sacking. And no amount of outcry that the Journal fast tracked not for any other reason but that
it was topical convinced the Association to change its stance. For further reading connected to this, please
refer to Hoey, Caplan, Elmslie
et al (1999); Smith (1999a, 1999b); Van Der Weyden (1999); Kassirer (1999a); and Horton (1999).
The same year, Jerome Kassirer, Editor of NEJM, was
sacked because he insisted the Massachusetts Medical Society, which owns the journal, not use the name of NEJM for ancillary
products as it may increase the credibility of the latter but ran the danger of reducing the credentials of the former, carefully
developed and crafted by Editors and their Boards by decades of hard work. Well, the argument too did not cut
much ice with the association wanting to cash in on the NEJM name, and he was fired too.
Marcia Angell, who came as interim Editor-in -Chief, too did not last long at the helm. For those who need to be updated,
she went on to write the reasonably well read, The Truth About Drug Companies: How They Deceive Us And What To Do About It
(Angell, 2004) after that, as she appeared fed up with the way pharma tried to manipulate medicine, and medical journals too.
Kassirer too, interestingly, went on to write his own book on a similar theme: Parmley (2000), Kassirer (1999b)
and Angell (1999).
of the Editorial Governance Plan 1999; DeAngelis and Maves 2004), as well as discussion on editorial governance
and independence by concerned academicians and editors (Davies and Rennie, 1999).
The JAMA since then has had a relatively smooth sailing.
What Sparked It All
The CMAJ episode was sparked off by two separate
but related incidents (although, to be fair, the CMA and the CMA Media Inc President deny any such links).
One was in September 2005, when a Plan B morning-after
pill (levonorgestrel), a pill for contraception to be used by females, was investigated in the CMAJ. (It is not only
a morning after pill. Well it is in a way, for supposed to be taken morning after, but effective if taken up to even 72 hours
later). The pharmacists had a big stake in the product. It was changed from a prescription to a non-prescription emergency
contraceptive drug, but with an important rider. The pill was costly enough, but the pharmacist was supposed to charge
almost an equal amount for counselling about the appropriateness of the drug. Moreover, they were supposed to collect personal
details, including sexual history, during this counselling. The CMAJ probed this by asking a few ladies whether they approved
of this, which obviously they did not (Eggertson and Sibbald, 2005). The Canadian Pharmacists Association objected, saying a medical journal had no business
to do investigative journalism. The CMA, the controlling body, concurred with the pharmacists for obvious reasons. Also, they
probably wanted a stick to beat an uncompromising editor with. The article was published with alterations suggested by the
CMA. But the Editor wrote an editorial on 3 January 2006 (early release 12 December 2005), denouncing the act, accusing
the publisher of editorial interference since they removed a sidebar to the journal's news article which suggested that pharmacists
were infringing on women's privacy rights by demanding and registering personal information on the Plan B contraceptive (CMAJ,
We have a transgression
to report. While the Dec. 6, 2005, issue was in preparation, the editorial independence of the journal was
compromised when a CMA executive objected strenuously to a news article we were preparing on behind-the-counter
access to emergency levonorgestrel (Plan B). The objection was made in response to a complaint from
the Canadian Pharmacists Association, who had learned about the article when they were interviewed by
our reporters. The CMA's objection was conveyed to CMAJ's editors, and to our publisher, who subsequently instructed
us to withhold the article.
The stated objection was to our reporting method; as one component of the story,
we had asked 13 women from across Canada to attempt to purchase Plan B from a pharmacy in their community and then
tell us what the experience was like. The CMA questioned the propriety of our investigation and the boundary
between news reporting and scientific research. Our story was not scientific research, however, but
legitimate journalism (CMAJ, 2006).
See: Reinstate Sacked Editors of CAMJ
The Ground Realities, And The Action Plan
Comment No 9 in Globe and Mail.
Why only damage control, why not redeem yourself, CMA?
From Interim to Long Term
Mens Sana Monographs [MSM]: A Mens Sana Research Foundation Publication