Correspondence

Expediting Publication to Inform Political Debates

N Engl J Med 1999; 340:1681-1683May 27, 1999

Article

To the Editor:

We firmly believe that you were correct in saying (Feb. 11 issue)1 that editors should have the liberty to publish articles or advance the publication of articles that create “a lively forum for exposure and discussion of important issues that involve, even indirectly, health and medicine.” However, we must disagree with the application of this logic to the article that you claim resulted in Dr. George Lundberg's dismissal as editor-in-chief of the Journal of the American Medical Association (JAMA). Advancing the publication date of the article in question did not “contribute to the development of public policy.” The timing of its publication was not “critical to the public health.” And, clearly, it was not an editorial expressing the opinion of the editor. The timing of the publication of this article was not even important with respect to providing substantive evidence for the Senate trial with which it was timed to coincide. Since none of the critical concepts that you use to frame this issue apply, we do not agree with either your indictment of the decision of Dr. E. Ratcliffe Anderson, the executive vice president of the American Medical Association (AMA), as “irrational” or your declaration that this is an “ominous precedent.” On the basis of other public statements, we believe that Dr. Anderson responded appropriately to an act that was a culmination of problems, not a single event.

Robert L. Phillips, Jr., M.D.
University of Missouri, Columbia, MO 65212

Charles J. Rainey, M.D., J.D.
Medical College of Wisconsin, Milwaukee, WI 53226

Edward R. Tuohy, IV, M.D.
Yale University School of Medicine, New Haven, CT 06520

1 References

1
Kassirer JP. Should medical journals try to influence political debates? N Engl J Med 1999;340:466-467
Full Text | Web of Science | Medline

To the Editor:

Your editorial regarding the firing of the editor-in-chief of JAMA was correct in every regard save one: its conclusion. The conclusion that the firing was “an irrational decision and an ominous precedent” is based on the flawed initial premise that the rationale for the firing was advancing publication of an article with the goal of influencing political events. If that premise were correct, most physicians and scientists, I among them, would agree with everything you wrote. At issue, however, was not a generic political event. Lundberg intended to influence a particular kind of political event — specifically, one that has nothing to do with medicine or health care. His choice of editorial subject lay outside what Dr. Anderson, representing the AMA, believed to be proper editorial boundaries.

In support of Lundberg, you cited the Journal's participation in debates regarding health policy, public health, and legal issues in health care; your own editorials on the medical uses of marijuana, a proposed federal ban on cloning experiments, and congressional practice of medicine; and your putting on a fast-track reports and opinion pieces on starvation in Somalia, health care reform, the tobacco settlement, and the ethics of clinical research in developing countries. Every one of those publications was in some way related to health care.

Regardless of whether the article in question was poor science, as some have claimed,1 the debate that Lundberg was trying to influence had nothing to do with health care. That gun control and domestic violence are related to health is plausible; the impeachment of a president is not. Timing publication to coincide with a Senate trial does not suggest an interest in health policy, public health, medical ethics, or health law. Rather, it bespeaks transparently partisan politics.

There are boundaries for the editorial policy of medical journals. I have not seen, nor do I expect to see, an editorial in the Journal or in JAMA supporting a particular candidate for public office or touting a specific common stock. One might agree, as I do, or disagree with Dr. Anderson's delineation of editorial boundaries for JAMA, but there can be no question that such a boundary exists and is necessary. The AMA is politically active and must work with both parties in achieving its health policy and public health goals. The use of JAMA to pursue partisan political goals, in my opinion, crosses the boundary of editorial propriety.

Robert M. Sade, M.D.
Medical University of South Carolina, Charleston, SC 29425

1 References

1
McCormick B. Removal of JAMA editor draws fire. American Medical News. February 1, 1999:1.

To the Editor:

. . . Your nicely documented personal approach to the topic of journalistic relevance offers a strong defense of Dr. Lundberg's editorial judgment. But it is Dr. Lundberg's judgment, not yours, that is in question. Although editorial independence is a hallowed journalistic concept, judgment is a personal characteristic. Implicit in every exercise of editorial independence is a review of editorial judgment by the readers and the publishers. Editors are not appointed for life, and editorial independence does not make them fireproof.

The medical profession and its journals are neither advanced nor ennobled by unwisely wading into the tortured semantics of an acrimonious political conflict, the outcome of which has nothing to do with public health, health care, or the medical sciences. Journals, institutions, leaders, and political candidates who strain to show their relevance to every passing issue, convinced of the illuminating nature of their comments, eventually become self-parodies, unable to tell big issues from little ones, thereby losing their effectiveness, their reputations, and ultimately their constituencies. A sharply focused sense of relevance is a signal difference between the professional journal and the common magazine.

Although you have defended Dr. Lundberg on the grounds of editorial independence, one is left to ponder whether you and the Journal would have expended any precious journalistic capital on the article in question. Nothing in my 30 years as a reader of the Journal suggests that you would have done so.

J. Richard Hickman, Jr., M.D., M.P.H.
Mayo Clinic, Rochester, MN 55905

To the Editor:

I firmly agree with Dr. Anderson's decision to fire the editor-in-chief of JAMA. I believe that any political views of an organization should be left to a specified section of the organization for study and action as may become indicated. Such views should not be put forth by an editor as if they represented members' viewpoints. . . .

Mary C. Burchell, M.D.
Box 769, Alamo, CA 94507

To the Editor:

You decry the firing of the editor of JAMA for publishing an article on the sexual attitudes of college students. . . . Was the JAMA article intended to influence a public health issue? Hardly. This was a blatant attempt to influence a national political process that had little to do with sex and nothing to do with health. JAMA was intruding on a purely political action and doing so on the side that I seriously doubt a third of the AMA membership would have supported. At medical meetings, I often find myself the sole supporter of liberal ideas. Clearly, JAMA exists to serve and represent the membership of the AMA. Just as the former editor excoriated the prior leadership of the AMA over the doomed deal with Sunbeam because it did not represent the views of the membership, so, too, was Dr. Anderson correct to end political adventurism.

A.J. Parmet, M.D., M.P.H.
1020 W. 66 St., Kansas City, MO 64113

To the Editor:

The content of one controversial article in JAMA over a 17-year span is not the issue. The fundamental problem is the interference of the publisher, the AMA. In one public tantrum and cudgeling, the AMA has destroyed the editorial independence of JAMA, assaulted not only the editor-in-chief but also the journal's editorial boards, and destroyed the confidence of potential contributors to journals published by the AMA.

As a past trustee and chair of the board of the AMA, I found that it was not unusual to receive complaints from persons and organizations about articles or editorials in the journals. The boards of trustees and the executive vice presidents of the AMA with whom I was privileged to work recognized the necessity for editorial independence. This is what brought these journals unprecedented renown, only to be destroyed by the autocratic actions of the current executive vice president, with the support of the AMA's board of trustees.

Raymond Scalettar, M.D.
730 24th St., NW, Washington, DC 20037

To the Editor:

Bravo for your editorial echoing the sentiments of many of us rank-and-file physicians. I, too, am outraged at the firing of Dr. Lundberg for publishing a survey of college students' opinions on oral sex. It was Dr. Anderson, in his knee-jerk firing of Dr. Lundberg, who committed an unforgivable political act within the framework of medicine. Dr. Lundberg was exerting his version of responsible judgment in a brave and timely fashion. If we disagree with the implied viewpoint of a publication, we can do so by writing letters to the editor, presenting contrary evidence in other studies, or otherwise exerting our rights to free speech and free intellectual inquiry.

Pepi Granat, M.D.
7800 Red Rd., South Miami, FL 33143

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