Correspondence
The Departure of Jerome P. Kassirer
N Engl J Med 1999; 341:1310-1313October 21, 1999
- Article
To the Editor:
I have always been proud of the great succession of editors at the Journal — Garland, Ingelfinger, Relman, and Kassirer. Their distinguished leadership and integrity transformed a fine regional medical journal into a national and international one, making it the most prestigious and reliable publication in the world and the most sought one in which to be published.
The great movement in medicine in the past 25 years has been the ever-increasing influence of our business-oriented society in fractionating medical care into profit-making segments. Nonprofit hospitals have set up profit centers. Some doctors have become entrepreneurs. The cost of pharmaceutical products and medical equipment has become far too high. Various insurance plans now use 35 percent of medical dollars for administrative costs. Health maintenance organizations have become more interested in divesting themselves of old people than in maintaining health. Increasingly, an attempt is being made to limit care by making it administratively difficult and time consuming for physicians to arrange. Professionalism is hard to maintain in such an atmosphere. Our whole system of medical care is deformed by this great drive for profits.
The Massachusetts Medical Society's Committee on Publications has now brought the weight of this corporate mentality to bear on the Journal, and the editor-in-chief rightly resisted the edict to sponsor profitable subsidiary ventures of uncertain or dubious merit. If the Society wishes to sponsor profitable subsidiaries, it must do so by itself, without reference to the Journal, of whose professional integrity let there be no doubt.
Arthur J. Garceau, M.D.
South Shore Medical Center, Norwell, MA 02061-1795To the Editor:
I regret very much the ousting of the Journal 's editor-in-chief, Dr. Jerome Kassirer. Concerning the “branding” of other publications of the Massachusetts Medical Society, I agree with Dr. Kassirer. I was often astonished to receive such promotions from the Society, and the number of these promotions seems to have increased, especially since 1998. If this kind of branding continues, I will consider canceling my subscription to the Journal, and I will surely look critically at the Journal 's quality under the new editors.
Christian Dieterich
Medizinische Hochschule Hannover, D-30623 Hannover, GermanyTo the Editor:
I read with anguish the July 27 article in the Wall Street Journal 1 announcing the ouster of Dr. Kassirer. Following as it does closely on the heels of a similar action by another prestigious journal, this action seems to imply that the future of print journals and the concept of high-quality peer review are in jeopardy.
For years I taught medical students and members of house staff to seek the best journal in their field of interest, and I used the Journal as an example. The quality of a journal may be defined in many ways, but the level of expertise of peer reviewers, the numbers of papers of current importance published, and the degree of editorial freedom are clearly important elements. We now face “parent” society management of the content and character of journals and the introduction of entangling commercial alliances. Is it possible that the bottom line is intruding into scientific journalism as well as into health care?
Also distressing is the fact that the issues governing the ouster of the editor-in-chief were never presented to the readership or subscribers. We are not privy to all the facts, but the article1 alluded to a conflict over both a Web-site link to a book publisher and, on a larger scale, electronic as opposed to print journalism. I am a retired chairman of medicine, a past president of our county medical society, and am reasonably computer literate, and I use the Web for information. However, I depend on peer-reviewed information in major medical journals to stay abreast of information vital to high-quality care of patients. Will I be denied the pleasure of reading in the supine position? Will I have the option to subscribe to paper journals or at least to click on “peer reviewed” before printing an article? Will the Journal remain the best? A discussion of some of these issues seems in order.
1 ReferencesEugene Furth, M.D.
416 Riverside Dr., Washington, NC 27889To the Editor:
It is difficult to convey the sense of dismay I felt on learning of Dr. Kassirer's dismissal as editor-in-chief of the Journal. Under his leadership the Journal has remained one of a shrinking number of islands of professionalism in a medical environment awash in a sea of marketplace economics. My dismay is heightened by the fact that Dr. Kassirer's dismissal is emblematic of the profound changes that have taken place in medicine, as in much of society, where virtually everything has a monetary value and where success is measured in terms of return on investment. With this as the dominant paradigm in our society, it now seems inevitable that Dr. Kassirer's repeated calls for a higher order of medical ethics would clash with the commercialism that is so prevalent.
Arnold L. Lentnek, M.D.
Kennestone Hospital, Atlanta, GA 30060To the Editor:
Doctors have long struggled with the conflict between personal gain and benefit to the patient. This conflict requires careful negotiation, often resolved by referring to the oath of Hippocrates: “Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption.” And it is the maintenance of this code that gives physicians their professional status. Professionalism is not simply the adherence to a series of abstract principles; rather, it requires the constant affirmation of a contract between society and the profession, in which physicians must continually prove to the public that they are worthy of the trust and respect extended to those who wear a white coat.
The dismissal of Dr. Kassirer as editor-in-chief of the Journal is a single event in a much larger and more disturbing trend in American medicine. The Massachusetts Medical Society has, in this dismissal, expressed a preference for business principles over intellectual integrity. Dr. Kassirer's refusal to dilute the standards and reputation of a leading medical journal in the face of attempts to “franchise” the name represents a decision to uphold the honorable principles of this profession.
David T. Stern, M.D., Ph.D.
Ann Arbor Veterans Affairs Health System, Ann Arbor, MI 48105M. Roy Schwarz, M.D.
China Board of New York, New York, NY 10017To the Editor:
Jerome Kassirer was a teacher and mentor of mine at Tufts University School of Medicine and the New England Medical Center from 1975 to 1980. His unwavering commitment to medical science, academic research, and science-based clinical decision making in a physician's everyday tasks was his mantle. No student or resident escaped his keen mind and demand for excellence. We rose to a higher level of achievement in his presence.
The Massachusetts Medical Society's decision to fire Kassirer because he refused to squander the Journal 's reputation for excellence confirms my cynicism about medicine in the modern era: the only thing that matters is the bottom line.
Shame on the Society. The Journal will be diminished by Dr. Kassirer's departure. I will remain convinced that it is impossible to do the right thing and prevail.
Heddy-Dale Matthias, M.D.
1 Roses Bluff Dr., Madison, MS 39110To the Editor:
Shock, then outrage, was my reaction to the July 31 article in the Lancet 1 on the departure of Jerome Kassirer as editor-in-chief of the Journal. Shock, because I had difficulty in placing the action of the Massachusetts Medical Society in the context of the fierce independence of ethical and professional advocacy I associated with the Ingelfinger–Relman–Kassirer triumvirate. Outrage, that my personal professional world had been violated.
My continuing education and love of medicine have relied heavily on my weekly “fix” from the Journal and the Lancet. I have urged successive cohorts of medical graduates to subscribe. Clearly, the Journal in its importance and status dwarfs its parent medical society and therefore imposes a duty of trust on the Society's officers. They seem to have learned nothing from the debacle at the Journal of the American Medical Association.
1 ReferencesWilliam P. Tormey, F.R.C.P.I.
Beaumont Hospital, Dublin 9, Ireland1
Horton R . Confusion as New England Journal editor is forced out. Lancet 1999;354:399-399
CrossRef | Web of Science | Medline
To the Editor:
The revelation in the July 27 New York Times 1 of Kassirer's forced resignation makes me very sad. As with Arnold Relman before him, Kassirer's editorial muscle helped maintain the Journal as the most potent and visible force for professional growth in the medical press. The Journal has been my constant source of the most credible information since I became a physician 44 years ago. It remains my only subscription even in retirement.
Kassirer's editorials and commentary during his tenure as editor-in-chief revealed his opinionated forcefulness, always fully referenced and believable. The fact that rejected articles were published in other journals explains why the Journal remains preeminent among its peers.
The Massachusetts Medical Society surely both takes pride in and reaps financial rewards from the Journal. Anything that diverts resources from the maintenance of the Journal 's excellence and preeminence will lead to its deterioration. The arrival of fancy boardrooms has presaged the decline of many flagship institutions in the industrial world.
The back-room debates and maneuvers for dominance at the Society were not revealed by the article in the New York Times. The result, however, is the forced resignation of Kassirer, who has aptly managed the Journal in its continued enviable preeminence and financial success. I am sad that the consequence may be an unnecessary and preventable decline in its value.
1 ReferencesAlan F. Carpenter, M.D.
1890 Granger Ave., Los Altos, CA 94024The above letters were sent for reply to Dr. Kassirer and to Dr. Jack T. Evjy, president of the Massachusetts Medical Society.
Author/Editor Response
Dr. Kassirer replies:
To the Editor: I am deeply touched by these letters of support and by the hundreds of letters and phone calls I have received in the past several weeks, many from people I have never met. Many asked how and why my tenure as editor-in-chief of the Journal was ended. The decision was made by the Massachusetts Medical Society's Committee on Administration and Management. This committee requested no input from the Society's trustees or the Committee on Publications, the body responsible according to the Society's bylaws for the publication of the Journal and the body to which the editor-in-chief has reported for decades. The announcement of my impending departure triggered resignations from the Committee on Publications, the Journal 's editorial board, and I am told, dozens of members of the Massachusetts Medical Society.
It is now common knowledge that I blocked many attempts to use the Journal 's name on unrelated products. I argued repeatedly that it was misleading to use this highly respected brand name to promote other products simply because the Society owned the Journal. I believed that such “cobranding” would sully the Journal 's reputation. The press also reported correctly that I objected strenuously to incorporating personnel in the separate and independent editorial office, currently housed in the distinguished Countway Library of Medicine at Harvard University, into the corporate headquarters of the Society in Waltham, some 12 miles west. I worried that transferring the Journal 's editors and staff away from their reflective and recondite haven in this library to the environment of the Society would eventually tempt the Society's administrators to involve the Journal 's highly focused and expert editorial staff in unrelated publishing ventures. In fact, such efforts were already under way without a planned move.
The set of principles that Dr. Marcia Angell, now interim editor-in-chief, announced in her editorial in the September 2 issue1 gives temporary solace, but as long as cobranding and the potential incorporation of the Journal 's editorial staff into the Society's corporate headquarters remain unresolved long-term issues, the crisis is not over. The Society's members and delegates must engage in open discussion about the preservation of the quality of the Journal and must develop better means of protecting its editor-in-chief against decisions by a small group that is not representative of the Journal 's larger constituency.
The search committee to name a permanent editor-in-chief must take strong action. The members must reject a narrow charge merely to interview candidates. They must examine how a decision to end the tenure of an editor-in-chief who was widely acknowledged (even by the Journal 's owners) to be successful could be made behind closed doors. They must insist that the next editor-in-chief have protection, and they could use the model recently developed by the American Medical Association as a starting point.2 Finally, they must take a strong position on the contentious issues that led to my departure.
I regret that I will not be reaching you from this bully pulpit regularly, but I cannot begin to express my gratitude for such extraordinary support.
2 ReferencesJerome P. Kassirer, M.D.
1
Angell M . The Journal and its owner -- resolving the crisis. N Engl J Med 1999;341:752-752
Full Text | Web of Science | Medline2
Rosenberg RN ,Anderson ER Jr . Editorial governance of the Journal of the American Medical Association: a report. JAMA 1999;281:2239-2242
CrossRef | Web of Science | Medline
Author/Editor Response
Dr. Evjy and colleagues reply:
To the Editor: The Massachusetts Medical Society and its leadership welcome Dr. Marcia Angell as the Journal 's interim editor-in-chief. We have every confidence in her. The principles she outlined in her inaugural editorial — principles we share — form a solid foundation from which to proceed into the future. A blue-ribbon search committee will find a new editor-in-chief to continue the high standards of the Journal.
The concern surrounding the departure of Dr. Kassirer as editor-in-chief is documented by the correspondents. Some are troubled by the public discussion surrounding the relationship of the editor to the publisher. Others worry that it is the intent of the Society's leadership to manage the content and character of the Journal or to use it for commercial purposes. It is important to address these concerns, since neither is true.
First, the Society's disagreements with Dr. Kassirer were never over editorial independence; rather, we were unable to find ways to work together to meet the challenges that now face medical journals and their publishers. Both parties knew there would be media coverage of the story, and we decided jointly that no one would be well served if every point of disagreement was listed for the news media to dissect.
Second, it is absolutely false that the Society has any intent to manage the content and character of the Journal. As its publisher, the Society remains committed to sustaining and enhancing the integrity and editorial independence of the Journal. We would argue that because we are a professional medical organization with a mission to advance biomedical science and to educate physicians, not a commercial enterprise, we are uniquely qualified to be the stewards of this publication. We have never forgotten our special obligation, as its publisher, to ensure that the information in the Journal 's pages is always of the very highest quality, since that information is used by physicians worldwide to improve the health of their patients.
Like the medical profession it serves, the Journal today sails in mostly uncharted waters. We face the growth of new for-profit medical-information aggregators on the Internet, the proposal by the National Institutes of Health to create a central on-line repository of federally funded biomedical research, and the influence of managed-care organizations on the way in which biomedical research is funded and conducted. These and other challenges present the Journal and the Society with potentially great opportunities and some level of attendant risk. It is our shared tradition to seek out new opportunities and to move ahead, not to stand still.
Subscribers should judge both the Journal and the Society by how well we meet new challenges while maintaining the highest editorial and quality standards. As we move forward, ask yourselves these questions about the Journal and its publisher: Do we continue to encourage diversity of opinion? Do we seek out and present different points of view? Do we foster, through discussion, new ideas before making a decision to proceed? Do we work together in a collegial and cooperative way, or do we let our relationship disintegrate into mutual disrespect and animosity?
Each week, the members of the Journal 's editorial and publishing staff dedicate themselves to maintaining the highest standards of medical publishing. The Society, as steward of this unique publication, pledges that it will continue to do the same. Working together, we are convinced that the Journal 's reputation and excellence can only flourish.
Jack T. Evjy, M.D.
PresidentVirginia T. Latham, M.D.
President-ElectFrancis X. Rockett, M.D.
Vice PresidentHarry L. Greene, II, M.D.
Executive Vice PresidentRonald A. Arky, M.D.
Chair, Committee on Publications, Massachusetts Medical Society, Waltham, MA 02451-1411- Citing Articles (1)
Citing Articles
1
Ronald M. Davis, Marcus Müllner. (2002) Editorial independence at medical journals owned by professional associations: A survey of editors. Science and Engineering Ethics 8:4, 513-528
CrossRef
