EDITOR’S PAGE
What did we learn from the New England Journal of Medicine?
William W. Parmley, MD, MACC
Reprint requests and correspondence: William W. Parmley, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology, 415 Judah St, San Francisco, California 94122
Last year was a tough year for editors. George Lundberg was fired from JAMA, as detailed in several editorial comments (1–3). Now we hear a similar story from Dr. Jerome Kassirer as he leaves the New England Journal of Medicine:
"Because the officers of the Massachusetts Medical Society and I could not resolve our differences over administrative and publishing issues, they decided to seek a new Editor-in-Chief ..." (4).
Without question, the New England Journal of Medicine is the premier general medical journal in the world. Dr. Jerome Kassirer has done a superb job as editor. His editorial insights and his management of the Journal stamp his as one of the greatest editors of our time. He is a man of principle, and that apparently was his undoing. The "differences over administrative and publishing issues" were described as "honest differences of opinion." To quote Marcia Angell (5), the Massachusetts Medical Society "plans to expand its role as a medical publisher, both in print and online, by launching and acquiring new publications, repackaging the Journal’s content for consumers, and entering into joint arrangements ("cobranding") with various information-based commercial enterprises." Are we going to have a New England Journal of Cardiology, among other things? Dr. Kassirer opposed these activities because they threatened the Journal’s credibility. As Editor-in-Chief, he would have no responsibility or governance over these new projects, which would be promoted as part of the Journal package. In simpler terms it seems like a conflict between greed and principle. In a changing medical environment that places so much attention on the bottom line, it is a sad commentary that a respected medical society has opted for business leverage of a good thing (the Journal) in order to further maximize profits. Since the income from the Journal alone must be considerable, how does this state medical society spend it all, and why are their financial needs apparently so great that they must have much more? This appears to be a blatant example of the commercialization of medicine.
I belong to an organization known as WAME (World Association of Medical Editors). The Executive Board of this group has sent a letter to Jack T. Evjy, M.D., President of the Massachusetts Medical Society, and has encouraged all editors of medical journals to publish this letter in their journals. I am happy to oblige:
"The Executive Board of the World Association of Medical Editors views with dismay the forced departure of the Editor-in-Chief of the New England Journal of Medicine over an issue that directly threatens the quality and independence of the Journal. We also protest in the strongest terms against the process of his removal, which bypassed the Journal’s Publications Committee. We strongly urge the Massachusetts Medical Society to review its relations with its Editor-in-Chief and to establish mechanisms for the future that will protect his or her editorial integrity."
As Marcia Angell takes over as the interim Editor-in-Chief, it appears that some negotiation has occurred on the principal issues (5). The new editor, when appointed, needs to have firmer guidelines, however, about editorial independence and the appropriate role of the Publications Committee. It is interesting that one of Dr. Kassirer’s strong editorials published last May 27 in the Journal was entitled "Editorial Independence" (6). His wisdom was evident in this quote "Medical journal editors walk a fine line. They must aspire to impartiality, open-mindedness, and intellectual honesty. They must try to select material for its merit, interest to readers, and originality alone. They also want their journals to have a voice and a personality. If they are doing their jobs well, they should give no favors, and they should have no friends." I am impressed by these and other of his comments and will continue to strive to maintain the excellence of JACC while preserving editorial independence. In his last editorial (4), Dr. Kassirer reflected on the eight years he served as editor of the New England Journal of Medicine. He chronicles the content of some of his 70 editorials and his advocacy for high ethical standards and professionalism. He then concludes: "There’s so much to say. Chances are you’ll be hearing from me again." We certainly hope so.
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References
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- Editors of JAMA and AMA Archives Journals. JAMA and editorial independence. JAMA. 1999;281:460[Free Full Text]
- Kassirer JP. Should medical journals try to influence political debates? N Engl J Med. 1999;340:466–467[Free Full Text]
- Parmley WW. What did we learn from the Journal of the American Medical Association? J Am Coll Cardiol. 1999;33:2083–2084[Free Full Text]
- Kassirer JP. Goodbye for now. N Engl J Med. 1999;341:686–687[Free Full Text]
- Angell M. The Journal and its owner—resolving the crisis. N Engl J Med. 1999;341:752–753[Free Full Text]
- Kassirer JP. Editorial independence. N Engl J Med. 1999;340:1671–1672[Free Full Text]
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