Map of life expectancy at birth from Global Education Project.

Wednesday, March 29, 2006

It might not just be the drug companies . . .

. . . who have inappropriate influence on what gets published in the major medical journals. It's the doctors as well -- not in their guise as biomedical researchers and healers, but as a political interest group. Most of the leading medical journals are owned by physicians' associations - associations that represent the political and financial interests of their members and lobby on their behalf. JAMA used to stand for the Journal of the American Medical Association, and that's who owns it. The Massachusetts Medical Society owns the New England Journal of Medicine, and the British Medical Association owns BMJ. JAMA also owns a lot of important specialty journals. (The specialist societies and colleges, such as the Society of General Internal Medicine, which also publish journals, are more focused on research and practice than on the personal interests of their members.)

There have been some significant disputes in recent years about the editorial independence of some of these journals in the U.S. JAMA's editor of 17 years, George Lundberg, was fired by the AMA in 1999 for publishing an article which concluded that 60% college students did not consider fellatio to be "having sex." The AMA board concluded that this was an attempt to downplay the importance of Bill Clinton's statement that "I did not have sex with that woman." (What a country.)

NEJM editor Jerome Kassirer was fired by the Massachusetts Medical Society in the same year for refusing to go along with the Society's schemes to make money by selling the Journal's name and logo to manufacturers of medical devices.

Now, although the lay media in the U.S. have ignored the story (probably because they are afraid to go to Canada to investigate due to the hazard of flying hockey pucks), the excrement has hit the ventilator in the international world of medical publishing, at least, over the firing by the Canadian Medical Association of Canadian Medical Association Journal John Hoey and his deputy Anne Marie Todkill. (PDF) Their crime? They published an article revealing that Canadian pharmacists were asking women who were trying to buy the Plan B "morning after" contraceptive intrusive questions about their sexual histories. The CMA is closely allied with the Canadian Pharmacists Association, which complained about the article. The CMA was already annoyed over earlier articles which had cast some physicians in an unflattering light.

This story continued, with Jerome Kassirer brought in to do an inquiry, the CMA apparently not accepting his conclusions that the journal should have editorial independence, and most of the editorial board resigning.

Medical journals must not have a mission of protecting the interests of physicians, as particular associations of physicians construe them -- and let's not forget that many U.S. physicians are not members of the AMA and do not approve of its policy positions. They must represent the public interest. Perhaps we need a new model of ownership.

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