Lamer quits as chairman of CMAJ governance panel
Quebec

David Spurgeon

Unspecified and unforeseen health problems had forced Mr Justice Antonio Lamer, formerly of the Canadian Supreme Court, to resign as chairman of the CMAJ�s governance review panel, he told the Canadian Medical Association (CMA) last week. The association�s journal had set up the panel after two top editors were sacked, in what many saw as a dispute over editorial independence (BMJ 2006;332:503, p 503).

"This is not a decision I took lightly, but it was the only one available to me. Fortunately, if anyone understands the importance of putting health first, it�s the doctors of Canada. I would like to wish the members of the panel well in their work, and I trust my announcement will not delay their efforts for too long," Mr Lamer said in the statement.

The CMA had established the panel to give it advice and guidance on how to best deal with what the association called "the complex relationship between editorial independence and accountability at the CMAJ."

Mr Lamer�s announcement followed closely the failed of attempts to recruit new members to the panel. Among those who were first invited to join the panel and who then had his invitation rescinded was Philip Devereaux, a clinical investigator at McMaster University and former member of the CMAJ�s editorial board. He had resigned from the board in March with most of the other board members, in protest against the firings of John Hoey, the editor in chief, and Anne Marie Todkill, a senior deputy editor.

Dr Devereaux said that he was invited to join by John Dossetor, an emeritus professor of medicine and bioethics at the University of Alberta and co-chairman of the panel. When he called later to discuss the invitation, however, he was told by Dr Dossetor that it was being rescinded because the association was unhappy with the choice.

Gordon Guyatt, of McMaster University, who earlier withdrew a successful series of articles that had been published in the CMAJ, was also invited to join the panel. He wrote to Mr Lamer and Dr Dossetor to decline because he had lost confidence in the participants and the process.

"What happened in the invite/disinvite/reinvite decisions remains troubling," Dr Guyatt wrote in a letter to Mr Lamer and Dr Dossetor. "Whatever the extent of the CMA�s influence, it feels to me that the sequence of events reflects basic problems in the panel�s process and mandate."

Dr Anita Palepu was one of three former editors of the CMAJ to write a letter of concern about the panel to Mr Lamer and Dr Dossetor. She was invited to join the panel but declined. Dr Drummond Rennie, deputy editor of JAMA, the journal of the American Medical Association, and now a consultant there, also declined an invitation.

Dr Palepu and her colleagues Drs Claire Kendall and Sally Murray resigned within weeks of the departures of Drs Hoey and Todkill. Their letter protested about the rescinding of invitations to Dr Devereaux and Professor Amir Attaran, of the law faculty of the University of Ottawa, "specifically because the CMA was unhappy with [Mr Lamer�s and Dr Dossetor�s] appointments of these individuals to the panel." They said "this interference constitutes an abuse of the panel�s process" and questioned whether the panel was "truly independent."

Professor Attaran, who is also a consultant to the Lancet, told the BMJ that, firstly, he was invited to join the CMAJ�s panel, then he accepted, and then he was uninvited. Subsequently he was reinvited, and finally he reaccepted. He said that he was grateful to "a lot of people who pressed for that to happen."

He added that his experience was similar to others who went through the process. Asked if he had any idea why there was all the confusion, he replied that he and others were told that the CMA had concerns about the size and expense of the panel.

Professor Attaran said that he had argued in front of Mr Lamer in the Supreme Court and had every reason to trust and respect him and had no reason to doubt that he would discharge the business of the panel with independence.

In a Canadian press report dated 26 April, Mr Lamer was quoted as strongly denying that the CMA had any involvement in the choices that he and Dr Dossetor had made for panel members (Hamilton Spectator, 26 April, p 7).

Dr Ruth Collins-Nakai, the CMA�s president, said that it was not up to the association to decide the membership of the panel: the panel had asked for some names, which the CMA had provided. "The only stipulation from our point of view was that they would not have previously passed judgment in terms of the process publicly."

Meanwhile, some former editorial board members of the CMAJ are planning to start a new medical journal that would be international in scope. Dr Jerome Kassirer, a former editor of the New England Journal of Medicine, has expressed his firm support for their action (http://cnews.canoe.ca/CNEWS/MediaNews/2006/04/27/pf-1553883.html).