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Rapid Responses published:

JAMA now under dark cloud of heavy handed censorship

Iain Chalmers   (19 January 1999)

World Association of Medical Editors condemns sacking

Fiona Godlee   (19 January 1999)

Unfair AMA politics

J Sam Miller   (19 January 1999)

AMA's act of barefaced and open censorship

Saveli Bashinski   (19 January 1999)

The George D. Lundberg Award for editorial integrity

Magne Nylenna   (19 January 1999)

Meritocracy and Democracy.

B M Hegde   (19 January 1999)

A bad example to the world

M McKee, D Odom, S Janson, C La Vecchia, J Mackenbach   (20 January 1999)

Copy of Sackett's letter to AMA

David L Sackett   (20 January 1999)

Fair trials

Christian Gluud   (20 January 1999)

POLITICS AND MEDICINE

Edwin Dias   (20 January 1999)

Support George Lundberg, M.D.

Joel R Cooper   (20 January 1999)

Ignore the Irrelevant in Responses to Sacking

Barry Pless   (20 January 1999)

Sensationalism or timely reporting?

Marilyn Fayre Milos   (20 January 1999)

Lundberg dismissal reflects serious defects

Hilliard Jason   (20 January 1999)

Council of Biology Editors Condemns Firing of JAMA Editor

Patricia Huston   (20 January 1999)

Politics, sex, and the AMA

Michael Callaham   (20 January 1999)

Lundberg wave crosses Pacific

John Dowden   (20 January 1999)

Anderson's Apology

Michael Innis   (20 January 1999)

Re: The George D. Lundberg Award for editorial integrity

Trish Greenhalgh   (20 January 1999)

Since when does "information" become "influence"?

Andrew Vickers   (20 January 1999)

Sacking of an Editor

Pramod P Bapat   (20 January 1999)

Stalin is back at AMA?

Zviad Kirtava   (21 January 1999)

An irresponsible infringement of editorial freedom

Bruce P Squires   (21 January 1999)

Science and politics in Lundberg's firing

Gerard Harbison   (21 January 1999)

The AMA should not mix its own politics with science

Anna Donald, Muir Gray   (21 January 1999)

Picayune!!

Adele Kalinowski   (21 January 1999)

Black Beacon's Day

Lai-Meng Looi   (21 January 1999)

Transparency Revisted?

L F Ng   (21 January 1999)

Sacking of an editor: readers have rights too.

Tom Oommen   (21 January 1999)

Re: Re: The George D. Lundberg Award for editorial integrity

Geert Aufdemkampe   (21 January 1999)

World medical journal editors should unite in protest petition

Simon Chapman   (21 January 1999)

Shameful

Sukdershan Singh   (22 January 1999)

Managerial ethics and editorial ethics

John Last   (22 January 1999)

This is not the way, Anderson

G R Sridhar   (22 January 1999)

Dark cloud of sanctimonious cliche settles on BMJ website

Douglas Carnall   (22 January 1999)

Boycott JAMA?

Michael Bracken   (22 January 1999)

Re: The AMA and Its Editors

Don Madison   (22 January 1999)

Sacking of George Lundberg

Brian Haynes   (22 January 1999)

Lundberg Desereved What He Got!

Ali Najafabadi   (22 January 1999)

AMA - the hypocritical political animal

Thomas Williams   (23 January 1999)

Decision weakens AMA

Kenneth J Rothman, Cristina I Cann, Janet M Lang   (23 January 1999)

American Medical Writers Association disapproves of firing

Barbara C Good   (23 January 1999)

AMA member's response

Charles D Price   (23 January 1999)

Is this the American virtue?

Noritoshi Tanida   (23 January 1999)

Getting past polarization

Timothy R Berigan   (23 January 1999)

Politics in Scientific Journalism

Jerald R Schenken   (23 January 1999)

Where does this lead to?

Norbert Hasenoehrl   (23 January 1999)

Re: Editorial Independence more Complex than Suggested

Andrew D McLean   (23 January 1999)

Stop it

Hans Huisman   (24 January 1999)

Relevance and the AMA

Ira P Gunn   (24 January 1999)

sigh!

James Byam   (25 January 1999)

Creator or a puppet?

Piotr Gajewski   (25 January 1999)

Response to Dr. Anderson of the AMA

Hilliard Jason   (25 January 1999)

Letter to Nancey Dickey, President of the AMA

Don Berwick   (25 January 1999)

Its a blow. Jobs and humour

C J Price   (25 January 1999)

Medico-political lynching

Ralph E Yodaiken, Naomi Baumslag   (25 January 1999)

The Demise of the American Medical Association

Raymond Scalettar   (26 January 1999)

ICMJE open letter to the AMA

International Committee of Medical Journal Editors   (26 January 1999)

Walk the talk

David C Kibbe   (26 January 1999)

Lundberg, a victim of AMA politics

A Waise   (26 January 1999)

Firing Dr. Lunberg is a serious and tragic error

Paul Gorman   (26 January 1999)

Hasty action.

G A Balint   (26 January 1999)

JAMA Editors Respond to Comments on Dr. Lundberg's dismissal

Bill Silberg   (26 January 1999)

Lundberg Dismissal: Scientific Outrage

Kathleen N Lohr   (27 January 1999)

editors should get together

Franco Cavalli   (27 January 1999)

Sacking of the JAMA editor seriously undermines the credibility of JAMA

Somnath Mukhopadhyay   (27 January 1999)

Code of practice required for societies as regards editorial freedom

J M Grant   (28 January 1999)

Editors, dry your eyes

Andrea O'Donnell   (28 January 1999)

Editorial independence of JAMA

E Ratcliffe Anderson   (28 January 1999)

The firing was just and REQUIRED

Malcolm Kahraman   (28 January 1999)

Of course sex is relevant to medicine!

Ayelet Kuper   (30 January 1999)

AMApalled

John Bramhall   (30 January 1999)

Sacking of JAMA editor hypocritical

Daniel W Smith   (30 January 1999)

Re: Editors, dry your eyes

Charles D Price   (30 January 1999)

He should have been Sacked...

Martin   (30 January 1999)

Press freedom

P Xavier   (1 February 1999)

Lundberg should be reinstated

Jayant S Vaidya   (1 February 1999)

Sex is a part of life

Gabi Caswell   (1 February 1999)

Re: Copy of Sackett's letter to AMA

Ursula R Pfister   (1 February 1999)

A well deserved fate

R Pidsley   (1 February 1999)

Unite against interference

I Gordon   (1 February 1999)

Untitled

Richard T James   (1 February 1999)

BMJ response to a survey with political context

Norman Vetter   (2 February 1999)

Lundberg firing a long time coming

Timothy Wheeler   (2 February 1999)

A plague on both of them

Jim Thornton   (2 February 1999)

My full support

Anders Arhammar   (4 February 1999)

Evaluation process for medical editors should be fair

Joseph F Waeckerle   (4 February 1999)

Hasty

Colin Mackenzie   (4 February 1999)

The AMA picked a general

Mayo Johnson   (4 February 1999)

Re: Science and politics in Lundberg's firing

Arthur S Elstein   (4 February 1999)

Good Ridence

Harold Helbock   (7 February 1999)

Joint Statement from AMA and George D. Lundberg, MD

E Ratcliffe Anderson   (7 February 1999)

A blow to scientific publications

Juan F Schuhl   (7 February 1999)

No more submissions to JAMA

James Dwyer   (7 February 1999)

Does the AMA want this kind of leadership?

Eliabeth C Burton   (7 February 1999)

Re: Editors, dry your eyes

Elizabeth C Burton   (7 February 1999)

AMA - Philosophy or Hipocrisy?

Dana Ann Troxclair   (7 February 1999)

Re: Joint Statement from AMA and George D. Lundberg, MD

David L Sackett   (9 February 1999)

Re: A well deserved fate

Charles Price   (10 February 1999)

British interest is impressive

John A Ewing   (11 February 1999)

Scientific freedom and fun

Margaret Shirley   (13 February 1999)

What Next - Blindfolds or earplugs ?

Victor D'Cruz   (17 February 2000)

JAMA now under dark cloud of heavy handed censorship 19 January 1999
Iain Chalmers UK Cochrane Centre Send response to journal: Re: JAMA now under dark cloud of heavy handed censorship	I was contacted by Gina Kolata, health correspondent at the New York Times, because I am a member of the editorial board of the Journal of the American Medical Association. She told me that Dr George Lundberg, Editor-in-Chief of JAMA, had been unceremoniously sacked by the Executive Vice President of the American Medical Association, Dr E Ratcliffe Anderson. This action, which one assumes must have been endorsed by the AMA Board of Trustees chaired by Dr Randolph Smoak, appears to have been taken because an article reporting the perceptions of college students on sexual behaviour will be published (without editorial comment) in next week's issue of the Journal. In his statement reporting this action (http://www.ama-assn.org/advocacy/statemnt/99jan15.htm, Dr Anderson states that Dr Lundberg "has threatened the historic tradition and integrity of the Journal by inappropriately and inexcusably interjecting JAMA into a major political debate that has nothing to do with science or medicine". He goes on to state that "There is no question that over many of the past several years Dr. Lundberg and his fine staff - always working with complete editorial independence - have advanced the stature of JAMA. Over time, however, I have lost confidence and trust in Dr. Lundberg's ability to preserve that high level of credibility and integrity." Dr Anderson's action is outrageous, and a slur not only on the integrity of Dr Lundberg, but also on the integrity of all those, like me, who have accepted Dr Lundberg's invitation to work with him for the benefit of JAMA. Dr Anderson concludes his message by having the audacity to state "On behalf of the AMA, we apologize to JAMA's readers, its contributors, and to any others who feel that JAMA has been misused in the midst of the most important Congressional debate of this century." I do not accept Dr Anderson's apology. Indeed, I feel sure that I am not alone in hoping that he will pay a severe price for his ill-judged interference in the editorial freedom of Dr Lundberg, a man who deserves the lion's share of the credit for JAMA being the respected journal that it is today. Dr Anderson has succeeded in making crystal clear to JAMA's readers and contributors that the Journal does not have complete editorial independence. His action has put JAMA's excellent reputation under the dark cloud of heavy handed censorship. Iain Chalmers, UK Cochrane Centre
World Association of Medical Editors condemns sacking 19 January 1999
Fiona Godlee Send response to journal: Re: World Association of Medical Editors condemns sacking	The World Association of Medical Editors unreservedly condemns the action of the American Medical Association in sacking the editor of JAMA, Dr George Lundberg. Dr Lundberg is an internationally respected figure who has provided leadership for editors of peer reviewed journals around the world. He is justly credited with raising the scientific and ethical standards of JAMA on which are based the journal's current high reputation among medical researchers and practitioners. Under his leadership, the journal has become a force for good in spearheading debates on medical, health care, and socio-political issues. By its actions, the AMA has brought into question its commitment to the vital principle of editorial independence. In doing so, it has seriously undermined the integrity and standing of both the journal and the association. Dr Fiona Godlee, Assistant Editor, British Medical Journal; President, WAME Professor Suzanne Fletcher, Former Editor, Annals of Internal Medicine; Professor of Ambulatory Care and Prevention, Harvard University; Vice President, WAME Dr Bruce Squires, Former Editor-in-Chief, Canadian Medical Association Journal; Vice President, WAME Professor John Overbeke, Editor-in Chief, Dutch Medical Journal; Treasurer, WAME Dr Daniel Ncayiyana, Editor, South African Medical Journal; Secretary, WAME on behalf of the World Association of Medical Editors
Unfair AMA politics 19 January 1999
J Sam Miller, Retired Retired Send response to journal: Re: Unfair AMA politics	BMJ... Thank you for the article about Dr. Lundberg's firing from JAMA. I believe that his dismissal was unfair and politically motivated. Assuming that the study and paper on oral sex was legitimate, Dr. Lundberg's fast tracking and publishing the article was exactly the kind of responsible medical reporting that is to be expected from JAMA. Findings on sexual behaviour and knowledge are of medical importance, and pertinant to the impeachment proceedings now underway. What other profession could speak with authority on sexual behaviour matters? Perhaps the AMA's actions should be investigated as part of the senate hearings.
AMA's act of barefaced and open censorship 19 January 1999
Saveli Bashinski, Editor International Journal of Medical Practice (Russia) Send response to journal: Re: AMA's act of barefaced and open censorship	Dear colleges: Dr. Anderson's act is a demonstrative example of barefaced and open censorship. It is clearly seen in the audacities of his statement style: "... we apologize to JAMA's readers, its contributors, and to any others who feel that JAMA has been misused in the midst of the most important Congressional debate of this century.". This pathetic tendance of the beloved subscribers resembles me a leading article in the "Pravda" newspaper of our recent totalitarian past. One may just replace "subscribers" and "contributors" for "nation" or "working class" and "Congressional debate" for "... in the threshold of the upcoming historic XXV Congress of the Communist Party of the Soviet Union held in the ambience of tremendous enthusiasm of the whole nation, Mr. X misuses (our credence, his editorial position, the freedom of speech, etc.) thus undermining..." This passages were accompanied by readers letters: "I personally did not read the article but want to say..." AMA's decision is a very dangerous breach of editorial freedom and should be decidedly condemned by CBE, WAME and organisations alike. I agree with Pat Huston 's idea to write joint statements to the Editors of major newspapers to support George Lundberg. And as Iain Chalmers I also hope that Dr. Anderson "will pay a severe price for his ill-judged interference in the editorial freedom of Dr Lundberg". Saveli Bashinski, Editor, International Journal of Medical Practice Russia
The George D. Lundberg Award for editorial integrity 19 January 1999
Magne Nylenna, Editor The Journal of the Norwegian Medical Association Send response to journal: Re: The George D. Lundberg Award for editorial integrity	This is a very sad event for editorial freedom in general and for medical journals world wide in particular. This disgraceful incident has shown that neither size nor success gives any guarantee for editorial freedom, - not even the two combined. The fight for integrity must go on continously in every editorial office every day. George D. Lundberg has been an example for other editors through his editorial integrity, scientific judgement and his personal strength and warmth.. I suggest that the global community of medical journal editors, through its organizations, establish an award for editorial integrity and name it The George D. Lundberg Award. Magne Nylenna, M.D. Editor The Journal of the Norwegian Medical Association
Meritocracy and Democracy. 19 January 1999
B M Hegde, Pro Vice Chancellor Manipal in India. Send response to journal: Re: Meritocracy and Democracy.	Lundberg has been one of the outstanding medical editors.JAMA's stature today is solely due to his untiring efforts to raise the standards of the articles published. He was one of the few editors who had the guts to publish even negative data, when it was very inconvenient for the drug lobby and other vested interests. Science tries to search for the truth. This was a study started long before the Clinton's sexual misadventures, as such the two have nothing in common. Students' opinions do not have legal validity anyway. The whole episode smacks of arrogance of the highest order.Lundberg paid a heavy price for his excellence in his job. Meritocracy and the so called democracy seem to be mutually exclusive. Small minds could shoot down even the greatest mind.
A bad example to the world 20 January 1999
M McKee, Editors of the European Journal of Public Health c/o Centre for Public Health Research, PO Box 9104, University of Karlstad, S-65009 Karlstad, Sweden, D Odom, S Janson, C La Vecchia, J Mackenbach Send response to journal: Re: A bad example to the world	Dear Editor, It is with great concern that we note how easily the principle of editorial freedom can be cast aside, even in a country where freedom of expression is specifically guaranteed in the first amendment to the constitution. On this occasion, those opposing freedom will be the main losers as the American Medical Association is now seriously discredited in the eyes of the international medical community. However, there is now a real danger that this incident will be cited by those in positions of power in other countries, especially where democracy and civic society have rather more shaky roots, as they seek to deal with troublesome editors. The argument that, "if the American Medical Association can do it, so can we" will have undoubted attractions. Such actions may receive rather less attention than the sacking of Dr Lundberg but, in their own way, are as important. There is a clear need for constant vigilance and for concerted action by the international community of medical editors on a range of fronts. A good start would be to take forward the suggestion by the editor of the Journal of the Norwegian Medical Association of an award for editorial integrity. Martin McKee Editor in Chief Don Odom Managing editor
Copy of Sackett's letter to AMA 20 January 1999
David L Sackett, Director NHS R&D Centre for Evidence-Based Medicine, Oxford Send response to journal: Re: Copy of Sackett's letter to AMA	Dave Sackett, an editor of Evidence-Based Medicine, has sent us copies of the letters he's faxed to the AMA's Executive Vice-President ER Anderson and President Nancy Dickey: Dear Drs Anderson and Dickey By way of background, I'm an American/Canadian who's published 23 papers in JAMA, going back to 1966, am a founding member of the "Evidence-Based Medicine Working Group," and was the original editor of the Rational Clinical Examination Series begun in 1992. I'm writing to protest the awful damage you've done the JAMA by [condoning the] firing [of] George Lundberg. You have you made the American Medical Association the laughing stock of the UK and the rest of Europe. More important, you've destroyed JAMA's hard-earned reputation as a journal that was free of censorship. You have lost your mandate to offer the profession and the public advice about other "political" issues such as racism, wife-beating, and child-molestation. Is it too late for you to regain the credibility of your journal and the respect of your colleagues around the world by reversing this dictatorial decision? Prof David L. Sackett Director, NHS R&D Centre for Evidence-Based Medicine Consultant in Medicine Editor,Evidence-Based Medicine Nuffield Department of Medicine, University of Oxford Level 5, John Radcliffe Hospital, Oxford OX3 9DU, England Phone:+44-(0)1865-221320 Fax: +44-(0)1865 222901 Email:sackett@cebm.jr2.ox.ac.uk WWW: http://cebm.jr2.ox.ac.uk
Fair trials 20 January 1999
Christian Gluud, Coordinating Editor Cochrane Hepato-Biliary Group, Copenhagen Trial Unit Send response to journal: Re: Fair trials	Findings on sexual behavior, including knowledge about and attitudes towards sexual behaviour, are of medical importance. The findings going to be published in JAMA tomorrow are important to the medical world. However, the findings are also important for a fair impeachment proceeding for President Clinton. It is my hope that Dr. Lundberg, the sacked Editor-in Chief of JAMA, will (also?) get the chance of a fair trial of his case. I therefore fully support the responses expressed by Iain Chalmers and the World Association of Medical Editors. Christian Gluud
POLITICS AND MEDICINE 20 January 1999
Edwin Dias, Paediatrician MANIPAL Send response to journal: Re: POLITICS AND MEDICINE	DEAR SIR, The relationship of medicine and politics has always been a stormy one.The recent sacking of the esteemed editor of the JAMA has raised a few eyebrows all over the world.It is therefore important that we physicians should leave the politicians to deal with their own cup of tea. It is sad that this should have happened to one of our colleagues.The world of politics does not have the same rules as medicine has,though both are difficult paths and strewn with the sacrifices, of many a soul.when these two meet the loser is the physician. I hope that the future physicians may be able to play a role in the politics of the new millenium.
Support George Lundberg, M.D. 20 January 1999
Joel R Cooper, editor in chief The Medical Reporter, Denver, Colorado USA Send response to journal: Re: Support George Lundberg, M.D.	1-15-99, Friday, Denver, Colorado USA Hello, I think WAME should come out with a statement in support of George Lundberg, M.D., who was fired today from JAMA. Thank you. all best, Joel R. Cooper editor in chief The Medical Reporter http://medicalreporter.health.org/ Denver, Colorado USA
Ignore the Irrelevant in Responses to Sacking 20 January 1999
Barry Pless, Editor, Injury Prevention McGill University Send response to journal: Re: Ignore the Irrelevant in Responses to Sacking	I have followed the reaction to the sacking of Dr.Lundberg and am in agreement with most correspondents who view this as an outrageous act. I think, however, that it is quite irrelevant and possibly harmful to include observations about the AMA's political leanings. The issue is one of intellectual freedom, pure and simple. I hope that we would react in the same way if the organization in question had the opposite leanings. And I also hope that, collectively, editors would not tolerate employers, whoever they may be, interfering if they thought there was a small p "political" element in material they choose to publish. Much of science is inextricably related to "la politique" -- for better or for worse. If this were to be a criterion for censure or impeachment (no pun intended) many of us would be in deep trouble. But more importantly, our readers would be deprived of an element of science that is part of the air we breath. In fact I believe we should encourage not censure papers that have relevant political points to make that clearly affect health or patient care. That said, I still believe the AMA's politics have nothing to do with the present issue and that introducing this element will only cloud the discussion.
Sensationalism or timely reporting? 20 January 1999
Marilyn Fayre Milos, Executive Director National Organization of Circumcision Information Resource Centers Send response to journal: Re: Sensationalism or timely reporting?	What better time to address an issue than when it is a currently relevant one? Lundberg did a service to the nation in determining what the American public thinks. Unlike the American Congress, which is ignoring the people it is supposed to be representing, Lundberg was not afraid to report public opinion. Who, then, was so afraid of the truth that an honest editor was muzzled?
Lundberg dismissal reflects serious defects 20 January 1999
Hilliard Jason, Editor, EDUCATION for HEALTH; Clinical Professor, Family Medicine, University of Colorado University of Colorado School of Medicine Send response to journal: Re: Lundberg dismissal reflects serious defects	I join the many others who have expressed appropriate outrage at the recent actions of the AMA leadership in dismissing George Lundberg. I think it is reasonable to assume that this action, like most major corporate decisions, reflects more than the reasons stated publicly as explanations. I expect that this profound assault on decency and on editorial independence reflects the actions of people at the AMA who are stuck in an irrelevant past, who were made uncomfortable by George's forward-looking focus on the broad social responsibilities of contemporary medicine. I expect that they have been eagerly waiting to pounce for a long time and have now seized upon an excuse that they think can justify their inappropriate behavior. I find it profoundly disturbing that at the AMA, as in other sectors of our society, those who are least equipped to help us prepare for the future seem to be shaping it. If anyone needs to be replaced it is those who devised and acted upon this serious assault on science and integrity, while claiming to be defenders of both. If corrective actions are not taken, I hope others will join in canceling our subscriptions to JAMA...in addition to whatever else can be done to bring negative consequences to those responsible for this shortsighted and inappropriate act. I can't help but wonder if those who perpetrated the foolish Sunbeam fiasco are still in control at that organization.
Council of Biology Editors Condemns Firing of JAMA Editor 20 January 1999
Patricia Huston, President, Council of Biology Editors University of Ottawa Heart Institute Send response to journal: Re: Council of Biology Editors Condemns Firing of JAMA Editor	The firing of George Lundberg marked a dark hour for scientific journal editors worldwide. When Dr Anderson, Executive Vice President of the American Medical Association, dismissed the editor-in-chief on the basis of the publication of a peer-reviewed study, he blatantly usurped editorial freedom. This action is deplorable. Editorial freedom is a cornerstone of scientific integrity and must be fiercely defended in order to prevent insidious censorship. The AMA's action amounts to tacit support for suppression of scientific information that may be politically sensitive.
Politics, sex, and the AMA 20 January 1999
Michael Callaham, Professor of Medicine Univ of Calif San Francisco Send response to journal: Re: Politics, sex, and the AMA	I can only concur with the dismay and astonishment of the others who have already commented on the firing of Dr. Lundgren. I think your editorial summed it up beautifully. I found it particularly interesting that the chief cited reason for this action was the Dr. Lundgren's meddling in a political process (or introduction of politics into the journal). I have quite a different reaction. I found the survey itself interesting, surprising, and very relevant to the history I take (now in quite different fashion, I assure you!) from my patients. I never would have thought of it as primarily political, nor do I now. From the publicly stated facts that the AMA themselves have released, I have more doubts about the political involvement and motivation of AMA leadership than I do that of Dr. Lundberg. Their use of this as a reason for firing seems to fit nicely under the category of Freudian projection. Their action raises questions in my mind about AMA leadership which were never there before. I've already expressed these opinions to them and hope others do likewise.
Lundberg wave crosses Pacific 20 January 1999
John Dowden, Editor, Australian Prescriber Canberra, Australia Send response to journal: Re: Lundberg wave crosses Pacific	You may be interested to know that the demise of Dr Lundberg was reported in the Sydney Morning Herald on Monday morning. Australia is part of the world! If someone with the international stature of George Lundberg can be dismissed for an editorial decision, then every medical editor, except perhaps Richard Smith, is now at increased risk. It will be interesting to see if the sacking encourages other organisations to restrict editorial freedom using the threat of dismissal. Perhaps we need a prospective study to monitor new restrictions and dismissals over the next year? John Dowden Medical Editor Australian Prescriber
Anderson's Apology 20 January 1999
Michael Innis, Honorary Consultant Haematologist- Retired 1 White-Dove Court Wurtulla. Queensland Australia Send response to journal: Re: Anderson's Apology	Anderson's apology to the readers of JAMA is nothing but a poorly disguised Republican maneuver to further humiliate President Clinton. It is unworthy of the AMA to endorse and be party to such blatant Republican political machinations and the sooner they re-install Lundberg and get rid of Anderson the sooner will they restore their credibility. Michael Innis
Re: The George D. Lundberg Award for editorial integrity 20 January 1999
Trish Greenhalgh, Director, Unit for Evidence Based Practice and Policy University College London Send response to journal: Re: Re: The George D. Lundberg Award for editorial integrity	I agree - whether AMA reverses its decision or not (and that seems unlikely), let's establish an award for editorial integrity named after Prof Lundberg, and let's send it to JAMA as a news item. I wonder if there's mileage in all protesters mailing JAMA and asking for a reprint of the 'offending' article? Trish
Since when does "information" become "influence"? 20 January 1999
Andrew Vickers, Editor Complementary Therapies in Medicine Send response to journal: Re: Since when does "information" become "influence"?	As I understand it, Lundeberg was sacked because of his attempts to publish a paper which contained factual information. He fast-tracked the paper because of a perceived need for that information. When information provision becomes seen as an "interjection" into a "political debate", all editors and researchers better watch out.
Sacking of an Editor 20 January 1999
Pramod P Bapat, Anaesthesiologist ( Private Practice ) Pune, India 411 052 Send response to journal: Re: Sacking of an Editor	Sacking of an Editor - It is clear that the editors of various journals are unanimous in condemning the sacking of George Lundberg. However one has to be dispassionate in choosing right from the wrong. Several points come to the mind. First of all - whether a study which is essentially a study of the social and moral codes of a society should have been published in a scientific medical journal ? The answer is debatable. The second and more important question is that the study is eight years old and therefore would it be relevant today ? Ideally an editor should publish only the research which is contemporary and not dated. In this case Lundberg might have believed that since there are no previous studies on this subject, he is well within his right to publish it, but why only now ? One can always cast aspersions that his intention to publish was politically motivited and editorial integrity questionable. Medical journals should publish knowledgeable articles which improve our understanding of human health and disease. In this case JAMA may well be within its right to sack Lundberg since he seems to have deviated from this path.
Stalin is back at AMA? 21 January 1999
Zviad Kirtava, Director National Information Learning Centre, Tbilisi, Georgia Send response to journal: Re: Stalin is back at AMA?	Dear Colleagues, I was astonished to hear news about Dr. Lundberg. I would imagine story like that could happen in USSR under Stalin, or North Korea still recently. One may doubt how much JAMA leadership was correct accelerating the publishing of article about American students belief during the nova- days "impeach - don't impeach" confrontation hectics, but surely Mr. Anderson has acted far-ahead incorrectly while performing his sharp decapitation of the JAMA, which I believe has recovered mainly thanks to elegant and thorough leadership of Dr. Lundberg. And I suggest, those who know Dr. Lundberg, can't support opinion that any of his actions might be driven by "sensationalism". Is this a world [of Democracy ruling] we are trying to create in developing countries??? Sounds more as dark past of totalitarian censorship. And how has happened that AMA rules are so much different from BMA policy. Are Americans less democratic than conservative Brits? Or is this a temporary side effect of Lewinsky-syndrome? Dr. Zviad Kirtava Director, National Information Learning Centre, Tbilisi, Georgia
An irresponsible infringement of editorial freedom 21 January 1999
Bruce P Squires, Former editor-in-chief, Canadian Medical Association Journal Send response to journal: Re: An irresponsible infringement of editorial freedom	E. Ratcliffe Anderson's dismissal of Lundberg was, I believe, ill- considered and unjustified. In his 17 years as editor of JAMA Dr. Lundberg demonstrated the highest standards of scientific medical publication and has provided leadership for editors of peer-reviewed medical journals in the United States and, indeed, around the world. Through his inexhaustible energy and commitment he has led JAMA into the forefront of medical journals, and by association has made a major contribution to the prestige of the American Medical Association (AMA). His adherence to the highest standards of medical editing have been an example for all of us who have been editors of peer-reviewed medical journals. I regard Anderson's action as an irresponsible infringement on editorial freedom, which can only lessen the influence of a leading medical journal and the AMA.
Science and politics in Lundberg's firing 21 January 1999
Gerard Harbison, Professor of Chemistry University of Nebraska Lincoln Send response to journal: Re: Science and politics in Lundberg's firing	The fundamental problem with JAMA is that it tries to be both a scientific and a political journal, and the two are simply incompatible. Lundberg has clearly used JAMA to advance causes associated with the political left in the US - its unscientific and feminist-influenced stances on domestic violence, its attempt to medicalize the gun-control issue, and now the ludicrous decsion to publish eight year old data on an accelerated schedule to attempt to influence Clinton's trial. Academic freedom clearly requires that there be no interference with the decision of an editor, guided by referees, to publish a scholarly article. On the other hand, the right to free speech requires us to allow the AMA to insist that editorial policies in a political magazine which they own and operate coincide with the organization's political position. In this case, the two are simply incompatible. The solution is to take the politics out of JAMA. Getting rid of Lundberg was a good first step.
The AMA should not mix its own politics with science 21 January 1999
Anna Donald, Editors, Evidence-based Healthcare London, Oxford, Muir Gray Send response to journal: Re: The AMA should not mix its own politics with science	We find Dr Anderson’s accusation that Dr Lundberg mixed medicine with politics to be either naïve or sinister, and at least hypocritical, as the dismissal of Dr Lundberg itself constitutes a serious political act of censorship. Dr Anderson’s assertion that medicine can and should be politically neutral seems absurd at the end of the 20th century, when we know from countless pieces of research and experience that health is largely a consequence of social and political conditions, which must be debated and researched scientifically if effective answers to disease and suffering are to be found. Therefore, we can only assume that politics does indeed lie at the heart of Dr Anderson’s decision -- those of the AMA, not of Dr Lundberg. No doubt this action will rebound uncomfortably for Dr Anderson and his colleagues, but in the meantime, we find it most regrettable for the future reputation of JAMA as a serious, scientific journal, and for ourselves as subscribers interested in science, not the politics of the AMA. Anna Donald and Muir Gray, Editors, Journal of Evidence-based Healthcare
Picayune!! 21 January 1999
Adele Kalinowski Retired Send response to journal: Re: Picayune!!	I've already replied to this story on other web pages, but I'm glad to find a place to vent my spleen! I think Dr. Anderson should be fired! Dr. Lundberg doesn't deserve such rash action to be taken! I wasn't offended by the article, nor do I think anyone with half a brain was! As a matter of fact, I share the opinion expressed in the article. Hope to see other replies posted. Thanks again.
Black Beacon's Day 21 January 1999
Lai-Meng Looi, Professor of Pathology University of Malaya Send response to journal: Re: Black Beacon's Day	I read of Lundberg's dismissal with profound dismay and share the sense of outrage that has passed like a shock-wave through the editorial community. This high-handed action is clearly a censorship of editorial freedom and marks a black day in JAMA's history. For lesser Journals like the one I serve, JAMA had been a beacon of integrity that we strove to emulate: imagine how dark the night has become. Lai-Meng Looi, MD, FRCPath, FRCPA, FASc Editor-in-Chief, The Malaysian Journal of Pathology Kuala Lumpur, Malaysia Professor of Pathology, University of Malaya
Transparency Revisted? 21 January 1999
L F Ng, Consultant Medical Oncologist CanCARE, Kuala Lumpur Send response to journal: Re: Transparency Revisted?	I regret to hear that Editorial freedom has been perverted in a country which has often claimed to be the world's policeman on many issues. It is now time for Anderson to retract his words of poor judgment and reinstate the well respected Dr Lunberg or he himself face the axe. My view is that this action puts the US medical profession viz the AMA into a embarrasingly serious position. How can an executive VP speak for the whole profession - or at least act on behalf of the whole profession without consultation? Is this a manipulation by the FBI? Yours faithfully, LF Ng
Sacking of an editor: readers have rights too. 21 January 1999
Tom Oommen, Deputy executive editor, BMJ (South Asia Ed.) Kasturba Medical College, Manipal, India Send response to journal: Re: Sacking of an editor: readers have rights too.	Dr. George Lundberg is no ordinary journalist. The JAMA had undoubtedly reached a pinnacle of scientific and academic excellence because of people of his caliber. It is not surprising that his journalistic proficiency and academic ecellence evoked jealousy and antagonism. No journal should be treated as the private property of a elite few. In professional ethics, who makes the rules? Are editors and their committees being forcefully deprived of their freedom of expression? Journals are not simply passive vehicles, and editors influence the way that science appears in the journals. The key to these changes - both in the journal's pages and beyond - is the imposition of process and structure. It is the sacking of Dr. Lundberg, and not, as Dr. Ratcliffe Anderson stated, Lundberg's paper, that "inappropriately and inexcusably interjected JAMA into a major political debate that has nothing to do with science and medicine". I would not be surprised if those responsible for taking this decision did so under political pressure or to sear their own consiences. From the responses that have been generated worldwide, and from the debate that has already ensued, in the interest of medical journalism, freedom of expresion and social justice, Dr. Ratcliffe Anderson should apologise for taking this autocratic decision and for the comments he has made against Lundberg, and Lundberg should be re-instated with full honours. It is better to be wise than otherwise.
Re: Re: The George D. Lundberg Award for editorial integrity 21 January 1999
Geert Aufdemkampe, Senior research associate Polytechnic of Utrecht, Netherlands Send response to journal: Re: Re: Re: The George D. Lundberg Award for editorial integrity	I support the idea to establish an award for editorial integrity named after Prof. Lundberg. Geert Aufdemkampe Senior research associate and former editor of FysioPraxis Polytechnic of Utrecht Faculty of Health Sciences The Netherlands
World medical journal editors should unite in protest petition 21 January 1999
Simon Chapman, Associate Professor of Public Health, Editor Tobacco Control University of Sydney Send response to journal: Re: World medical journal editors should unite in protest petition	Editor:- As every editor knows, there are occasions when we time the publication of piece of research so as to add new information to a current community or political debate, an up-coming major report or an anniversary of some significance. If editors are supposed to make a virtue out of being indifferent to topicality and relevant world events, heaven help medical publishing. George Lundberg's "crime" was that he scheduled a study to be published that has information that many would find germane to one of the central issues in President Clinton's impeachment. Among the many things to which Clinton's conduct and its sequalae have drawn world attention, are issues about changing sexual standards. While many found it incredible that he played word games about whether fellatio was actually sex, a key finding in the new study shows that 59% of young people share the same opinion. At a recent dinner with friends, we were talking about our teenage children's sexuality. One parent who had recently hosted a teenage party had been advised by other parents to leave the garden lights on to discourage an epidemic of blow jobs in the bushes. All the 45+ year olds present were gob-smacked by the very thought that this is what kids are up to. But later when I discussed it with my doing-well-at-school, considerate and civilised teenagers, they were all "gee, dad you haven't a clue have you?" While I didn't sense that they themselves were up to such tricks, I sensed it was hardly exotic. I felt very old. The pecksniffs at the AMA, who may well be motivated by Republican sentiments, are wanting the medical community to accept that changing community standards are immaterial to the debate and that Lundberg could only have been exercising some naked political agenda. Numbered among JAMA readers would be many adolescent and sexual health researchers and clinicians. The idea that JAMA readers ought not be subjected to papers mapping such social changes is plainly comical. The timing of the publication, at a time when the whole world is being force fed this subject, is relevant and very appropriate. I would urge an e-mail petition of protest be developed among the world's medical journal editors.
Shameful 22 January 1999
Sukdershan Singh, Director Hospital Keningau, Sabah Hospital Keningau Send response to journal: Re: Shameful	Sir, I think it was a shameful thing to sack a senior editor it is probably an overkill by Anderson. So what was wrong in publishing such an innocous title. I did not know that there were tin pot dictators in the Western world that touted so much of frrdom of speech and expression. I seriously feel that the sacked Editor should be given a chance to speak his piece - and that to a committee rather that a one man decision. Thank you.
Managerial ethics and editorial ethics 22 January 1999
John Last, Emeritus professor of epidemiology University of Ottawa Send response to journal: Re: Managerial ethics and editorial ethics	As a former journal editor (Can J Public Health, Annals of Royal College of Physicians and Surgeons of Canada, Am J Prev Medicine, on whose management board I've also served) I have experienced a few disputes. This is the most barefaced, outrageous interference in editorial freedom and integrity outside of a totalitarian state for many years. It must not be allowed to stand. All of us must show solidarity with George Lundberg, all of us must do all we can to ensure that the AMA leadership is made fully aware of the widespread revulsion and disgust for this wrong that has been done, and ensure that those responsible are punished for this wrongdoing. Under George Lundberg's leadership JAMA has become a top quality journal. The article in question hardly seems to me to be politically loaded -- rather it sounds like a plain statement of facts well-known to anyone who communicates with college and university students. Will the AMA's leaders suppress dissent with their views and sink to the level of dictators around the world, or will they demonstrate their statesmanship by punishing those responsible for this miscarriage of justice?
This is not the way, Anderson 22 January 1999
G R Sridhar, Editor, Indian J Endocrinology and Metabolism Visakhapatnam, India Send response to journal: Re: This is not the way, Anderson	I condemn the sacking of George Lundberg editor of JAMA. That he could be removed at will, and the removal after more than 15 years as Editor, communicated to him by a phone call, period, places a big question mark on the reason for his removal. It is not difficult for Anderson to explain ones actions. Reasons can be put forward. They will be put forward. And have been forward. One is not surprised by such actions in a non-democratic process. I believe this is not the way Lundberg should have been treated. There are channels of communication. From what has happened there is no evidence that any one of them was even opened. I resent the action of Anderson in removing Lundberg.
Dark cloud of sanctimonious cliche settles on BMJ website 22 January 1999
Douglas Carnall Send response to journal: Re: Dark cloud of sanctimonious cliche settles on BMJ website	The outpouring of support for Dr George Lundberg is gratifying in its promptness; mom and apple pie seem universally desired. It makes me particularly warm inside to see citizens of the former Soviet Union chastising their American counterparts (justifiably) on the issue of free speech. It's good that people care for journalists, but let's not forget that, so far, Lundberg hasn't been shot or jailed, and that he was coming up for retirement age. It is naive to imagine that publications exist for any other reason other than to serve the interests of their owners. The editorial latitude allowed by tolerant Victorians such as the BMA merely reflects the security of its establishment, and perhaps, a belief that to do anything else would result in a publication of such stupendous tedium that we might as well all go home in any case. JAMA's hideous typography meant that I for one would never read it for pleasure; but if Lundberg was such a great guy, no doubt AMA will live to regret their decision as all his friends and allies in the office resign or strike in protest, and America's doctors cancel their subscriptions in great numbers. It's a useful maxim that one ought to try and do something once a day that ought to get you fired. (Yes, this is today's attempt for me). Lundberg has finally succeeded. Well done George, and a happy retirement. Congratulations to JAMA for a hot start to the public relations campaign on the "paper that turned the impeachment hearings," and the best of luck with the redesign.
Boycott JAMA? 22 January 1999
Michael Bracken, Prof & Head Chronic Disease Epidemiology Yale University Send response to journal: Re: Boycott JAMA?	My most recent article in JAMA was published eight months ago. Should it be the last? Authors need to seriously consider whether they should continue to publish in a Journal which cannot guarantee the independence of its editor. I know I will seriously consider these events before I submit another manuscript to JAMA.
Re: The AMA and Its Editors 22 January 1999
Don Madison, Professor of Social Medicine University of North Carolina at Chapel Hill Send response to journal: Re: Re: The AMA and Its Editors	Morris Fishbein, who edited JAMA (and all other AMA periodicals) for 26 years--from 1924 until 1950--survived the publication of literally hundreds of non-scientific, politically-tinged articles. The majority of these were written by Dr. Fishbein himself. The difference between Lundberg and Fishbein is that in a time when the vast majority of American physicians believed whatever the AMA told them to believe, Fishbein’s editorship consistently defended the Association’s party line and attacked the opposition--whether it be a small group of physician dissenters or the President of the United States. Lundberg on the other hand has attempted, successfully, to present all sides, this at a time when the vast majority of American physicians were, at best, agnostic regarding the AMA’s claim to lead.
Sacking of George Lundberg 22 January 1999
Brian Haynes, Professor McMaster University Send response to journal: Re: Sacking of George Lundberg	The American Medical Association has recently undermined the trustworthiness of the organization through its endorsements for profit, and now it has compromised its stated policy of editorial independence for its journal. A next step could be to select a puppet for editor. If so, I hope it will be one named Pinocchio and that the editor's profile will be put on each issue so we will know when truth has been corrupted by organizational priorities. As an alternative, the Board of the AMA should reaffirm the editorial independence of JAMA and reappoint George Lundberg, the man who built JAMA's reputation as a major world source of credible medical science reports. Brian Haynes Hamilton, Ontario, Canada
Lundberg Desereved What He Got! 22 January 1999
Ali Najafabadi, President & CEO International Diagnostic Consultants Send response to journal: Re: Lundberg Desereved What He Got!	Dear BJM Editor: After reading your commnetary about Dr. Lundberg's termination as the Editor of JAMA, I felt strongly to favor the decision. In recent months that our country has been striken with a wide variety of political sex scandels and has been practically the laughing stock of every community in the world, it is NOT appropriate of a reputable medical journal to partake in a study that has absolutely no relevance to its mainstream mission and obligation. As a clinician, I could careless what the medical students think about what constitutes oral sex let alone publish the findings in a well-recognized medical journal. I feel that we sometimes tend to get carried away with the freeom of press and as a result tarnish the very basic principle of democracy upon which our country was founded. I am NOT here to deny the 17 yeas of hardwork and dedication that Dr. Lundberg gave to JAMA, but what angers me more than any thing else is to see our highly educated, skilled, and intellectual tier of our society, namely medical society, to participate in a "Clinical Study" that practically defames the very basic essence of any objective clinical study. Frankly, I am amazed by the fact that Dr. Lundberg did NOT possess the necessary perception and vision to circumvent the publication of such an article. So what came to Dr. Lundberg is well deserved.
AMA - the hypocritical political animal 23 January 1999
Thomas Williams, Director, Biomedical Library and Media Production Services University of South Alabama Send response to journal: Re: AMA - the hypocritical political animal	One of the reasons Anderson and others at AMA "sacked" Lundberg was their claim that he (Lundberg) put the AMA in the midst of the "political debate." In addition to making a fool of himself and the AMA, is Anderson out of his mind? The AMA places itself squarely in the midst of political debates all the time. The AMA bias against Clinton is readily apparent with its $450,000 contribution in support of incumbent Republican Congressman Jon Fox in the 3rd district in Pennsylvania. Fox was up against a democratic challenger, Joseph M. Hoeffel 3rd, whom he defeated in the previous election by 84 votes. (from the Philadelphia Enquirer, Oct. 29, 1998). In spite of the largesse of the AMA, Fox went down to defeat by something like 10,000 votes. The people of the 3rd district in Pennsylvania clearly have more common sense than the AMA. According to the Philadelphia Enquirer article, the AMA also spent a total of $450,000 on two other "embattled" republicans; J. Greg Ganske of Iowa and Ernest l. Fletcher, Lexington, KN. So NOW who is placing the AMA into the "political debate?" SHAME on the AMA
Decision weakens AMA 23 January 1999
Kenneth J Rothman, Editor, Associate Editor, Associate Editor Epidemiology, Cristina I Cann, Janet M Lang Send response to journal: Re: Decision weakens AMA	We are appalled by the decision to fire George Lundberg as a rebuke for his editorial judgment. Dr. Lundberg has been an exemplary editor who has shaped JAMA into a leading biomedical journal. His editorial guidance has served the journal and its readers remarkably well for the past 17 years. To discharge him over a question in editorial practice makes a mockery of the concept of editorial independence, and weakens any claim for respect to which the AMA might aspire.
American Medical Writers Association disapproves of firing 23 January 1999
Barbara C Good, President American Medical Writers Association Send response to journal: Re: American Medical Writers Association disapproves of firing	The following letter was sent to Dr. Anderson on behalf of the American Medical Writers Association: If the AMA truly believes that "the editorial decisions of the world's most trusted medical journal [presumably JAMA] are based on...the highest standards of medical journalism," then you should understand that those standards include allowing all sides of an issue to come to light. In choosing to publish what he did, Dr. Lundberg exercised the duty of an editor to reveal information pertinent to issues of current importance. The argument that this information is not suitable for a medical journal on the basis of content is specious. In the age of AIDS, does it not matter to physicians that a significant percentage of their young patients may be reporting they have never had sex when in fact they may have indulged in a variety of sexual behaviors that could be dangerous to their health? As medical writers and editors, we are also concerned about the unspoken assumption that accompanies the AMA's precipitous action, namely, that an outstanding medical editor can be easily disposed of because he can be easily replaced. Dr. Lundberg has been lauded on all sides for the stellar job he has done in raising the quality, visibility, and reputation of JAMA. It was a job not just anyone could have done.
AMA member's response 23 January 1999
Charles D Price, Assistant Clinical Professor, MCV, Richmond, VA, USA Kilmarnock, VA. Send response to journal: Re: AMA member's response	I have been a practising physician in internal medicine and cardiology in a rural community in Virginia for 21 years. I have been an American Medical Association (AMA) member for essentially all of this time. I am involved in the teaching of medical students through a cooperative community based program directed by the faculty at the Medical College of Virginia. I served for years as my hospital's liason member to the Hospital Staff Section of the AMA. I have at times served as a delegate from my local medical society to the Medical Society of Virginia. I have always strongly advocated the desirabitity of combined membership in local, state, and national societies (the AMA being the focal point of national membership dabate), even at a time when my dependence upon the JAMA was nil. In the more recent years of my personal experience I have found the papers published in the JAMA to be much more often relevant and pertinant to issues of substance in my practice. I peruse the table of contents of every issue when it comes - in the more distant past I would throw it away without examining it. I feel betrayed by the AMA in its action to fire Dr. Lundberg. I am disgusted by the suggestion that I may have trouble digesting the paper which has become the center of the firestorm of AMA politics. I wonder how my colleagues view my consistant encouragement of their becoming AMA members (and recipients of the JAMA) after this debacle. My view is that the wrong man was fired. The editor should be rehired with a bonus for having been so harassed. Dr. Anderson should be banished to purgatory or some other equally univiting place of confinement. I have not yet decided what to do regarding my own membership in the AMA nor what to recommend to my practice partners in this regard. My commitment to this organization has not been challenged to this degree before.
Is this the American virtue? 23 January 1999
Noritoshi Tanida, Associate Professor of Internal Medicine 4 Hyogo College of Medicine Send response to journal: Re: Is this the American virtue?	The latest newsletter of Japan Medical Association (JMA) was issued on Jan 20. In this issue, summary of the meeting between JMA and AMA which was held last autumn was reported. In response to the query by JMA Vice President Dr Koizumi about AMA's polycy to JAMA, Dr Anderson EVP answered that the JAMA's edotorial office was well cooperative with him and he would impose no restriction or censorship in any of the papers submitted to JAMA. Was this Dr Anderson's statement compatible with his recent action on Dr. Lundberg? (Dr Anderson's words were re-translated to English from the Japanese version by NT.)
Getting past polarization 23 January 1999
Timothy R Berigan, Psychiatrist Ft Bragg,North Carolina Send response to journal: Re: Getting past polarization	The firing of Dr.Lundberg is unfortunately a further example of just how far this national tragedy has polarized the American people. Under Dr.Lundberg, JAMA, has taken its place as one of the most widely read medical journals in the world. Physicians need to move past this rhetoric and use our political efforts to take on the more serious health care issues facing the nation. Although an interesting article discussing the attitudes of college students toward sex, it doesn't quite reach the level of a high crime or misdemeanor.
Politics in Scientific Journalism 23 January 1999
Jerald R Schenken, Pathologist Omaha, NE Send response to journal: Re: Politics in Scientific Journalism	The Editor of the Journal of the American Medical Association (JAMA) was fired for publishing a controversial article, which his employer (AMA) felt had inappropriate political overtones. This was not good for the AMA nor for the public. The firing of JAMA's editor George Lundberg brings into focus one of the conflicts in scientific journalism today. Where does freedom of the press end and political action begin? Where is the line to be drawn? What politically charged pieces are appropriate for a scientific journal to publish? The problem is not limited to the JAMA. Some years ago I objected to the publication of an article in the New England Journal of Medicine (NEJM) aimed at proving that the American Medical Association's Political Action Committee (AMPAC) contributed to the campaign of members of congress (House) whose voting record (in this case a cigarette tax) seemed to be in opposition to the policies on smoking of the AMA. The authors had the final votes of the House of Representatives on a comprehensive tax bill, only one part of which had to do with tobacco. The votes that count are in the committee of jurisdiction . It is impossible to reach such a conclusion about that final vote. The conclusion may or may not have been correct but the paper did not prove it. I did recommend that editors be appointed to peer review both scientific articles and op-ed pieces with clear political implications. I also recommended that an editorial be included in the same issue which presented the opposite point of view when a controversial piece clearly had two sides. (This is routinely done in both the JAMA and the NEJM for controversial non-political medical articles.) Unfortunately, the suggestion was totally rejected. I served on the Board of Trustees of the AMA for nine years and periodically made similar requests of Dr. Lundberg. To my knowledge, such an approach to politically charged articles was never made part of JAMA's editorial policy. In failing to implement such a policy, Dr Lundberg inadvertently set the stage for the current conflict. The current JAMA article in question, Would you say you ' had sex" if…? is a case in point. It addresses a very important issue related to public health policy (how valuable are polling surveys in addressing one of the nation's great threats, sexually transmitted diseases and teen aged pregnancy) at an inopportune time (the beginning of the Senate's trial of the President, William Jefferson Clinton, for perjury and obstruction of justice related to sexual misconduct). This subject would seem to be quite consistent with the AMA's goal of " betterment of the public health" and its objective of "forcast important issues and trends". An article on sexual terminology begs for a balancing op-ed piece raising questions such as: Was the survey reliable? What value is 1991 material today? How does this relate to what else is known about the general public's attitudes about sex? What is or would be the response of a survey of lawyers? What are the dangers of extrapolation of these results to fit other situations, etc? The list goes on. Given the lead-time between a paper's submission and its publication, few would question that this article might be used in relationship to the trial of the President. The article was clearly political as well as medical. When the subject is gray, the issue controversial, the public divided, and the landscape volatile, the other side of the issue should be solicited, peer reviewed and presented if appropriate. Dr. Lundberg also made a mistake here. All this being so, it is a very dangerous precedent to fire Dr. Lundberg . Absent a specific policy, he should have been warned. The JAMA could have developed a policy for a balanced approach to this type of political controversy. A special editorial group should be appointed to advise the editor on these kinds of politically charged papers. Firing sends a political statement just as unbalanced as Lundberg's critics might claim that publishing the article did in the first place. The AMA has opposed insurers that apply gag orders to physicians but now seems to be gagging its editor. Under Dr Lundberg's leadership, the JAMA has risen to the top of the heap in the scientific world. The AMA is not well served by this precipitous action. What subject will become tabooed next? Who will decide and under what circumstances? As a Republican activist, I am dismayed at the President's conduct. I was also dismayed at the timing of the article. I do not look forward to anything that might be spun to the President's benefit as this piece is so clearly designed to do. As a citizen and a physician, however, I oppose this episode of political censorship even more. The AMA needed to get the shadow of the Sunbeam affair behind it. Instead, it has now seems to have removed sunlight from medical journalism. This is bad omen for American medicine. Jerald R Schenken MD Practicing Pathologist, Omaha, NE Former Trustee of the American Medical Association (1985-93), Former Secretary Treasurer of the American Medical Association, Former Chairman, Nebraska Republican Party (1991-95) and member of the Republican National Committee
Where does this lead to? 23 January 1999
Norbert Hasenoehrl, Editor in Chief Medical Tribune, Office Vienna Send response to journal: Re: Where does this lead to?	I fully agree with you about the recent sacking of George Lundberg as editor of JAMA. The madness of "political correctness" ends up in a crucible against anybody who will not act accoring to the party line. And journalists or editors of all sorts are to be among the first victims. Especially in scientific publishing there is a tendency to succumb to all kinds of influences, especially from the pharmaceutical industry. I am glad to hear that this is not happening with the BMJ. Thank you and keep going. Yours sincerely Norbert Hasenoehrl Editorial note: This letter was also posted as response to BMJ 1999; 318: 2(The firing of Brother George, Richard Smith)
Re: Editorial Independence more Complex than Suggested 23 January 1999
Andrew D McLean, Research Fellow University of Pennsylvania Send response to journal: Re: Re: Editorial Independence more Complex than Suggested	Editorial independence is not at all complicated. The editor of a scientific journal is either free to publish as they see fit or they are not. The editor of JAMA was sacked because of his decision to publish a research paper. The conclusions to be drawn from a paper are based on, and limited to, the data contained within the paper. The fact that this particular paper had immediate political repercussions is irrelevant. If anyone disagrees with the conclusions drawn from this or any other paper they are free to argue against them. That is what freedom of speech is all about. The sacked editor is accused of currying favour with the US government by agreeing to publish a research paper which, by Mr Thackers own admission, can be interpreted in any number of ways. His implication is that those reading the article should not be allowed to carry out this interpretation for themselves. Mr Thacker also points out that the now silenced editor of JAMA had political motivation for choosing to publish this paper. The board of the AMA clearly had political motivation for sacking him. Motivation is not the issue. The issue is freedom. Mr Thacker, in introducing the question of motivation, is basically accusing those who read the press of being too stupid to infer motivations for themselves. In a country which proclaims itself as the world's greatest bastion of free speech, the AMA has undertaken an act of blatant political censorship. Thankfully, the loudest voices raised against this censorship come from within the USA. It is not complex at all. You are either free to say what you think or you are not. Freedom come all ye! Andrew D McLean FRCS Editorial note: This letter is a rapid response to a letter responding to BMJ 1999;318:213 ( 23 January )[News, JAMA's editor fired over sex article, Janice Hopkins Tanne , New York]
Stop it 24 January 1999
Hans Huisman, GP Wijk bij Duurstede Send response to journal: Re: Stop it	To much time and to much anger is put in something that has happened and was of no consquens for politics in the US en in the world. If serious doctors are now starting to misuse their time on this subject , they too, like the politiciens, will lose respect and credibility with all well thinking people outside the US. Is there really nothing more important than this childish en sad event? One almost would become homesick for times we had a cold war or nuclear bombs. Hans Huisman, GP Holland
Relevance and the AMA 24 January 1999
Ira P Gunn, Consultant, Nurse Anesthesia Professional Affairs Self-Employed Send response to journal: Re: Relevance and the AMA	As a nurse anesthetist, a former editor, and a reader and sometime subscriber to medical journals, I deplored the action of the American Medical Associations'(AMA)Executive Vice President, in firing Dr. Lundberg as editor of JAMA. Unfortunately, while AMA is a major player in political affairs within the United States (US), most medical journals are guilty of pushing political agendas in some way or another, but the variety of articles published give some evidence, also, of the degree of "fairness" and "objectivity" such journals attempt to achieve. I think the value of the article published in the January 20 issue of JAMA is that the data was "old" as some accuse--it was pre-Clintonian, thus not affected by the political "follderol" going on in the U.S. and thus more reliable. Neither was it surprising to me, though I demonstrated that some things don't change much. In my days as a college student, some 50 years ago, such opinions were consistent with "petting", "heavy petting" and "having sex" though I don't know anyone made a scientific study of it. Unfortunately, in an age in which health care reform is essential, if patients, consumers, and governments are to be able to obtain and/or provide health care as a basic human right to people in need, this action is indicative of the growing irrelevance of AMA in this public debate. They want to go back to the "good ole days" when doctors were considered God, and their words were omnipotent--in an age when people know different. Such actions call into question, even the AMA's ability to be a viable leader for the future. I am waiting for Anderson and his cohorts to start throwing out the words "socialism" and "communism" as a basis for their action as they have historically and hysterically in every effort to improve the health care system in the US. Ira P. Gunn, MLN, CRNA, FAAN Consultant, Nurse Anesthesia Professional Affairs
sigh! 25 January 1999
James Byam, surgical registrar port of spain general hospital, republic of trinidad & tobago Send response to journal: Re: sigh!	I can sympathise with some suspiscion regarding the resurrection of an "EIGHT YEAR OLD ARTICLE" which demonstrates that American adolescent males of a certain socio-economic group do not consider receiving a blow- job to have the same kudos as "getting laid"; and that females do not equate giving one to "putting out"(and the same for different permutations of oral-perineal -and other- explorations short of "conventional" coitus....). Even for second-hand consumers of American culture, like folk in my part of the world, this is not news. It would, perhaps have been more relevant to publish a survey of the "beliefs" of a more "mature" cohort of Americans e.g. "Would you say you'd had extramarital sex if....?" or "Safe Sex?: Current Practice in American Political Life". One can do no more than suspect the motives of the editor in this instance. It would appear,however, that his prosecutors do not labour under a paticularly heavy burden of proof. The action of Mr Anderson has simply created a side-show in the circus featuring Bill n Ken in centre ring and,apparently, made a martyr of his political adversary.
Creator or a puppet? 25 January 1999
Piotr Gajewski, Editor-in-chief, Medycyna Praktyczna II Department of Internal Medicine, University School of Medicine, Krakoe, Poland Send response to journal: Re: Creator or a puppet?	Success of any journal depends heavily on its editor commitment, skills and knowledge. A good editor must have a precise vision of his or her journal. It is his or her obligation to guard not only the quality of the journal, that ensures high readership, but also its independence. Dr Lundberg has provided both quality and independence for JAMA. All editors make from time to time questionable judgements. If it happens to often, a journal looses. But when a journal is on the rise, it proves that its editor has been doing a good job, that he or she has been a creator. Or would you rather have a puppet? Piotr Gajewski MD Editor-in-Chief, Medycyna Praktyczna Poland
Response to Dr. Anderson of the AMA 25 January 1999
Hilliard Jason, Editor, EDUCATION for HEALTH University of Colorado Send response to journal: Re: Response to Dr. Anderson of the AMA	Date: 1/22/99 8:58 AM Dear Dr. Anderson: I am surprised and distressed by your letter, below. Whether you, or someone on your behalf, chose to regard my letter of severe condemnation as a letter of support, I want to publicly register my deep concern that you are at risk of reporting false statistics. If you are counting the responses to your actions for use in reports to your Board of Trustees and to the public, and you are treating responses such as mine as expressions of support, than your posture as a defender of integrity is even more deeply in question that it already was. I hope you have not set up a barrier between yourself and the reality of what is going on around you. Large numbers of medical editors, medical academics, and others, internationally, have been virtually unanimous in condemning your actions. I find your statement below hypocritical and dangerous. Whether acting on your own initiative or carrying out the directive of your Board, your actions have seriously sullied the already faltering reputation of the organization you represent. You have done far more damage than Dr. Lundberg could possibly do with the publication of one article in JAMA. Hilliard Jason, MD, EdD Editor, EDUCATION for HEALTH: Change in Learning and Practice On 1/21/99 4:19 PM you wrote: >Dear Dr Hilliard Jason, > >Thank you for writing to express your support regarding the recent change >of leadership at the Journal of the American Medical Association. My >decision to remove Dr. Lundberg as editor of the journal was difficult, >but it was necessary, and I'm confident it will have a positive affect on >JAMA. > >I firmly believe that the AMA has a responsibility to the medical >profession, to our patients and to the country to ensure that we protect >JAMA's reputation as the world's most trusted medical journal. Trust and >integrity are at the very heart of the work we do together every day here >at the AMA. Nothing is more important. > >Unfortunately, over time, I have lost confidence in Dr. Lundberg's role as >editor of JAMA. > >A search committee has already begun the process of finding a new editor >for JAMA. Meanwhile, the JAMA staff is hard at work putting out their next >issue, and I am certain JAMA will continue to bring you the very best in >medical and scientific information based on the highest standards of >medical journalism. > >Thanks again for letting me know of your support. > >Sincerely, > >E. Ratcliffe Anderson Jr., MD >Executive Vice President, AMA
Letter to Nancey Dickey, President of the AMA 25 January 1999
Don Berwick, President Institute for Healthcare Improvement Send response to journal: Re: Letter to Nancey Dickey, President of the AMA	Dear Nancy, George Lundberg has been for many years one of the most effective, courageous, and respected leaders in American medicine. His work stimulates thought, challenges the best in us, and has reflected well on the AMA. His voice has been eloquent, constant, professional, committed to truth, perceptive, and integrative. Through his leadership, JAMA has emerged as almost without peer as a professional journal in health care. I am proud to count him among my friends and colleagues. I am outraged by the action taken to remove George as Editor of JAMA. The loss to JAMA is inestimable. I have little doubt that George's outstanding qualities and extraordinary achievements will allow him to maintain an active and admired role in the leadership of medicine worldwide, with or without his position as JAMA's Editor. The AMA is at much higher risk. Its impulsive and short-sighted action in discharging George will indelibly blot its reputation for fairness, commitment to independent scientific journalism, and simple common sense. The damage will be severe. In my opinion, you and the AMA leadership would be well- advised to reconsider and reverse this action immediately. Those many of us who hold George in the highest regard may have a hard time forgetting what the AMA did in this instance, but we will most certainly respect the courage of an organization able to admit when it makes a mistake as serious as this one. Sincerely, Don Berwick
Its a blow. Jobs and humour 25 January 1999
C J Price, gp cwmbran gwent cwmbran Send response to journal: Re: Its a blow. Jobs and humour	Humour has always been an essensial part of Medicine, usually satirical and sometimes situational. This proposed publication however in a mainstream journal of a study that has direct impact on the current (am) musings of the American Senate has to be naieve at best and does raise the question of political bias. Imagine the scene as Mr. Clinton's lawyers brandish JAMA "Mr. Clinton was only expressing a view held by a substantial propotion of college kids". While understanding the implications on editorial freedom, surely it would have been just as relevant and reflective if the article was accepted for publication after the verdict, in a Christmas issue or part of a series on sexual beliefs. Editors must have freedom, they must also use that freedom wisely.
Medico-political lynching 25 January 1999
Ralph E Yodaiken, Clinical Prof. George Washington Medical School: Georgetown University Medical School Washington D.C., Naomi Baumslag Send response to journal: Re: Medico-political lynching	Unfortunately Washington D.C. is in the process of a political lynching which has infected all segments of the population not excluding, professionals. That Dr. Lundberg was drawn into this morass is unsurprising and that he should have attempted to inject a scientific and public health opinion is in keeping with his responsiilities as physician and editor of a respectable medical journal. His ejection as editor is not unique. He joins the ranks of distinguished precedessors such as Rudolf Virchow. who was dismissed for his liberal views but reinstated after solicitations by professional societies. It can only be hoped that sufficient numbers of professionals as well as medical organizations including other medical journals, will stand up and be counted; will exert sufficient pressure on the AMA to restore the freedom of the medical press. If not, every medical, nursing, industrial health editor will look over his/her shoulder before publishing any scientific article that may suggest a political bias. Papers that discuss the root causes of ill health among minorities, the impoverished, the handicapped, will all be suspect. We don't believe free world medical or other health care practioners should live in such a restrictive environment.
The Demise of the American Medical Association 26 January 1999
Raymond Scalettar, Clinical Professor of Medicine George Washinton Medical Center Office practice; 730 24th St, NW Wash DC 20037 Send response to journal: Re: The Demise of the American Medical Association	As a past Trustee and Chair of the AMA('92-'93), the recent action of the new EVP, a former Surgeon General of the US Air Force comes out of the wild blue yonder. Dr. Anderson who acknowledges he was not even a member of the AMA until 5 years ago has literally flown the AMA into the mountain. The aggresive defense of his actions by Drs. Dickey and Smoak, President and current Chair, reveal that this was orchestrated with the support of the AMA leadership. After the recent Sunbeam scandal, the attempt to curry favor with the Republicans on parial birth abortion for increased mediare reimbursement, reflect the impoverishment of the current leadership. They have even disregarded their own report of June '93 which affirmed the independence of JAMA. (I was Chair at that time). Sadly, the AMA's tailspin continues. This action is truly a mortal blow and takes the AMA back to its reactionary past which I and so many of my colleagues tried to end. JAMA has been the "Jewel in the Crown" of the AMA, thanks to the 17 year reign of Dr. Lundberg. Sadly, this action reveals the AMA would rather be dead than read! Raymond Scalettar, Chair AMA "92-"93.
ICMJE open letter to the AMA 26 January 1999
International Committee of Medical Journal Editors , coordinator CMAJ Send response to journal: Re: ICMJE open letter to the AMA	January 25, 1999 Dr. Nancy W. Dickey President Dr. E. Ratcliffe Anderson, Jr, Executive vice-president American Medical Association 515 North State Street Chicago, IL 60610 By Fax: (312) 464-5543 Dear Dr. Dickey and Dr. Anderson: The International Committee of Medical Journal Editors regrets and views with alarm the decision of the American Medical Association to fire the editor of JAMA. The decision taken by the AMA is a serious infringement of editorial freedom. The Committee has issued a statement on Editorial Freedom and Integrity and we re-iterate that statement here. Editorial freedom and integrity Owners and editors of medical journals have a common endeavour -- the publication of a reliable and readable journal, produced with due respect for the stated aims of the journal and for costs. The functions of owners and editors, however, are different. Owners have the right to appoint and dismiss editors and to make important business decisions, in which editors should be involved to the fullest extent possible. Editors must have full authority for determining the editorial content of the journal. This concept of editorial freedom should be resolutely defended by editors even to the extent of their placing their positions at stake. To secure this freedom in practice, the editor should have direct access to the highest level of ownership, not only to a delegated manager. Editors of medical journals should have a contract that clearly states the editor's rights and duties in addition to the general terms of the appointment and that defines mechanisms for resolving conflicts. An independent editorial advisory board may be useful in helping the editor establish and maintain editorial policy. All editors and editors' organizations have the obligation to support the concept of editorial freedom and to draw major transgressions of such freedom to the attention of the international medical community.* * Uniform requirements for manuscripts submitted to biomedical journals. Additional statements from the International Committee of Medical Journal Editors. CMAJ 1997;156:571-4 This letter has been endorsed by the following members of the International Committe of Medical Journal Editors: Annals of Internal Medicine (Frank Davidoff) British Medical Journal (Richard Smith) Canadian Medical Association Journal (John Hoey) JAMA (Richard Glass) Nederlands Tijdschrift voor Geneeskunde (John Overbeke) New England Journal of Medicine (Marcia Angell and Jerome Kassirer) The Lancet (Richard Horton) The Medical Journal of Australia (Martin van der Weyden) Tidsskrift for Den Norske Laegeforening (Magne Nylenna) Ugeskrift for Laeger (Liselotte Hoejaard) and submitted on their behalf by, John Hoey, MD Editor-in-Chief Canadian Medical Association Journal competing interests: We are all editors.
Walk the talk 26 January 1999
David C Kibbe, Adjunct Assistant Prof. HPAA School of Public Health, University of North Carolina at Chapel Hill Chapel Hill, North Carolina Send response to journal: Re: Walk the talk	Colleagues: There is only one response, for those of us who feel strongly that Dr. Lundberg's dismissal was wrong, that will send a message to the AMA leadership: leave the AMA. It just so happens that my annual dues renewal form was on my desk when the announcement broke, awaiting payment. I will not renew my membership in the AMA for 1999. DCK
Lundberg, a victim of AMA politics 26 January 1999
A Waise, Consultant Chemical Pathologist Friarage Hospital, Northallerton, N.Yorks.,UK Send response to journal: Re: Lundberg, a victim of AMA politics	I find the action of the vice president of the AMA unforgivable and a serious slur on editorial freedom. It is clear from Anderson's announcement that the publication of the article in question was the last straw. Anderson's, it would appear, has been unhappy with Lundberg's editorial approach. Whether this is simply due to personal grudge, jealousy or some deep and fundamental ideological difference, is something we may never know. It would appear that the sacking was not because Lundberg had accepted the study, on the issue of 'oral sex', to be published in JAMA. It is the fast tacking of the publication that seems to have annoyed Anderson. Anderson is blaming Lundberg, for sensationalism. We should, in return, accuse Anderson of an unacceptable sensitivities and apparent desire to appease conservative political forces, leading to a grave misjudgment and unwarranted interference with JAMA's outstanding editorship. It is highly desirable that we know Lundberg's view of events. I am sure, baring some legality, we will be told of his side of this 'sensational' story. The publication of sexual issues, which not everyone agrees constitute a topic of medical interest, is always going to controversial. Is the BMJ 'politically correct in publishing the current series on sexual issues under the heading of sexual health? Would the BMJ editor have been sacked if the issue was topical and 'politically sensitive'? I think not. The BMA is free to speak its mind and does not appear to have to express views or take actions to appease politicians. The action of the AMA is another manifestation of the impact of the way health care is funded on the way such institutions operate. Something surely to strengthen the argument against any attempt to adopt a similar way of funding healthcare in the UK and the potential pitfalls of private and other powerful insurance organizations funded care.
Firing Dr. Lunberg is a serious and tragic error 26 January 1999
Paul Gorman, Family Physician Portland, Oregon Send response to journal: Re: Firing Dr. Lunberg is a serious and tragic error	The AMA has committed a serious, tragic error in firing Dr. Lundberg as editor of JAMA. In so doing you have "threatened the historic tradition and integrity of the Journal of the American Medical Association." During my training, papers in JAMA were regarded as unimportant and of questionable quality. We rarely copied them, read them, or cited them. Today, papers published in JAMA are a constant presence in supporting the work of those involved in evidence based patient care, teaching, and research. Under Dr. Lundberg's leadership, JAMA was transformed from a relatively trivial publication to its recent status as one of the premiere medical publications in the world. With Dr. Lundberg as editor, JAMA has played a leadership role in improving the quality and impact of not only its own content but of medical publishing in general. Consider JAMA's role in: o) advancing the new paradigm of Evidence Based Medicine, including landmark publications such as the initial Evidence Based Medicine Working Group paper, the User's Guides to the literature series, and the Rational Clinical Exam Series; o) promoting the publication of valid and clinically relevant clinical research, especially high quality randomized controlled trials and unbiased systematic reviews - many of the most important of these have been published in JAMA; o) sponsoring and participating in international conferences on peer review, to improve the quality of publications in all health related journals; o) embracing information technology that permits rapid and broad dissemination of health information, by electronic publishing of JAMA and by keeping its readers informed about informatics related topics, including a recent issue devoted to the internet and computers in medicine. o) focusing the attention of health professionals on important, albeit controversial health care issues with social and political ramifications, including articles and special issues of the Journal on Domestic Violence, tobacco, war, sports, and medical ethics. Publication in JAMA has provided the scientific basis for rational debate and substantial progress in each of these areas, improving the practices of clinicians and the lives of patients. Dr. Lundberg's positive impact on medical publishing, medical science, and medical care has been widely felt and will be sorely missed. It is a tragedy that the Journal of the AMA will no longer enjoy the benefit of his leadership. Paul Gorman, MD Portland, Oregon
Hasty action. 26 January 1999
G A Balint, Professor Albert Szent-Gyorgyi Medical University,Szeged,Hungary Send response to journal: Re: Hasty action.	To mix up everything intentionally with the present impeachment process,- this is far from objectivity. On the other side it would have been better to postpone the publication of the mentioned article.
JAMA Editors Respond to Comments on Dr. Lundberg's dismissal 26 January 1999
Bill Silberg, Editorial Director, Medical News and New Media JAMA Send response to journal: Re: JAMA Editors Respond to Comments on Dr. Lundberg's dismissal	The editors of JAMA and members of the JAMA Editorial Board appreciate the many comments and concerns regarding the dismissal of George Lundberg, MD, as Editor of JAMA. An Editorial entitled “JAMA and Editorial Independence,” published in the February 3, 1999 issue of The Journal, expresses our disagreement with the decision to summarily dismiss Dr Lundberg and our pledge to readers, authors, and peer reviewers to maintain the Journal's editorial integrity. Considering the interest in this topic, this editorial has been released early and can be read in full on the JAMA Web site. You may reach this editorial either through the JAMA home page (http://www.jama.com) or directly at: http://www.ama-assn.org/sci-pubs/journals/archive/jama/vol_281/no_5/ed90009x.htm Richard Glass, MD Phil Fontanarosa, MD Interim Co-Editors JAMA
Lundberg Dismissal: Scientific Outrage 27 January 1999
Kathleen N Lohr, Director, Health Services and Policy Research Research Triangle Institute, North Carolina, USA Send response to journal: Re: Lundberg Dismissal: Scientific Outrage	I want to decry in the strongest possible terms the abrupt, ill- considered, and damaging dismissal of George Lundberg as editor of the Journal of the American Medical Association. This action puts the AMA hand-in-glove with the hard-core right wing of the Republican party [in the American political system]. It destroys any claim that the AMA might care to make about the independence of its journal from its political leadership and sponsors or advertisers. It will be extremely difficult for the AMA to find a replacement JAMA editor who will not always be suspected of being under the AMA's thumb, and this undercuts in a significant way the credibility of the journal and the confidence one can put in its articles, editorial policies, and the like. The AMA could have simply taken the high road of distancing itself from any position about this article or issuing some statement to the effect that the AMA was uncomfortable with the timing but that it is AMA policy not to interfere with the editorial policies or scientific integrity of materials published in JAMA. If, of course, this was just an excuse to rid JAMA of an independent, highly principled editor, then the scientific world has lost a good deal, and the AMA will have lost even more in reputation and credibility. Finally, one hopes that the AMA can find a way to reverse this decision, as George is a highly respected editor who has made JAMA into a (perhaps the) premier general medical journal in the country (and thus the world). Reinstatement and some face-saving language about the Association having acted in undue haste might be able to undo the damage. Kathleen N. Lohr, Ph.D. Director, Health Services and Policy Research Research Triangle Institute Research Triangle Park, North Carolina USA
editors should get together 27 January 1999
Franco Cavalli, Editor-in-Chief, Annals of Oncology Director of the Oncology Dept. Ospedale San Giovanni, 6500 Bellinzona, Switzerland Send response to journal: Re: editors should get together	I consider the dismissal of the Editor of JAMA a very shameful decision and one which threatens the freedom of Editors. I feel that all editors should get together, in order to put whatever pressure could be needed on JAMA's publishers. Prof. Franco Cavalli, M.D., FRCP (London) Editor-in-Chief, Annals of Oncology Via Soldino 22 6900 Lugano, Switzerland
Sacking of the JAMA editor seriously undermines the credibility of JAMA 27 January 1999
Somnath Mukhopadhyay, Senior Lecturer (Honorary Consultant) Ninewells Hospital and Medical School, Dundee Send response to journal: Re: Sacking of the JAMA editor seriously undermines the credibility of JAMA	I feel the sacking of the JAMA editor very seriously undermines the credibility of JAMA as a top-ranking medical journal. If the Editor has been sacked, it suggests he could have been under considerable pressure under other occasions to accept or reject articles. This suggestion is entirely inconsistent with what is to be expected of good medical journals. Short of re-instating Lundberg and providing an unqualified apology to the scientific community it expects to serve, I do not know how JAMA can hope to resurrect itself in the foreseeable future.
Code of practice required for societies as regards editorial freedom 28 January 1999
J M Grant, Editor-in-Chief British Journal of Obstetrics and Gynaecology Send response to journal: Re: Code of practice required for societies as regards editorial freedom	The sacking of George Lundberg has serious implications for all society journals: it undermines the unwritten, but inherent, principle that it is the editor who governs the process by which papers are reviewed, selected and published, outwith the political and policy concerns of the society. Lundberg's dismissal was unjustified and if confirmed could sound the death knell of editorial freedom of all medical and scientific journal editors. We need urgently a code of practice for societies for the protection of journals and their editors. Societies which breach this code of practice should be named and shamed.
Editors, dry your eyes 28 January 1999
Andrea O'Donnell, International Marketing Manager The Lancet Send response to journal: Re: Editors, dry your eyes	It is always distressing when someone loses their job. But where is the reaction from readers of JAMA or any of the other journals whose editors express their outrage so, well, outrageously? Come on readers, don't you care about your editors? Don't you think your journals will suffer if editors are removed?
Editorial independence of JAMA 28 January 1999
E Ratcliffe Anderson, Executive Vice President American Medical Association Send response to journal: Re: Editorial independence of JAMA	Since the announcement a few days ago about the change in editorial leadership of the Journal of the American Medical Association, this forum and others like it, have raised important questions about exactly what has happened and why. Much of the discussion in this forum, understandably, has centered on the question of editorial independence. I'd like to address that subject briefly. Editorial independence has been a hallmark of JAMA, and the AMA intends to keep it that way. Nothing will interrupt JAMA's publication or its high level of excellence. Today, January 27, we are announcing the formation of a distinguished search committee of top experts in ethics, basic science, academic science, clinical medicine, scientific integrity, health services research, and medical journalism. The committee will take as much time as necessary to make sure we find the right person to become the new editor of JAMA. Our priorities are finding the best editor and preserving the Journal's editorial independence. I'm pleased to announce that the search for a new editor will be headed by Roger N. Rosenberg, MD, a distinguished professor in neurology at the University of Texas Southwestern Medical Center in Dallas and editor of Archives of Neurology. Dr. Rosenberg holds the university's Zale Distinguished Chair in Neurology. Dr. Rosenberg's search committee will include: Floyd E. Bloom, MD, Editor-in-Chief of Science Magazine and Chair of the Department of Neuropharmacology, Scripps Research Institute; William H. Danforth, MD, Chair of the Board of Trustees, Washington University; Bernadine Healy, MD, former Director of the National Institutes of Health (NIH) and Dean of the College of Medicine and Public Health, The Ohio State University; Michael M.E. Johns, MD, Executive Vice President for Health Affairs, Emory University; Joseph B. Martin, MD, PhD, Dean of the Harvard Faculty of Medicine; Edmund D. Pellegrino, MD, Director of the Center for Clinical Bioethics, Georgetown University Medical Center; Drummond Rennie, MD, JAMA Deputy Editor (West) and Adjunct Professor of Medicine, University of California, San Francisco; and John E. Wennberg, MD, MPH, Director of the Center for the Evaluative Clinical Sciences and Peggy Y. Thomson Professor for the Evaluative Clinical Sciences, Dartmouth Medical School. We are grateful that these outstanding leaders believe so strongly in JAMA that they are willing to undertake this assignment that is so vital to American medicine and the integrity of the Journal. Our charge to the committee will be to review existing practices and develop safeguards that will guarantee JAMA's integrity, editorial independence and responsibility. The committee also will be charged with determining how the editor's performance can best be measured. Dr. Lundberg devoted the better part of two decades to building the stature of JAMA, and we are grateful for his contribution. Now we are asking Dr. Rosenberg's committee to find the very best available medical editor to define the next era of excellence for JAMA in the 21st century. This will be a worldwide search. We will encourage the committee to take as much time as necessary to make sure they find the right person for the job. Our priority is to assure AMA's members and all of JAMA's readers, the Journal's contributors, the academic community, and our patients that the proper protections are in place to guarantee JAMA's high standards and editorial independence. During the search process, two experienced JAMA deputy editors -- Richard M. Glass, MD, and Phil B. Fontanarosa, MD -- have stepped in as interim co-editors. They have my full confidence, as does the tremendous JAMA staff, who are the mainstay of the Journal. We anticipate that the flow of important scientific contributions from the academic community will continue unabated. You may be interested to check the JAMA web site, because JAMA has posted an editorial from the February 3 issue that I think offers a clear and balanced assessment of several of the important issues that go straight to the heart of the Journal's integrity and excellence. You will also find my own statement about the editorial, and see that the editors of JAMA and I agree on a strong commitment to maintaining JAMA's editorial independence. You can find the editorial at http://www.ama- assn.org/public/journals/jama/
The firing was just and REQUIRED 28 January 1999
Malcolm Kahraman Send response to journal: Re: The firing was just and REQUIRED	Editorial note: This was originally submitted in response to Richard Smith's editorial "The firing of Brother George" and is included here for completeness. You state JAMA has damaged itself by firing of Lundberg. The real "damage" to the publication would've occured if they had decided to keep him on after printing something so outrageous. Firing Lundberg was just and required. He decided to print "findings" not relevent to JAMA and certainly not relevent to any publication that expects to be viewed by it's membership as credible. You're attacks on JAMA and the AMA are typically reminiscent of those that are attacked in this country for venturing an opinion against this president. This is evidenced by your mention of "upsetting the deeply conservative membership of the association "... perhaps the term "vast right-wing conspiracy" is getting a bit hacked?
Of course sex is relevant to medicine! 30 January 1999
Ayelet Kuper, Medical Student University of Toronto Send response to journal: Re: Of course sex is relevant to medicine!	I was very surprised to read Mr Kahraman's statement that the article in question was somehow not relevant to JAMA. It comes in sharp contrast to a seminar I attended just this afternoon on dealing with teenage concerns such as STDs and contraception. How, I might ask, will I be able to provide the best standard of care for the patients I will have someday if I do not know how to communicate with them about issues of sexuality? Doesn't communication require knowledge of what patients mean when they say things like they "had sex" or "didn't have sex"? I think the AMA is setting a terrible example for current and future physicians. I am appalled by the arrogance of the AMA in trying to determine acceptibility for publication not by the standards of scientific method but by those of their own political self-interest. Am I supposed to learn from this that I shouldn't someday undertake research that might be controversial? That medicine doesn't include political issues (like poverty, abuse, effects of socio-economic status on health care)? Is the AMA really saying that medicine is only about science? I applaud the BMJ, the CMAJ, and their sister publications for taking a stand against this reactive censorship. I am glad to see someone setting an example of integrity for those of us who are future physicians to be able to follow. Ayelet Kuper, AB MSt DPhil (Oxon)
AMApalled 30 January 1999
John Bramhall, Assistant Professor University of Washington Send response to journal: Re: AMApalled	Yet another reason NOT to belong to the AMA! As a medical student I was exposed to the insensitive, business- oriented manner in which the AMA promotes its view of how American medicine should be practiced. I loathed it then, and I loathe it now, many years later.
Sacking of JAMA editor hypocritical 30 January 1999
Daniel W Smith, Senior Scientist Conestoga Rovers, Inc. Send response to journal: Re: Sacking of JAMA editor hypocritical	As JAMA is a science journal, it would be good to view the original article and the sacking in terms of science and science journals. First, consider the complaint that the article was simply politics, not "science." I find this charge very troubling, because it continues an all -too-common charge that someone else's work can be dismissed as not "science." As far as I can tell, the questionnaire sampled a population with a reasonably well-accepted methodology. Are these results any less science than measures of any other attribute - e.g., concentrations of chemical or biological factors - that pass as good science in any number of articles in any number journals? Unless one wants to assert that sociology is not science and to reject all "science' based on questionnaires, this charge seems incorrect and inequitable. There is also the charge that teen-agers and young adults are not a reliable population from which to gather data. Again, this is,, I believe, an unsupportable complaint. Since the intent of the work was to assay how sexually active adults describe their sexual behavior, it is totally appropriate to look at this group. In fact, as this group may be among the highest risk group for sexually transmitted diseases, college students may be the most appropriate group to have surveyed, the exact opposite of what critics are saying. Lastly, we have the supposed offence of relevance to the current scandal. This again seems like a strange complaint, as the importance of a manuscript is always a critical factor in deciding to publish or reject. Isn't the fate of the President of the United States an important public health issue. Aren't there many other papers in JAMA and elsewhere in the literature with less relevance to public health? As for JAMA interjecting itself into a political debate, how is this different than most articles concerning impacts of environmental chemicals, abortion, gender and ethnic differences, etc.? Hypocritically, the sacking of the JAMA editor seems to have been motivated by ascientific and political reasons, exactly the charges leveled at the JAMA editor. People didn't like the results, as opposed to the methods, and AMA apparently found the results politically inconvenient. It's perfectly fine for the AMA to control the content of its journal. It is not, however, valid to justify these decisions as being scientific.
Re: Editors, dry your eyes 30 January 1999
Charles D Price, Assist Clinical Prof Med, MCV, Richmond, VA Private practice, Kilmarnock, VA Send response to journal: Re: Re: Editors, dry your eyes	Ms O'Donnell suggests that the relative absence of grass roots AMA members responses on the British Medical Journal's web page devoted to the issue of Dr. Lundberg's dismissal as editor of JAMA implies an indifference on their part to this event. I suspect that if she were to weigh the communications addressed to the AMA directly she might come to a quite different conclusion. I am an AMA member of long standing who occassionaly visits the BMJ web page. I happened to come on line for reasons that had nothing to do with JAMA, AMA, or Dr. Lundberg shortly after this issue was enjoined and decided to join in the debate. It is quite apparent to anyone who gives the issue any thought that it was Dr. Anderson who cried "fire" in the theater! There is no way that this small paper published without editorial comment and as part of a normal issue of JAMA would have ever created anything like the furor that Dr. Anderson's thinnly veiled politically conditioned hatchet job has engendered. If Dr. Anderson survives this firestorm as an AMA executive, then my membership in the AMA will not.
He should have been Sacked... 30 January 1999
Martin Send response to journal: Re: He should have been Sacked...	He should have been sacked. The printing of this article at this time was meant to be prejudicial...
Press freedom 1 February 1999
P Xavier, retired-health grounds. home Send response to journal: Re: Press freedom	Sir, Editorial freedom is something we fail to defend at our peril. Here in Europe we wonder what the fuss about Bill Clinton's private life is all really about; it looked like a set-up from start to finish. The wrecking of Hilary Clinton's health scheme for the USA was bad enough; is this kind of gross unfairness to the JAMA editor and muck-raking directed at Bill Clinton all the political opposition can do? Come back Ronald Reagan and George Bush; your party needs you!
Lundberg should be reinstated 1 February 1999
Jayant S Vaidya, Hon. Lecturer University College London Send response to journal: Re: Lundberg should be reinstated	While everyone concerned has clearly judged the firing of Dr Lundberg to be wrong- I am surprised that none of the commentaries suggest a solution. - At the risk of being called extremely naive I am suggesting the obvious- the best way to correct the mistake is to reinstate the esteemed editor - that will be the easiest way the integrity of journal and its association could be at least partially restored.
Sex is a part of life 1 February 1999
Gabi Caswell, Medical student University of Queensland Send response to journal: Re: Sex is a part of life	As a medical student, who is a little older than most, who has children and who has had a life outside of medicine, I am continually surprised by the actions and motivations of those in the medical profession - and I firmly believe that most of those in medical authority live in another time (perhaps another place). Conservatism has a place in the running of things - but power (and remember absolute power corrupts absolutely) has no place in the distribution of information, the views of others and open debate. Sacking a editor because he was going to publish a survey is the absolute corruption of power of the Chairperson and obviously the charter of the AMA (or perhaps it's not?). Sex is a natural act and more investigation of this act and the modern views of the generation for which sex is an open subject, is important in the care and management of the sexual health for this generation - open discussion should be encouraged from the top of the tree - not hidden in a back alley where "deals are done" by a few elite. It may surprise the Chairperson of the AMA, but there are people having and discussing sex all over the world and it needs to be discussed by the medical profession in a professional environment, the fact that the president of the USA is in trouble for having (or not having) sex is not the concern of the journal - but it might make the article topical and more widely read than it may have previously been. I wonder if the BJM might publish the manuscript so I can have the pleasure of reading it?
Re: Copy of Sackett's letter to AMA 1 February 1999
Ursula R Pfister, Editor in chief Gazette Médicale, Switzerland Basel/Switzerland Send response to journal: Re: Re: Copy of Sackett's letter to AMA	I firmly agree with every word in Sackett's letter. I am shocked and disappointed: How can I read JAMA and believe in reading an independent and uncensorized journal in the future?! I support the idea to establish an award for editorial integrity named after Prof.Lundberg. Ursula R. Pfister, editor in chief, Gazette Médicale, Switzerland
A well deserved fate 1 February 1999
R Pidsley, District Medical Officer Australia N.W.AUstralia Send response to journal: Re: A well deserved fate	The Ama by this decision has maintained its political integrity and neutrality .Surely medical journals should be concerned with clinical medical matters rather than contemporary politics. The Bmj hopefully might learn a lesson from this , and concentrate more fully on the world of medicine, and leave its politically biased campaigns to other media.
Unite against interference 1 February 1999
I Gordon, Consultant Radiologist Great Ormond Street Hospital for Children Send response to journal: Re: Unite against interference	31 Jan. 1999 The dismissal of Dr. George Lundberg, editor of JAMA by the AMA. Reviewing the current correspondence on the BMJs world wide web pages, I note that there is no comment on this matter by the following societies of which I am a member. Society of Nuclear Medicine (J Nucl. Med.); British Society of Nuclear Medicine (Nucl. Med. Comm.); European Association of Nuclear Medicine (Euro. J Nucl. Med.); British Institute of Radiology (Brit. J Radiol); Royal College of Radiologists (Clin. Rad.); Royal College of Paediatrics and Child Health (Archives Dis. Child.) and the European Society of Paediatric Radiology (Ped. Radiol.) The AMA’s decision is a dangerous breach of editorial freedom and should be decidedly condemned by all editors of medical journals. Further, a search committee has been set up to look for a new editor of JAMA, headed by Roger N Rosenberg MD, professor of neurology at University of Texas South-western Medical Centre, Dallas. He is also the editor of Archives of Neurology. Surely concerted effort should be put on Professor Rosenberg and his search committee to resign. Failing this they should obtain written confirmation of the editorial independence of any future editor of JAMA. As a single voice in the medical fraternity, exerting any influence on such matters is limited. But by the combined action of the medical fraternity, I hope every organisation of which I am a member and has a journal will not only condemn Dr. Lundberg’s dismissal, but will unite with all other medical journals to exert pressure on the officers of the AMA to acknowledge their error. Furthermore I am sure that members of the AMA will also voice their opposition to prevent such unacceptable practices. From: Dr. Isky Gordon FRCP, FRCR, FRCP&CH Consultant Radiologist, Great Ormond Street Hospital for Children, London WC1N 3JH, England. Sent to: The editors of Journals of which I a member of the society: BMJ.; J Nucl. Med.; Nucl. Med. Comm.; Euro. J Nucl. Med.; Brit. J Radiol.; Clin. Rad.; Archives Dis. Child.; Ped. Radiol.
Untitled 1 February 1999
Richard T James, Editor, Practical Pointers 400 Avinger Lane #203 Davidxon NC 28036 USA Send response to journal: Re: this article	Outrageous !
BMJ response to a survey with political context 2 February 1999
Norman Vetter, Reader in epidemiology Cardiff, Wales, UK Send response to journal: Re: BMJ response to a survey with political context	I thought you might be interested to know of an experience I had with the BMJ. The 'limited list' of medications was due to come out shortly - back in the 80s when I was running a research unit for elderly people. We had lots of prescribing data from elderly people in the community and I rattled together a paper on the proportion of elderly people taking the tabs mentioned in the restricted list, with suggestions about the alternatives they might be given and possible problems - 'but I always get a red one doc'(1). The BMJ fast tracked this to get it out before the legislation. No one was sacked as far as I know, though one might consider this a political move. Or was it a legitimate addition to the debate from a medical point of view? 1. Vetter NJ, Jones DA, Victor CR. The effect of the limited prescribing list upon the elderly. BMJ 1985;290:1712-1714.
Lundberg firing a long time coming 2 February 1999
Timothy Wheeler, Director Doctors for Responsible Gun Ownership, a Project of The Claremont Institute Send response to journal: Re: Lundberg firing a long time coming	As an American surgeon and long-time member of the American Medical Association (AMA) I offer this background on the Lundberg affair. BMJ readers not living in the United States may not appreciate the clearly political nature of Dr. Lundberg's editorial policies at the Journal of the American Medical Association (JAMA). These policies were inconsistent with good science. For years Dr. Lundberg used the AMA's leading scientific journal to advance such non-scientific political causes as gun prohibition and affirmative action (race-based preferences in medical school admissions). Authors of JAMA articles during the Lundberg era frequently had hopeless conflicts of interest, such as the authors of "studies" showing gun ownership to be dangerous. This gun research, for example, was mostly funded by the federal Centers for Disease Control (CDC). The CDC's own funding was cut by Congress due to CDC officers' confessed bias against gun ownership. The finely timed sex survey article was only the last straw, as the AMA's Executive Vice President Dr. Anderson made clear in his strongly worded statement. Dr. Lundberg's removal was timely and vital. The only question is whether the AMA Board will make permanent changes in JAMA's editorial policies, or if Dr. Lundberg's firing is only a symbolic gesture.
A plague on both of them 2 February 1999
Jim Thornton, Reader in Obstetrics and Gynaecology University of Leeds Send response to journal: Re: A plague on both of them	Sir, - The AMA owns JAMA, and employed editor Lundberg in the first place. They are surely entitled to sack him. There is no interference in free speech because he and his supporters have many other outlets for their views, including this website. In fact the opposite is the case. An editorial code of practice or similar, which forced the AMA to retain him, would infringe the liberty of AMA members. Those members who oppose Anderson have two actions open to them, to lobby for his sacking, or to leave the organisation. Readers similarly can vote with their feet, and AMA members will consider the circulation, profitability and impact factor of JAMA, when deciding whether to support Lundberg or Anderson. The free market in medical publishing is working well. By the way, who should old fashioned liberals support? Although the AMA supports private medicine and has successfully protected Americans from the worst excesses of socialised medicine over the years, it is profoundly illiberal in other ways. It restricts entry to the profession, and lobbies for insurance tax breaks and regulations, which allow members to push their fees well above the market rate. However, as we in the UK know only too well, Lundberg and his supporters' cure would be worse than the disease. Socialised health care not only displaces private medicine and lowers health expenditure overall, but diverts resources to an infinite variety of politically correct lifestyle interventions. Even the curative care in the NHS is of comparatively poor quality, and planned efforts like audit, patient charters and clinical governance seem singularly unable to improve it. A plague on both of them.
My full support 4 February 1999
Anders Arhammar, Chief editor Swedish arthritis today Send response to journal: Re: My full support	Dear sirs, My full support for the editor of JAMA. And my contempt for this Anderson, that has only recently been parachuted into the AMA’s top job. Apparently he knows not much about publishing, less of editing and nothing about JAMAs purpose. Obviously he has been promoted to his level of incompetence. Well, even over that. Hopefully someone will make him aware of that.
Evaluation process for medical editors should be fair 4 February 1999
Joseph F Waeckerle, Editor in Chief Annals of Emergency Medicine Send response to journal: Re: Evaluation process for medical editors should be fair	As the Senior Editors of Annals of Emergency Medicine, we have been following the recent events at the American Medical Association regarding JAMA, and they concern us greatly. We believe the relationship between the AMA and the Editor of JAMA must respect editorial freedom and integrity. In fact, JAMA has championed this cause through its longstanding support of the International Committee of Medical Journal Editors. The evaluation process of the Editor of an association journal must be based on wide input to include the Editorial Board, reviewers, authors, and perhaps Editor peers, as well as association staff and Board members. Action taken based on this broad process demonstrates a willingness to be inclusive and fair to all involved. We understand there may be issues about the value and timing of the article that gave rise to this action. However, the AMA has long advocated for editorial freedom and a fair and ongoing evaluation process for medical editors should preclude undue emphasis on any single activity. We sincerely hope the firing of Dr. Lundberg does not represent a change in direction for the AMA. Medical editors everywhere have expressed their concern and should be concerned that this could happen to a colleague or themselves. Sincerely, Joseph F Waeckerle, MD Editor in Chief Michael L Callaham, MD Deputy Editor William G Baxt, MD Associate Editor Robert K Knopp, MD Associate Editor Judith E Tintinalli, MD Associate Editor
Hasty 4 February 1999
Colin Mackenzie, Retired MD California n/a/ Send response to journal: Re: Hasty	A man who has been a satisfactory editor of a major medical journal for 17 years should surely not have been sacked for poor judgement in publishing an article. I take no side on the issue. Whether one comes down on one side or the other. Is not the point. He should not have been sacked. If he was judged to have erred then something far short from sacking should have been considered and then not in public. I am afraid that the AMA will come off poorly in this matter just like the Sunbeam business. It seems to me that the wrong man was sacked. It would seem that the problem lies not with the editor of the AMA but with with a group of faddy duddies at the top. This is the reason why I left the Association some years ago. This after I had been polically involved on a district level. The stables need cleaning out. Leave the horse in the stable. It's true that if you sack the horse you won't have any mess but then you won't have any hors
The AMA picked a general 4 February 1999
Mayo Johnson, visiting surgeon Beverly Hospital, Beverly, MA Send response to journal: Re: The AMA picked a general	The AMA picked a general, and they sure got a military mind when they selected Dr. Anderson. What an impulsive, dumb thing to do, firing the best editor the JAMA has had in my professional lifetime over such a petty matter! This will surely further discourage doctore to join the AMA, and make we present members think carefully before renewing our membership.
Re: Science and politics in Lundberg's firing 4 February 1999
Arthur S Elstein, Professor, Dept. of Medical Education University of Illinois at Chicago Send response to journal: Re: Re: Science and politics in Lundberg's firing	I am the editor-in-chief of a small scientific quarterly, Medical Decision Making. It is well to state at the outset that I have an obvious interest in maintaining editorial and scientific independence. I wish to record that the Publications Committee of the Society for Medical Decision Making, to which I am responsible, has never interfered in any way with the editor's decisions. Firing George Lundberg was a hasty and ill-considered decision, clearly directed at the editorial independence of one our leading medical journals. Marcia Angell is quite correct in discerning that a great deal of damage has been done to the reputation of JAMA, which Dr. Lundberg has built up over a distinguished editorial career of 17 years. Moreover, it is difficult to envision how the AMA will find an editor who will not insist on an ironclad guarantee of editorial independence. Who would take the job without that? As an observer of the American political scene, however, I suspect that one should not overestimate how much impact the data reported in the article at issue will have on the trial of President Clinton. The AMA's internal politics are but a pale shadow of what is being played out in Washington. Our senators do not need a poll that is 8 years old to know (a) that conflicting definitions of what constitutes "sex" are available in American society, and (b) that whatever other virtues Mr Clinton has, tight construction of the English language regularly eludes him. I admire his political skills, but his enemies did not call him "Slick Willie" for nothing.
Good Ridence 7 February 1999
Harold Helbock, Molecular & Cell Biology UC Berkeley Send response to journal: Re: Good Ridence	Goodby George, may you never return! Your friends are aghast but, I for one, am tired of your politicalizing our journal. When you had an article on firearms you got Sara Brady to write the editorial comment. Why not have the KKK write the editorials on race related social studies? The specific article in question was trivial, as pointed out by the NEJM. Who cares how a group of teanagers define words? Further, the way the question was asked it was designed to get the answer that was obtained. In recent teenage vocabulary, "had sex" means coitus. Are we really to conduct our national debates over this kind of grossly confounded "data"? In my view, George was truely desperate to resort to " science" of this caliber I am surprised at the BMJ. They support the JAMA publication of this "science" despite the fact that BMJ just published an article on female sexuality which defines one of the untrue "myths" about sex as "sex is intercourse". Does anyone really believe that Dear George never realized nor intended that the timing of this article would politicalize its publication? In my view, the man used our journal to promote his personal political beliefs. Good riddance!
Joint Statement from AMA and George D. Lundberg, MD 7 February 1999
E Ratcliffe Anderson, Executive Vice President American Medical Association Send response to journal: Re: Joint Statement from AMA and George D. Lundberg, MD	Below is new information that clarifies the relationship between the AMA, JAMA and Dr. George Lundberg. Included here are excerpts from a news statement, released on Feb. 3, that underscores the absolute commitment of both the AMA and Dr. Lundberg to the continued integrity and editorial excellence of JAMA. Maintaining JAMA's historical quality is a goal that unites us. For the entire statement, visit the AMA Web site at http://www.ama- assn.org/advocacy/statemnt/99feb03a.htm. Joint statement from the AMA and George D. Lundberg, MD (excerpts) The AMA and George D. Lundberg, MD, former editor-in-chief of The Journal of the American Medical Association, have reached agreement on the terms of Dr. Lundberg's departure from the AMA. In the best interest of JAMA's on-going mission, the AMA and Dr. Lundberg have agreed to focus on the goals that unite them. They share common cause in maintaining JAMA's vital role in improving public health, advancing medical science, ensuring the integrity of scientific research, promoting informed and responsible debate on public health issues, and contributing to public policy decisions with sound research and data. Most importantly, both parties wish to underscore their absolute commitment to JAMA's editorial integrity, independence and excellence. Further, for JAMA to carry through in its mission without distraction, they are calling on all of JAMA's readers, contributors, peer reviewers and the concerned public to afford the editors and staff of JAMA their full support and constructive involvement. Today, JAMA and its family of Archives journals are internationally recognized for their first-rate articles and comprehensive presentations of critical health issues. The renown and prestige that JAMA now enjoys are the results of the devoted service and tireless efforts of Dr. Lundberg and the Journal's highly-qualified staff, editorial board, thousands of outstanding medical and scientific contributors, peer reviewers and readers. The AMA and Dr. Lundberg have now resolved their substantive differences. Neither party wants the important mission and enduring accomplishments of JAMA and the AMA jeopardized or diminished in any way by this matter. Dr. Lundberg intends to devote the same effort, skill and determination that he brought to JAMA for nearly two decades to critical medical and health issues, as well as contributing to scientific medical research and journalism, including JAMA, subject to editorial discretion. The AMA wishes Dr. Lundberg well in his future endeavors and expresses sincere appreciation and thanks for his many contributions to JAMA and the medical profession.
A blow to scientific publications 7 February 1999
Juan F Schuhl, Practising physician Montevideo - Uruguay Send response to journal: Re: A blow to scientific publications	To dismiss an editor of a Scientific Journal based only on the publication of a scientific research paper,disqualifies this journal,because one of the basic principles of scientific research is the freedom,independence and responsiblity of the researchers;editors are only responsible to ensure the scientific methodology used in the papers published.
No more submissions to JAMA 7 February 1999
James Dwyer, Professor of Preventive Medicine Univ of Southern California School of Medicine Send response to journal: Re: No more submissions to JAMA	As a scientist who has published in JAMA during the current editor's tenure, I would urge colleagues not to submit articles to JAMA until the editor is reinstated.
Does the AMA want this kind of leadership? 7 February 1999
Eliabeth C Burton, Resident, Pathology LSUMC Send response to journal: Re: Does the AMA want this kind of leadership?	I am outraged at the decision to dismiss George Lundberg as editor of JAMA. This decision made by E. Ratcliffe Anderson is an embarassement to me as a member of the AMA and a physician. How ironic it is for George Lundberg, who has been such an advocate for editorial independence, to be fired for for an editorial decision which brings to question JAMA's editorial independence. This was purely a politically motivated decision made at George Lundberg's expense. The JAMA, Medicine, the nation, and the world will all suffer from this wreckless decision. JAMA will now face serious difficulty finding a new editor because of these actions. The AMA needs to seriously consider if they want this kind of new leadership.
Re: Editors, dry your eyes 7 February 1999
Elizabeth C Burton, Resident LSUMC, New Orleans, LA Send response to journal: Re: Re: Editors, dry your eyes	I am an AMA member, a resident, a JAMA reader, and a JAMA contributor and I am thoroughly distressed over E. Ratcliffe Anderson’s decision to dismiss George Lundberg as editor of JAMA. I have expressed my opinions to both Dr. Anderson and to the AMA and have received the expected response. Interestingly, this past week the AMA’s president, Dr. Nancy Dickey was in New Orleans and spoke at the Louisiana State University Medical Center (LSUMC) and the Medical Center of Louisiana (MCLNO). Dr. Dickey’s talk at LSUMC was directed to medical students and at MCLNO, to residents. I attended both talks with some degree of skepticism. Addressing the medical students, Dr. Dickey alleged the AMA’s commitment to quality patient care. Aware of the disillusionment expressed to medical students and young doctors concerning the future of medicine, she warned her audience “not to listen, and to walk away” from such negativism. She emphasized that medical students, residents, and young doctors have a voice and can influence the future of medicine. She claimed that their opinions matter and encouraged medical students to participate in the AMA’s forums. During her talk directed to residents, again she emphasized the philosophy of quality patient care. She spoke about managed care, influencing policy and the importance of involvement in organizations such as the AMA as an avenue for impact and change within medicine. She reported that only 40% of U.S. physicians are members of the AMA and emphasized that the AMA is the voice of U.S. physicians. She claimed that in order to impact decisions and policies, a single voice is too quiet and many people must align and speak loudly to influence change. In both talks she emphasized the importance that physicians must settle disputes between themselves behind closed doors and not publicly. How can someone in this position stand with a clear conscious and speak these words at a time when there is such unrest within the AMA. The AMA states that its core purpose is to promote the art and science of medicine and the betterment of the public health. Its core values are: 1) leadership, 2) excellence, and 3) integrity and ethical behavior. It’s key objectives are 1) to be the world’s leader in obtaining, synthesizing, integrating, and disseminating information on health and medical practice, 2) to be an acknowledged leader in promoting professionalism in medicine and setting standards for medical ethics, practice, and education, 3) to be the most authoritative voice and influential advocate for physicians and their patients, and 4) to be a fiscally sound organization that provides value to members and employees. This is the AMA’s philosophy, so long as it does not interfere with the vision of the political and powerful. In actuality this appears to be more George Lundberg’s philosophy, than that of the AMA. He certainly has lived up to this vision more so than the AMA. He succeeded in giving stature to the JAMA by “publishing high quality articles that advance medical science, improve patient care, protect public health, and inform health policy”. He has focused much energy on bringing together clinical researchers and health services researchers by focusing on issues of public policy that relate to health care and health of the American people. His values and integrity are without question. What voices were heard from the AMA membership concerning the decision to dismiss George Lundberg as editor of JAMA? I assure you it was not the voice of the majority, but in fact a decision made by a single person or very few who were politically motivated. These actions certainly were not discussed behind closed doors, in fact this has been one of the most publicized embarrassments that I can think of, excluding the impeachment trial. Part of the problem with medicine today is the inability to admit that we sometimes make wrong decisions. There has been a strong public outcry extending to all corners of this world. The decision to dismiss George Lundberg was clearly wrong and should be reversed. Never have I been more disillusioned about medicine.
AMA - Philosophy or Hipocrisy? 7 February 1999
Dana Ann Troxclair, medical student lsumc Send response to journal: Re: AMA - Philosophy or Hipocrisy?	How can the AMA preach its philosphy to advance the betterment of patient care and medicine, then unthinking and without due process dismiss George D. Lundberg, as editor of JAMA? George Lundberg has upheld this philosphy better than anyone else and certainly better than the AMA has. Anderson's decision to dismiss George Lundberg tells the real truth of what the AMA's true philosophy is - do as I say, not as I do! Anderson and the AMA should reverse their hipocrisy with a public apology and a reinstatement of George Lundberg as editor of JAMA.
Re: Joint Statement from AMA and George D. Lundberg, MD 9 February 1999
David L Sackett, Director, NHS R&D Centre for Evidence-Based Medicine Oxford, UK Send response to journal: Re: Re: Joint Statement from AMA and George D. Lundberg, MD	I've written to Dr Anderson to inquire about the AMA press release stating: "The AMA and George D. Lundberg, MD, former editor-in-chief of The Journal of the American Medical Association, have reached agreement on the terms of Dr. Lundberg’s departure from the AMA." My inquiry asks for information on whether this agreement prohibits Dr. Lundberg from making public statements about his side of this affair under pain of losing any or all of his pension, benefits, or any other financial arrangements with the AMA. If so, isn't this yet another example of censorship by the AMA, but this time employing blackmail ("you tell your side and we'll cut your severance pay")?
Re: A well deserved fate 10 February 1999
Charles Price Send response to journal: Re: Re: A well deserved fate	Reply to Dr. Pidsley Editorial note: Dr. Price's original intent was to reply privately to Pidsley (1). Since that was not possible via e-mail, he addressed his comments to our website. "What a narrow perspective you present. It is a rather common occurrence that things medical have not only health and disease implications but public policy implications as well. Are those issues which touch on public policies to be ignored? This paper in JAMA is so simple and elementary it hardly needs comment. However, it is important. Until these authors pointed out in simple and documented terms that our sexual behavior and the language we use to acknowledge that behavior have quite significant degrees of variance and that the words used can very readily have different meanings, some will insist (and have surely insisted) that there are no shades of gray. You surely don't believe that. Adding some more data to a debate that is certainly national and probably international does not coerce anyone. If the members of the senate cannot deal with this data, then they are less able than I give them credit for being. I have seen noting that challenges the accuracy of the data presented. Some have described it as a "light weight paper", but the methodology has not been challenged. Some have argued that "a more suitable subject group" might have been found. You can only report the data that you have, not that which you would like to have. This is the real world. Sometimes the reality of the real world is not the neat little doll house we'd like it to be. The basis for a charge of perjury against any person has to pass a reality test. To recoil in horror because someone shows that the alleged perjury relates to the use of a word or phrase that reasonable people do not define in the same concrete manner is ludicrous. That difference only makes the debate more essential and the data provided by the paper more pertinent and timely." (1) R Pidsley. A well deserved fate. eBMJ , 31 Jan 1999 http://www.bmj.com/cgi/eletters/318/7177/DC1/EL95
British interest is impressive 11 February 1999
John A Ewing, Emeritus Prof. of Psychiatry University of North Carolina Send response to journal: Re: British interest is impressive	I am Scottish born and Edinburgh University educated and came "for 3 years" to North Carolina in the 1950s. I became an American citizen and at one time occupied the Chair of Psychiatry at the University of North Carolina. Under Dr. Lundberg's leadership JAMA has become almost as good as the BMJ. The act of Dr. Anderson was blatantly political and I have written to him, to JAMA Board members and the President of AMA requesting Dr. Lundberg's reinstatement. Anderson had the gall to send an e-mail to me and presumably thousands of others stating that JAMA had editorial independence! I am gratified at the interest being shown about this in the UK.
Scientific freedom and fun 13 February 1999
Margaret Shirley, Acting Chief of Staff; Head, Dept, Medicine Colchester Reg. Hosp., Truro, Nova Scotia Send response to journal: Re: Scientific freedom and fun	Right on, Lundberg. Your reputation is longstanding and well- deserved. Your firing is a meretricious and cowardly action. I found the article informative and interesting, as well as surprising. I make the disclaimer that I do not speak for my hospital. but I speak loudly for myself.
What Next - Blindfolds or earplugs ? 17 February 2000
Victor D'Cruz, Medical Officer Dept. of Radiology Send response to journal: Re: What Next - Blindfolds or earplugs ?	I read with great interest, the news of THE sacking.Its strange that this should happen in a country that chooses to practise freedom- that too, in an establishment as distinguished as AMA. I seriously believe that "Integrity and Duty" are among the lamest reasons that a man can come up with, as justification for an action. Opinions, however distasteful they may be, should be pondered upon, if relevant to the times. Whoever it was that orchestrated the sacking, I reckon, has very strong opinions on sex, politics and integrity. (So did Hitler!) Politics?..........Doesn't the practice of the Medicine and the future depend on it? So any hypocrisy on the part of Practitioners would be a shame. Anyway, "politics" sure does get in the way of a man's work, as seen in this case. For the future - all the best.