Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Addendum to firing of JAMA editor
- Philip A Branton (9 July 2004)
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BMJ Freedom Pays.
- Sergio Stagnaro (9 July 2004)
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How might the growing risk to the BMJ's editorial freedom be overcome?
- David L. Sackett (9 July 2004)
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Richard Smith : The BMJ's Final 'Editorial Gladiator'
- Joseph . C . Obi (9 July 2004)
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RETROGRADE STEP
- BM HEGDE (9 July 2004)
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Pungent Criticisms
- Jay Ilangaratne (10 July 2004)
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Yes, an Oversighting Committe
- Stephen R Leeder (10 July 2004)
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Medical Editors have harder jobs than U.S. Iraq administrator Bremmer
- Eddie Vos (10 July 2004)
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Politics of Editorial Independence!
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (11 July 2004)
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Independance of the BMJ
- susanne mccabe (12 July 2004)
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Misleading Prescribing Information
- philip barber (12 July 2004)
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One committee
- Anthony EJ Fitchett (13 July 2004)
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Re: Addendum to firing of JAMA editor
- David Curtis (15 July 2004)
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Re: Re: Addendum to firing of JAMA editor
- Michael O'Donnell (15 July 2004)
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Comparison of Sri Lanka
- Murali Vallipuranathan (16 July 2004)
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I don't read your rag but......
- Joseph B. O'Connor (16 July 2004)
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Editorial freedom should be underpinned by editorial fairness
- Anton E Joseph (19 July 2004)
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Freedom is power for the editor, Fairness is what the contributor and reader want
- Anton E Joseph (19 July 2004)
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Re: I don't have a parrot but....
- David Curtis (21 July 2004)
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Philip A Branton, Vice Chair, Pathology Fairfax Hospital, Falls Church VA USA
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I must make a small coda to Dr Smith's editorial re: the firing of a JAMA editor. The formation of a 'buffer board' between the editor and the powers that be is probably a good idea (though it conjures of images of the eternal multiplication of addtitional layers of bureaucracy). I must note that the firing of Dr George Lundberg (to whom I believe the veiled reference is made) was due to Dr Lundberg's temerity to publish an article expressing perceived 'liberal' (the "L" word as it is now known in the States) views, to the discomfiture of the sitting CEO of the AMA, a retired Air Force general. Full disclosure requires that I reveal that I wrote a protest letter to the AMA over this matter, and resigned my membership, which I have never renewed. Competing interests: None declared |
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Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genova)Italy.
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Sir, I completely agree with the author of the paper who tells about “Editorial freedom” of BMJ (1). Moreover, as far as my experience is concerned, I must say that BMJ freedom regards also Rapid Responses. In fact, weekly it has been publishing my own theories for more than two years now (2, 3) (See website HONCode 233736, www.semeioticabiofisica.it). Among my theories, especially two of them, i.e., Single Patient Based Medicine and Oncological Terrain (2,3), are now-a-days recognized also by EU Competent Authorities for European Health Planning, for Cancer Primary Prevention, http://europa.eu.int/comm/health/ph_information/documents/ev_20030710_co01_en.pdf , wherein they quote a Rapid Response of mine from BMJ. 1) Smith R. Editorial independence at the BMJ . BMJ 2004;329 (10 July), doi:10.1136/bmj.329.7457.0-g 2)Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. 3)Stagnaro-Neri M., Stagnaro S. La Melatonina nella Terapia del Terreno Oncologico. Edizioni Travel Factory, Roma, 2004 Competing interests: None declared |
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David L. Sackett, Director, Trout Centre at Irish Lake Markdale, ON, Canada N0C 1H0
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We have witnessed the gutting of the New England Journal of Medicine and JAMA when their parent medical associations succumbed to their profound conflicts of interest. These associations' pursuit of revenue, coupled with their willingness to suppress papers that they or their advertisers didn't like, violated the editorial freedom of these journals' editors and diminished the prestige, credibility, and influence that these journals formerly enjoyed. I believe that the current reorganization of the BMJ and BMJ Publishing Group risks the same fate for the BMJ. This would be all the more tragic in light of substantial recent growth in the credibility and influence of the journal, not just in the UK but worldwide. I suggest that the BMJs risk would be reduced by the creation of an Oversight Committee, constituted so that its membership is as free of professional and financial conflicts of interest as possible (with representation from, but not controlled by, the BMA Council). This Oversight Committee would be tough with BMJ editors about how well the latter were applying high scientific standards in the review and publication of relevant submissions, and would scrutinize complaints about the journal's editorial policies and performance. Its vital function would be to arbitrate editorial disputes between the BMJ and the BMA Council. But to be effective, and to maintain the credibility and influence of the journal, the Oversight Committee's editorial decisions would have to be final. Oversight Committees have been established recently at the CMAJ and JAMA (in the latter case, alas, too late to prevent serious damage). I believe that we could overcome the growing risk to the BMJ's editorial freedom, credibility, and influence by creating a BMJ Oversight Committee now. Competing interests: Already on your website. In addition, I am a member of the BMJ Editorial Board. |
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Joseph . C . Obi, Professor Of Complementary and Alternative Medicine (CAM) Research ; School Of Natural Medicine , Larnarca , Cyprus , European Union .
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Alas , the British Medical Association (BMA) is gleefully now going to have it's 'Wicked Way'. Any 'New (Incoming) Editor' of the British Medical Journal (BMJ) will henceforth not be given as much 'Independence' to be as 'Forthright' as our dearly beloved 'Outgoing BMJ Editor' , Professor Richard Smith CBE ; and could woefully end up being an 'Abjectly Shameless Mouthpiece' for the 'British Medical Establishment'. Indeed, there was once a time when I (personally) wished that Professor Smith would be 'Publicly Spanked' for some of his 'Editorial Controversies' , but having now fully understood the 'Highly Pressurized Circumstances' under which he worked , it would have been 'Exceedingly Wishful' to have expected anyone of lesser 'Timbre And Calibre' to effectively do the job. Mark my words : The British Medical Journal (BMJ) will defintely collapse ; if 'Another Richard Smith' is not ethically appointed to steer it away from 'Impending Oblivion'. My main consolation is that Richard will (gratefully) soon be moving on to a '7-Figure Salaried Post' , where he will not only have absolute control over his department, but also make a 'Huge Therapeutic Difference' to the 'Monstrously Impaired Lives' of millions (and millions) of Patients throughout the 'United States Of Europe'. Good Luck , Richard : We Shall Never (Ever) Forget You. Competing interests: Professor Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants . He humbly invented the 'Omnipill'. |
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BM HEGDE, Retd. Vice Chancellor Mangalore-575004 India
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Dear Editor, It is sad that the owners of the prestigious BMJ have decided to curtail the absolute freedom that the editor enjoyed so far. BMJ commands the respect of the medical community primarily due to its independent editorial policies. I hope and pray that the owners do not take this retrograde step to lower the prestige of the BMJ in the eyes of the community. While editorial independence is of paramount importance, it should be coupled with the selection of the right person to replace Richard- as authentic as Richard was-to maintain the high standards set by Richard. bmhegde Competing interests: None declared |
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Jay Ilangaratne, Founder Medical-Journals.com
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Just wondering why the Editor has chosen to elaborate on 'editorial independence' in the final lap of his tenure.Perhaps,he has been given an extra ounce of freedom to express himself by the journal owner(BMA) because he is leaving.As we are unaware exactly why the Editor is leaving (apart from the fact his desire to get 'repotted'),it would not be unfair to think that his departure is not an entirely happy one.Of course,we can't expect him to tell us everything publicly.Anyway,I look forward to the 'pungent criticisms' of the BMA which the Editor is promising us next week;is that going to be his parting shot? Competing interests: None declared |
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Stephen R Leeder, Professor of Public Health University of Sydney
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David Sackett has argued cogently and clearly the case for an oversight committee to serve as defence, advocate, and guarantor of fidelity of future BMJ editors. Stanley Fish, dean of the College of Liberal Arts and Sciences at the University of Illinois at Chicago, in a recent New York Times op-ed, offered a three-part piece of wisdom for academics, presumably including professors who are also journal editors. He wrote: do your job; don't try to do someone else's job as you are unlikely to be qualified; and don't let anyone else do your job. These may be suitable terms of reference for the incoming editor which the committee of oversight might ensure for him or her. Competing interests: None declared |
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Eddie Vos, maintains health-heart.org Sutton Qc Canada J0E 2K0
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I second Dr. Sackett's opinion that many Journals are at great peril from corporate interests and that this currently influences what gets published, and what is allowed to go unsaid in trials. A recent opinion piece on statins in NEJM contained clear errors and omissions and a letter to the editor about this that I co-authored was rejected. Later I learned that this became a top selling reprint for NEJM and it would, therefore, have been a conflict of interest to publish our letter that pointed to some of the vital problems with this industry pleasing article. The Lancet, owned by a publishing giant and not a medical organization, in some of the recent abstracts and articles about statin drugs simply omitted full all-cause mortality data. In addition to whatever commercial conflicts, the loss of a medical editor is always a bit of a tragedy. Editors of medical journals have harder jobs than the U.S. administrator Bremmer had in Iraq. Competing interests: None declared |
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Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Locum Psychiatrist Postcode.64399, SBAHC, Riyadh, KSA
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Sir; There are diverse interlocking factors that determine editorial independence from and dependence on those who regualrly provide diverse information and data for publication in any journal. Only the political factors are the most powerful in nature that often cripple the editorial independence globally. Next equally important and powerful factors are based on profit-loss equation that also dwarf the editorial independence. All editors always try to put patients' interest above all interests but in reality that is the least observable phenomenon. Unsurprisingly, most journals in the western world are heavily politicized and work for collecting huge profits for the publishing groups who own them. I believe that political pressures and financial interests can often destroy completely the editorial independence. Reference: Richard Smith. Editorial independence at the BMJ BMJ 2004; 329: 0-g. Competing interests: None declared |
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susanne mccabe, gardener cardiff cf24 3pf
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Contests for power and control shift over time. It is less likely now perhaps that new editors will drastically reverse the road to democracy down which Richard Smith has led the BMJ - but time will tell. His editorship has been inspiring especially as few challenge parts of the power cliques in the medical world without some pain as well as gain. Perhaps his constant awareness of the pain and drudgery in which too many live out their lives has informed his conviction that it is an editor's duty to inform the uninformed, empower the disenpowered, provide a voice for the widest constituency in addition to suppporting more traditional aims of medical journals. Power games behind closed doors as well as direct treatments have too often caused harm, whether in areas such as the contest for funding' the use of people for unethical research; witholding information - or the way committees operate. Why the secrecy about appointing a new editor? Could candidates not publish their CVs and mission statements in the BMJ? Who sits on the appointments committee and what are their qualifications for doing so? What is the process being used? Hopefully there will soon be wider diversity of people on committees. The same people seem to circulate around in various positions. Appointments should be made more open, transparent and democratic. This includes appointments from overseas. If a Buffer Committee is set up, who will decide which individuals are 'highly respected' and so entrusted to assist rather than control the Editor? Looking from an historical perspective it may not become just another 'bureaucratic layer' but develop all the same old power games which have become embedded in the medical world and which as modernising agendas show, are so hard to shift. Power strugles behind closed doors amost always include bullying, pressurising, skulduggery, secrecy and silencing involve huge expenditure of energy, are inevitably destructive to some individuals, block creativity - but are now possible almost impossible to keep hidden in the inter-net age. Those who have been critcal of aspects of the medical worls are not troublemaking 'activists' but ususally care deeply about concepts such as Human Rights in medicine as in all areas of life. Competing interests: None declared |
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philip barber, consultant respiratory physician Wythenshawe Hospital M23 9LT
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The BMJ is getting so interesting, these days, that I've even started reading the adverts, including this week's double-page spread on Celebrex. The small-print prescribing information includes the usual list of reported adverse effects. Dyspepsia is listed as 'common', along with dizzyness, insomnia, pharyngitis, rhinitis and upper respiratory tract infection. Now, we all know that COX-2 inhibitors cause dyspepsia; I get it myself with absolute predictibility; I have recently encountered two patients with G.I. bleeding, and a relative of mine has been similarly affected. (These are anecdotes that perhaps only Prince Charles would approve of, but seem full of meaning, nevertheless). We all know, equally, that Celecoxib does not cause upper respiratory tract infection, this being a reported temporal association simply because it is so common. The listing of causal and non-causal associations in this way seems certain, perhaps designed, to confuse. A sharper image can be focused by amalgamating dyspepsia-related adverse effects from the various listed categories in the same advertisement, thus: Interactions: increases risk of G.I. ulceration with even low-dose aspirin Common adverse: dyspepsia, abdominal pain Uncommon: anaemia, gastritis, vomiting Rare: duodenal, gastric and oesophageal ulceration,dysphagia, oesphagitis, melaena (These 'rare' effects are listed as on a par with 'ataxia' and 'alopecia'. Perhaps peptic ulceration is 'rare' because most patients with NSAID dyspepsia never have an endoscopy). Could it be (gasp) that Celebrex is no better or worse for our digestion than older and cheaper alternatives, and that its prescribing information is artfully displayed to conceal that possibility until its patent expires? Medical Journals need to scrutinize advertising material for such disingenuities. Competing interests: None declared |
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Anthony EJ Fitchett, General Practitioner Mornington Health Centre, 169 Eglinton Road, Dunedin, New Zealand
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Richard Smith is right in suggesting that an Oversight Committee, and the committee that appoints the Editor, of the BMJ should include members from outside Britain, as is David Sackett in proposing that the BMA should be represented on, but not control, the Committee. Is there any reason why one Committee should not appoint and oversee the Editor? May I suggest that such a Committee, consisting of international medicos, journalists, and representatives of the BMA could be established with a job description which includes: * appointing the Editor of the BMJ * overseeing the Editor's work * ensuring editorial independence, the decisions of which would not be subject to ratification by or appeal to the BMA? Renunciation of control is not an easy step for any organisation to take, and would require generosity of spirit on the part of the BMA. But it could ensure that the BMJ remained independent and, almost as important, that it is seen to be so. I do not believe I have any 'competing' interests, but I certainly have an interest. I am a regular reader of the BMJ, and value its independence and, under Richard Smith's editorship, both its willingness to ask uncomfortable questions and its ability to be at times lighthearted. Competing interests: None declared |
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David Curtis, Consultant and Honorary Professor in Psychiatry Royal London Hospital, Whitechapel, London E1 1BB
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It's amusing that Branson resigned from the AMA because they sacked the JAMA editor. I resigned from the BMA because they didn't sack the BMJ editor. At least not quickly enough for my liking. Oh well, better late than never. I think Smith may have been OK as a journalist but his anti-scientific attitude to life did no service to British medicine and I for one am glad to see the back of him, even if he is going to end up getting horribly rich in consequence. I'm glad there'll be an oversight committee, but not so much to protect the editor as to see they don't make too much of a hash of things. P.S. Since resigning from the BMA and being spared the weekly sky blue irritant I have invested in a subscription to the Lancet. Now there's a proper journal. Competing interests: I have previously published criticism of Richard Smith and his journal's "contents" |
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Michael O'Donnell, Loiterer Loxhill GU8 4BD
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Conundrum of the week. If Honorary Professor David Curtis has given up the BMJ in favour of the Lancet - indeed rejoices in "being spared the the weekly sky blue irritant" - why is he posting his thoughts on this site? Come to think of it, how did he come to read the article to which he is responding? Are honorary professors gifted with psychic powers that enable them to tune into articles in journals they claim not to read? Michael O'Donnell Competing interests: None declared |
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Murali Vallipuranathan, Medical Officer Department of Health,385, Deans Road, Colombo _10, Sri Lanka
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Sir, I refer to the article on "Editorial Independence at the BMJ" (1). I wish to draw your attention to the parallel situation in Sri Lanka. Ceylon Medical Journal (CMJ) is a quarterly publication of the Sri Lanka Medical Association (SLMA). The two editors of the CMJ are appointed by the council of the SLMA every 3 years and they become ex-officio members of the council (2). The CMJ is an independent journal like BMJ, though there is no explicit statement in the CMJ stating that the "views expressed in the journal are those of the authors and may not necessarily comply with the policy of SLMA". However in August 2000, it was brought to the notice of the SLMA Council that two fillers appeared under the caption "Economist on the LTTE" (3,4) could damage the reputation of the SLMA because CMJ has been an official publication of the SLMA. The editors of the CMJ agreed to make observations to the council on this matter (5). Comparing a similar situation to that of the BMJ, though the editors must be accountable, the arrangement of BMJ editor reporting to the BMA secretary will definitely affect the editorial independence. The BMA tradition of editorial independence should be continued and should set an example to similar journals published in other countries. To ensure accountability is safeguarded, idealy an oversight committee should act as a buffer between the BMA and the editor. This committee can not infringe on the editorial freedom. It should remain as an advisory body on matters of controversial interests that affects the BMA. Eminent professionals and editors of other medical journals together with wider representation from outside Britain should be in the committee. This would ensure a healthy atmosphere for discussion and deliberations which make the task of the editor easy. 1. Smith R, Editorial independence at BMJ, BMJ 2004; 329 (10 July), BMJ 329.7457. 2. Memorandum and Articles of the Association of the Sri Lanka Medical Association, Articles 40 and 58, 14-17. 3. "Economist on the LTTE(1)", CMJ June 2000; 45, 51 4. "Economist on the LTTE(2)", CMJ June 2000; 45,54 5. Minutes of the SLMA Council, August 2000, 2000.08.10 CMJ(b) Competing interests: I have been a member of the SLMA Council since 2000. |
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Joseph B. O'Connor, Consultant Surgeon Waterford Regional Hospital, Waterford
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I share Michael O'Donnell's concern about Professor David Curtis' criticism of the BMJ which Professor Curtis implies he does not read. Writers in professor Curtis' position need to preface their letters to the editors of such repugnant publications with the phrase "while lining the bottom of the parrott's cage with your publication my eye was accidentally drawn to........" Competing interests: None declared |
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Anton E Joseph, Consultant Radiologist Mayday University Hospital, Croydon, Surrey,CR7 7YE
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There is far too much talk and emphasis on freedom, to the point that the author states that Journals should be on the side of the powerless not the powerful, the governed and not the governors. This almost gives the impression that the powerless and the governed are always in the right. The powerful and the governors should have equal rights. It sounds as if some one has to lose if the other is to enjoy their rightful frredom. May I therefore suggest the legacy that Richard Smith leaves for his successor is editorial fairness. The powerless and the powerful, the governed and the governors should all be treated fairly. The readership will respect the fair editor. Fairness will beget freedom and freedom will be bestowed on the fair. Competing interests: None declared |
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Anton E Joseph, Consultant Radiologist Mayday University Hospital, Croydon, Surrey,CR7 7YE
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I regret that I wanted to emphasise the slightly varied interests that the editor and the reader or the contributor have in my previous submission but submitted it before I had discussed this aspect. It would be helpful if one can save a partly completed response to think over it and submit it later. The issue is that editors crave for freedom because they feel that it gives them the power. As a reader and a contributor although I would very much like to see editorial freedom guaranteed, I would like to know that the editor is also fair. So it should be Fairnes for the reader and freedom for the editor and we will all live happily ever after. Competing interests: None declared |
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David Curtis, Consultant and Honorary Professor in Psychiatry Royal London Hospital, Whitechapel E1 1BB
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I don't have a parrot whose cage I can line with unread BMJs so I can't claim to have stumbled across the editorial in that context. I was engaged in a cyber-equivalent activity, of browsing the job ads. I could point out that I do now possess a rabbit, which does indeed eat newspaper. Avid searchers of these web responses will be able to discover that I previously criticised Dr Smith for his undue soppiness where rabbits were concerned, albeit as an aside when challenging the BMJ's policy on publishing photos of identifiable minors. I would now like to publicly state that I do see the attraction of rabbits. Especially the dwarf himalayan ones. Competing interests: Rabbit ownership. |
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