To expunge politically sensitive topics from medical journals is “folly”BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7551.1175-a (Published 18 May 2006) Cite this as: BMJ 2006;332:1175
John Hoey, until recently editor in chief of CMAJ, the journal of the Canadian Medical Association, last week broke his silence and spoke out about his firing and the firing of his deputy from their posts (New England Journal of Medicine 2006;354:1982-3).
The association has never admitted to firing the two editors, but Dr Hoey writes that, on 20 February, after almost 10 years as editor in chief, “I was fired without cause,” along with Anne Marie Todkill, senior deputy editor and 12 year veteran. Until now, both he and Dr Todkill have declined to comment on their dismissals because of a confidentiality agreement with the CMA.
Dr Hoey said that the CMA gave no reasons “for the firings other than, initially, to ‘freshen’ the CMAJ and, later, for ‘irreconcilable differences’ (so far unspecified) between me and the CMA.” The most striking of these differences was “the censoring by the CMA of a report describing the difficulties Canadian women had in obtaining Plan B (a non-prescription drug) from pharmacists.” This action, he writes and as he explained in a CMAJ editorial at the time, was a clear violation of the principle of editorial independence.
“‘Independence,’ like ‘freedom,’ is a word etched deep in human history,” writes Dr Hoey. “Although both evoke and provoke human emotions and actions, the words themselves are intangible abstract nouns, like ‘love.’ Our understanding of these words comes with experience… Thus, it is highly probable that each editor of a journal and each publisher and owner will have different views of editorial independence. In fact, it may be necessary for them to have differences, else the concept of editorial independence remains an abstraction, empty of meaning.”
Editors and publishers have different perspectives on journal ownership, writes Dr Hoey: “Owners see their legal rights and responsibilities, their corporate objectives… For an editor, the journal is much more than legal ownership [and] is fundamentally about ideas. The dissemination of medical science is, or should be, ultimately a humanitarian project, and not merely the special preserve of professional associations.”
Failure by journal owners to understand the larger constituency of authors, peer reviewers, editorial boards, journalists, and, above all, interested readers, both professionals and members of the broader public, “forced the American Medical Association to establish an independent journal oversight committee for its journal, JAMA. In Canada, former members of the CMAJ editorial board and others recently announced that they will launch their own general medical journal as early as this fall,” (BMJ 2006;332:1114).
Journal owners and publishers, who are generally risk avoiders, may see a larger constituency as of little interest to their subscribers and potentially damaging to their economic priorities, writes Dr Hoey, and restrict the scope of their journal to the narrower interest of their physician readership.
“This is neither my vision nor that of the other editors who were fired or resigned from the CMAJ… The notion that politically sensitive topics can be expunged from a medical journal is folly. It is also irresponsible. Physicians and their patients must have faith that professional journals facilitate a discourse unencumbered by the economic and political interests of their owners… Editorial decisions cannot be discussed or even divulged to the publisher until the articles have been published. To do otherwise, to enter into an operational partnership of some sort with the publisher, is to gut the editorial independence of a journal.”
He describes the importance of medical journals by saying: “In a world where political correctness obfuscates and public discussions are managed by public-relations firms and paid experts, there is a desperate need in medicine for open, plain-spoken discourse. Without it, the current erosion of public trust in science and medicine will continue and will ultimately translate into poorer individual and population health.”
Dr Hoey writes that dramatically expanding online readerships and the growth of open access journals are beginning to threaten the tranquility of the past, when readers were mainly physicians who received medical journals as a benefit of membership in a professional association.
“Online readers [of CMAJ] now outnumber print readers by more than 6 to 1, and only about a third are residents of Canada… Contributing little or no revenue, online readers now contribute most of the CMAJ's content (manuscripts and letters), interest, and general buzz… As journal editors stroke eagerly into the more open seas of worldwide readership, will owners be able and willing to follow?”