Edit at your own risk

The list of fired medical journal editors became longer in February when the two top editors at the Canadian Medical Association Journal were fired after a dispute with the publisher over an article about emergency contraception. The deposed editors have joined a distinguished club whose members include: George Lundberg, whom the American Medical Association deposed as editor of the Journal of the American Medical Association after he published a sex survey in 1999 at the height of the

By | April 1, 2006

The list of fired medical journal editors became longer in February when the two top editors at the Canadian Medical Association Journal were fired after a dispute with the publisher over an article about emergency contraception. The deposed editors have joined a distinguished club whose members include: George Lundberg, whom the American Medical Association deposed as editor of the Journal of the American Medical Association after he published a sex survey in 1999 at the height of the Clinton impeachment hearings; and Jerome Kassirer, whose contract as editor of the New England Journal of Medicine (NEJM) was not renewed after disagreements with the publisher over expanding the journal's brand name.

In 1983, the Medical Journal of Australia's editor since only the year before, Alan Blum, was fired after he allegedly designated too much editorial space to the harms of tobacco. A few years later, the Irish Medical Journal (IMJ) fired Eoin O'Brien after the editor openly criticized IMJ doctors for taking industrial action. Editors at the British Medical Journal (BMJ) and The Lancet have narrowly avoided similar sackings, again stemming from clashes over editorial independence. Many other cases likely exist, where editors have quietly been paid to step down, avoiding a media blitz.

Is being fired simply an occupational hazard for medical journal editors? "I think the reality is that it's normal for editors to be fired, and it's no more common now," says Richard Smith, former editor of the BMJ and now CEO of UnitedHealth Europe and board member of the Public Library of Science. Smith says that tension between editors and publishers is expected, as the two factions have decidedly different interests: For editors, it's scientific integrity, and for publishers, it's profit. These missions often don't coincide, and if editors are "quiescent" and bow to publishers' requests, they aren't doing their job, Smith notes.

Publishers have the power to do something about that. A survey published in 2002 in Science and Engineering Ethics found that the board of directors could hire and fire editors at half of 33 medical journals owned by nonprofit associations, such as the AMA. And at approximately one-third of the journals, the editor must report to the board.

Still, former NEJM editor Kassirer says a few high-profile cases of deposed editors are "hardly a trend." Instead, people may believe more editors are being fired just because it's been in the news. "People tend to perceive that salient events are more common than they really are," he notes in an E-mail interview.

CMA Media president Graham Morris says he fired highly-respected editors John Hoey and Anne-Marie Todkill to bring a "fresh approach" to the journal. In theory, this is not necessarily a bad idea, says Michael Callaham, president of the World Association of Medical Editors. Before World War II, editors were "practically appointed for life," he says, and were highly nepotistic. "There is much more turnover of editors now than in those days, which might be the influence of publishers and owners and commercialism, but also might mean just a little bit more accountability," he says in an E-mail, "just to be the devil's advocate."

Still, in times of economic belt-tightening, this tension between the people who focus on editorial content and the people who pay for it can become exacerbated, causing a "steady souring of relationships," says Smith. The unspoken rule about editorial independence, he adds, is that "you can have it as long as you don't use it."

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