Journal Editors Fight for Control

Last November, after several hours of tough debate, the Massachusetts Medical Society's House of Delegates voted down a proposal that would give future editors of the society's New England Journal of Medicine (NEJM) complete control over the use and marketing of the prestigious journal's logo. Instead, in a concession to supporters of the journal's editors, the group agreed to set up a committee comprising deans of medical schools and schools of public health to arbitrate disputes between future editors in chief and the officers of the medical society. Those decisions represented the climax of a long struggle that had led the society to dismiss Jerome Kassirer, the journal's editor in chief, in July. "I thwarted many attempts to use the name of the NEJM on various Massachusetts Medical Society products," Kassirer wrote in a letter published in the Lancet, the British journal of medicine, on Sept. 4. The dismissal met with a chorus of objections, particularly from the academic medical community. In September, Joel Baron, the Massachusetts Medical Society's vice president for publishing, also resigned. According to Kassirer, Baron had frequently disagreed with the editors over Baron's efforts to use NEJM's name in marketing other publications that Kassirer and his staff regarded as less carefully reviewed than NEJM. One proposal rejected by Kassirer and his editors: a kind of NEJM Lite series, which would carry papers rejected by the tough criteria of NEJM itself. Kassirer's dismissal followed by just a few months another high-profile editorial departure. The American Medical Association fired George Lundberg, editor of JAMA: The Journal of the American Medical Association. According to AMA executive vice president E. Ratcliffe Anderson, Lundberg had "threatened the historic tradition and integrity" of JAMA by accelerating publication of a survey about college students' attitudes toward oral sex. The issue was in the news at the time because it related to President Bill Clinton's impeachment. This annus horribilis for two of the world's most influential medical journals raises major questions for all editors of scholarly journals: Who's really in charge of publications owned by professional societies? Should editors determine how journals and their logos are used, as well as oversee their content? To what extent do business ethics differ from medical ethics and academic freedom in journal publishing? And should editors of other journals worry that their independence will be compromised? To get some answers, The Scientist talked to editors involved in the recent controversies. The Problem of Control The existence of the problem of control reflects the remarkable growth in journals' profitability over the past two decades. In the late 1970s, even the top medical journals added no more than a few tens of thousands of dollars to their owners' annual accounts. "The New England Journal name wasn't very valuable until about 20 years ago," says Marcia Angell, the journal's interim editor in chief. That has all changed. Today, estimates suggest that the NEJM and JAMA earn at least $20 million annually for their societies. The journals' prestige also represents the opportunity for further revenue. That's neither surprising nor a cause for condemnation, according to journal editors. "The [Massachusetts Medical Society] is doing what medical societies around the land are doing," says Angell. "It's what's happening in the world. The market rules." Catherine DeAngelis, who has taken over as editor of JAMA and editor in chief of all of AMA's publications, agrees. "There's nothing wrong with a society making money, as long as the money is put back into doing good," she says. "As long as I am assured that all my people have appropriate resources to do the best job possible, I don't care how it's used." There's no doubt that major journals occupy a significant and unique role in the practice of medicine and research. "We sit astride the public and private sectors," says Angell. "The research we publish is by and large supported by the public sector. I feel that gives us a large responsibility." Many editors see that responsibility as the imperative for ensuring academic freedom. But attitudes toward such freedom differ among academics and many practicing professionals. "The people who are vocal about this tend to be academics," explains Drummond Rennie of the University of California, San Francisco. "The people who are not vocal, except at society meetings, are very important voices in the societies that own journals. They don't have to fight the issue of editorial freedom, which is the same as academic freedom. That issue means very little to the average doctor, who will say: 'I think the journal should be the trade paper of the society. The editor's a functionary of the society.'" Drummond Rennie Journal editors certainly encounter commercial pressure. In one celebrated example in 1992, drug companies stopped advertising in the Annals of Internal Medicine. The journal, owned by the American College of Physicians-American Society of Internal Medicine, had published a study that suggested that drug company advertisements in journals were often misleading about new drugs' safety and efficacy. Most conflict between editors and the administrators of medical societies involves more subtle issues. The arguments focus on administrators' efforts to exert control over what editors regard as their fundamental authority. As editors see it, the forbidden zone covers the spectrum from determining editorial content to piggybacking commercial projects on journals' prestige. Lundberg was fired as a result of an argument over the former issue, Kassirer over the latter. Ironically, the reaction to those two dismissals may have strengthened the hand of the editors now in charge of NEJM and JAMA. "I know that the reaction on the part of academic physicians, scientists, and the public to the departure of both Dr. Kassirer and myself was one of shock, chagrin, and a lot of anger," says Lundberg, who is now editor in chief of Medscape, a medical Web site. "I also know that the owners of both journals have had to make significant apologies for their behavior to many groups," he adds. "So my sense is that those two journals are stronger today because of these events than they were before, although I doubt that many would have liked it to have happened that way." Immediate Turnaround Certainly the "two angels"--Angell and DeAngelis--have benefited from the hullabaloo. "I have considerably more explicit authority than Dr. Kassirer," says Angell. "I was explicitly given control over use of the name and content of the New England Journal. Under Dr. Kassirer it was a constant pull and tug." Adds DeAngelis: "I was very influential in establishing a firewall between the AMA and myself as editor. Unless I was absolutely assured that the final editorial decisions rest with me, I would not have touched the job. Anything to be published will rest entirely on the merit of the article and the available space. Any other interference will ruin the integrity of what I consider to be one of the best medical journals in the world." Adds Rennie, a deputy editor at JAMA who participated in the negotiations over editorial independence: "I congratulate the AMA on having the foresight and wisdom to do this." Full Disclosure The Scientist is owned by Eugene Garfield, who took over the publication from the Institute for Scientific Information (ISI) in 1988 when it was spun off by JPT, a publishing group headed by Theodore Cross. ISI was subsequently sold to the International Thompson Group. Garfield is editor in chief and president of the publication, which derives its revenues mainly from product display advertising and classified advertisements. The publication has an informal wall to protect its editorial content. "Rather than a strict and formal policy, there's more of an understanding between the editorial and commercial sides about what's allowed and what isn't," says publisher Alexander Grimwade. "We don't write articles specifically at the behest of advertisers, or change anything in an article at the behest of advertisers unless it's manifestly inaccurate."--Peter Gwynne That doesn't mean that DeAngelis will ignore AMA administrators' comments. "Suggestions about topics to cover are very appropriate," she says. "Anyone can make those suggestions. I would certainly take them more seriously from anyone who has a vested interest in the AMA. But the final decisions about specific topics and certainly about specific articles rest in my hands." That strengthening of editorial control bodes well for journals of academic science generally. "I suspect that other journal editors have been heartened by the outcry," adds Lundberg. "They may even have had their own ethical positions enhanced by the outcry, which fundamentally said that the journals were more important than the political and business needs of their owners." But arguments over editors' control are far from over. "The pendulum always swings," says Rennie. Thus, November's vote by the Massachusetts Medical Society's House of Delegates means that the NEJM permanent new editor in chief, expected to be appointed in summer, will have less control than Angell. DeAngelis, meanwhile, sees potential trouble in electronic commerce. For example, the AMA and seven other societies have put together an affiliated group, called MEDEM, that will publish material from the societies' journals on the Web. "I have to have a say in the use of any material from any of the scientific publications on the Web," says DeAngelis. What does this mean for editors of journals less prestigious than NEJM and JAMA? "Becoming an editor is like entering a marriage," says DeAngelis. "You don't marry someone expecting that he or she will change. The first thing you must be assured of as an editor is editorial freedom. I think there is no other way except to say: 'If you take editorial freedom away from me, I resign.' If you're not prepared to do that, don't take the job. Editors had better be individuals who are willing to risk it all." Peter Gwynne (pgwynne767@aol.com) is a freelance science writer based in Marstons Mills, Mass.

Journal Editors Fight for Control

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