The Journal of the American Medical Association (JAMA) announced a new policy for exposing violators of conflicts of interest policies, and it is essentially states that JAMA encourages you to report those who fail to report potential conflicts but do not tell anyone you told them.
In what amounts to censorship of ideas, the editors at JAMA would like to keep all their faults and flaws under wraps.
The Policy
JAMA will require that the individual bringing the allegations provide a written, detailed explanation of the unreported conflicts of interest and provide documentation to support the allegation. The person bringing the allegation will be: (i) specifically informed that he/she should not reveal this information to third-parties or the media while the investigation is under way; (ii) will be informed about progress of the investigation, upon request, as appropriate; and (iii) will be notified when the investigation is completed. In addition, once the investigation into unreported conflicts of interest is completed, and the letter of explanation and the correction are finalized, those documents will be immediately posted online and linked from the article, and then subsequently published in the print journal.
Though, I agree with the spirit of what they are proposing, because who needs to be falsely accused of something before it is checked out, I also have reservations.
The tone and the actions they undertook, and admitted to trying to stop “a short and potentially obscure letter” from being published by Jonathan Leo, an obscure neuro-anatomy professor at an equally obscure medical school of Lincoln Memorial University is unwarranted.
We discussed last week, in detail, the intimidation tactics JAMA editorial staff used on Professor Leo in their editorial and they admit that:
Personal Rebuke – Demand an Apology
After receiving an e-mail from Professor Leo that he was going to publish a letter critical of JAMA in The British Medical Journal (BMJ), Katherine DeAngelis, M.D., Editor of JAMA, called him personally to let him know that “his actions were inappropriate,” and Professor Leo stood behind his letter (he was frustrated not having heard from JAMA for five months whether they were following up on his requests).
According to Leo, months later, before publishing the BMJ letter, he called JAMA editorial staff twice to talk about the upcoming piece, and he also sent an email. Given the topic of the letter, he wanted to give JAMA an opportunity to correct any factual errors. No one from JAMA responded to his phone calls or e-mails. The letter underwent legal review at BMJ and was approved for publication. BMJ then published what they thought was a fairly unremarkable letter primarily of interest to researchers who study conflicts of interest.
JAMA’s own words outlined their actions, against Professor Leo:
As Leo continued to refuse to acknowledge any problems with his actions, even after he was informed that the investigation was completed and was advised to read the upcoming March 11 issue of JAMA (where the letter of explanation and apology from Robinson and the formal correction were in press).
Banned for Life
Leo also was informed that, if his actions represented his apparent lack of confidence in, and regard for, JAMA, he certainly should not plan to submit future manuscripts or letters for publication. Although we [JAMA] appreciated Leo alerting us to the potential omission of some financial disclosure information by Robinson, we [JAMA] maintain that his actions were inappropriate in contacting the media and by his posting on the BMJ website prior to publication of the correction and letter of apology from Robinson.
So what do you do when you do not get the answer you want, and you are the boss of the world; you go to that person’s boss:
Since Leo apparently did not appreciate the serious implications of his actions, despite our attempts to explain, we felt an obligation to notify the dean of his institution about our concerns of how Leo’s actions were potentially damaging to JAMA’s reputation. We sought the dean’s assistance in resolving this issue involving a member of the faculty of his institution, to assure there would be no need to publicly identify that faculty member.
We Are JAMA – You Must Obey
JAMA, in their Editorial, again said: No dean wants his or her institution implicated in a publication reflecting improper behavior by a faculty member. We fully expected a professional and appropriate response and assistance with resolution, as has occurred when we have notified other deans about related issues in the past, such as in other cases involving undisclosed financial conflicts of interest and cases of duplicate publication.
According to The Wall Street Journal, the dean of the medical school where Dr. Leo teaches said Dr. DeAngelis threatened in a telephone conversation earlier this month that she would "ruin the reputation of our medical school" if he did not force Dr. Leo to retract the BMJ letter and stop talking to the media. In an interview Friday, Dean Ray Stowers said Dr. DeAngelis "flat out" threatened him and attempted to bully him during the conversation.
The telephone call was followed by an e-mail exchange. In a March 11 e-mail, Dr. DeAngelis wrote to Dr. Stowers: "As I've already expressed to you, I don't want to make trouble for your school, but I cannot allow Jonathan Leo to continue to seek media coverage without my responding. I trust you have already or soon will speak with him and alert me to what I should expect."
Dr. Stowers responded the next day by saying he couldn't find any fault in Dr. Leo's actions and pressed JAMA editors for more specifics on what they believed was wrong with Dr. Leo's writing or actions. "I think this can be worked out without your continued threats to our institution which are not appreciated, and I believe to be below the dignity of both you and JAMA," he wrote. Dr. Stowers says he has not heard from JAMA since sending that e-mail. Dr. Godlee said BMJ would not retract Dr. Leo's letter because "there are no factual inaccuracies."
Now JAMA editors deny this interaction ever happened?
From a Nothing and a Nobody to a Somebody Doing Something Very Important
Alerted of the letter in BMJ and the controversy of Wall Street Journal Reporter David Armstrong, contacted Dr. DeAngelis and was told “He is a Nothing and a Nobody” in the editorial this week, and she stated that her comments have been misrepresented by the media and widely misinterpreted. She now says Professor Leo “is somebody doing something that is very important.”
Industry is Friendly – JAMA is Not
According to Professor Leo, the implications of JAMA’s reaction to our letter are significant. For instance, the pharmaceutical industry is often criticized for their impact on evidence-based medicine. In the past, I have criticized direct-to-consumer advertising of psychiatric medications, which is not helpful to big pharma. However, I have never been telephoned or threatened by representatives from big pharma. In contrast to my experience with JAMA, any exchanges have been civil and appropriate.
Editorial
So far, my count according to the editors at JAMA, at least three people lied about their interactions with JAMA editorial staff. If you follow their reasoning, there must be a conspiracy among the professor, dean, BMJ editor, and The Wall Street Journal to destroy the reputation of JAMA.
I would hardly say this is the case. JAMA editors, as they stated in their editorial, “the tone of their interactions was strong and emphatic.” This may be the understatement of the year.
The information age is, by and large, an uncomfortable place for journal editors, where information is instant and the need for information grows exponentially. The age of the imperial journal editors is over, and the editorial staff at JAMA are the last vestiges of what remains of a dying generation whose goal it is to control information.
Losing control is a hard thing, it is the equivalent of a king losing his kingdom. One day, the editors of JAMA will realize the world has changed around them.
Source Documents
WSJ Medical Journal Decries Public Airing of Conflicts
WSJ Blog: JAMA Sets New Policy in Wake of Disclosure Flap
JAMA: Conflict of Conflicts of Interest
Lincoln Memorial University: Statement by Jonathan Leo, PhD
Policy and Medicine: JAMA Editor: Calls Critic “A Nobody and a Nothing”