Of Editors and Publishers

You are not only responsible for what you say, but also for what you do not say.
Martin Luther (1483-1546)

The world of biomedical publishing was recently thrust into the media spotlight as a result of the standoff between the editorial board of the Canadian Medical Association Journal (CMAJ), the Canadian Medical Association (CMA), and its publishers. Briefly, the CMAJ intended to publish an investigative report concerning the practices of some pharmacists who were dispensing the emergency contraceptive Plan B. Upon receiving a complaint from the Canadian Pharmacists Association that its members should have been informed and allowed the opportunity to consent to being included in the article, the CMA instructed CMAJ editors to amend the article and leave out the interviews. Another news piece was also revised in order to appear more supportive of Federal Health Minister Tony Clement’s stance on health care privatization. The situation came to a head when the CMA fired the editor-in-chief and his deputy without revealing the cause, followed by the resignation of more than half of the CMAJ editorial board in protest of the initial firings.

It should come as no surprise that many editors feel the pressure of external interests that may seek to dictate journal content. Journals rely heavily on income from advertisers, and angering those that control one’s purse strings is undeniably imprudent. Then what makes the CMAJ case special? Certainly, the fact that the scandal surrounds Canada’s largest and most prestigious medical journal has been enough for many of the world’s top scientific publications to weigh in with their opinions, creating a public relations debacle from which the CMAJ may not recover. Perhaps what is unique in this situation is the way in which the CMA has handled the matter with a shroud of secrecy; CMAJ staff past and present are bound by confidentiality agreements that prevent discussion of any internal matters related to this incident.

Pundits have suggested that establishing a medical journal that is completely removed from corporate and political affiliations would be the most obvious solution to maintaining an acceptable standard of editorial independence. It is not surprising that Open Access publishing has received considerable attention in the last few years as such journals are not reliant on advertising income. However, until Open Access publishing attains permanence and widespread appeal, the current system of scientific publishing will be what most contributors trust.

Editors and publishers therefore wield tremendous power over what their subscribers will read, and both should ultimately be held responsible for journalistic integrity. When a similar situation of editorial independence erupted at the Journal of the American Medical Association in the 1990s, it was resolved when the publisher set a system in place to maintain appropriate autonomy. The journal has since regained and maintained its second spot ranking amongst the top international medical journals. The CMA has only recently outlined these guidelines and established a journal oversight committee with actual influence. Transparency in the relationship between the CMA and its editorial board is required to re-establish contributor and reader faith in the journal. Editors need to be protected from undue pressure to include articles for various interest groups. One can only hope that the reforms established by the CMA will not be too late for Canada’s medical journal and will serve as a model for those that follow in its footsteps.

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