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Canadian Medical Association vs. CMAJ editoral staff

Big Cheese

TRIBE Member
didn't know anything about this until i stumbled across this article tonight. interesting reading. don't know much about this topic other then what i've just read but i think it paints a pretty clear picture of what went down, regadless if the players are keeping a tight lip on the whole thing.

sorry if this piece or similar ones have already been posted, just wanted to share

The CMAJ firings
Crisis at Canada's most influential medical journal

The Canadian Medical Association Journal (CMAJ) has developed a worldwide reputation as one of the leading general medical journals. In terms of international "impact", it is ranked fifth, behind only the New England Journal of Medicine, The Journal of the American Medical Association, The Lancet, and the British Medical Journal.

The CMAJ is a mix of peer-reviewed research articles, reviews, commentary, editorials, and health news. It has been published since 1911 and reaches the vast majority of Canada's doctors. It is also the main source for some of the most influential medical stories that get reported in the Canadian media.

But recently, the Journal has been making news for another reason. Its well-earned reputation has been tarnished by a dispute that erupted publicly in February 2006 with the firings of its editor-in-chief and senior deputy editor. In the days and weeks that followed, several other editors resigned. The majority of the Journal's editorial board also quit. Other prestigious medical publications weighed in with critical comments of their own.

The main issue in the dispute has been portrayed as one of editorial independence. Since the main players are largely keeping mum about the specifics, the details have primarily come from other sources close to the parties.

One thing is clear: On one side are the CMAJ's editors. On the other side are the Canadian Medical Association (which represents more 85 per cent of Canada's doctors) and Graham Morris, who, as president of CMA Media Inc., is the Journal's publisher.

Editorial independence is a vital part of any respected medical journal and the CMA says it "recognizes the necessity of editorial independence of the Editor-in-Chief." As mentioned above, the content of a journal goes beyond peer-reviewed medical research. It includes commentary, reviews, letters, editorials, and investigative pieces that have the potential to generate controversy among the many stakeholders in the medical community – hospitals, drug companies, governments, regulatory bodies, and lobby groups like the Canadian Medical Association itself.

The idea of editorial independence is to prevent a medical journal (like the CMAJ) from buckling to political pressure or becoming a mouthpiece for the organization that publishes it (the Canadian Medical Association).

In this case, editor and publisher parted company in a way that made big waves in the medical community around the world.

Here are the key developments in the dispute:

John Hoey (file photo)Dr. John Hoey takes over as editor-in-chief of the CMAJ.

May 2001
The CMAJ publishes an editorial calling for the decriminalization of possession of small amounts of marijuana for personal use. That runs counter to the CMA's position. A former member of the CMAJ's editorial board says the CMA's general council complained to Hoey, the Journal's editor.

September 2002
A CMAJ editorial wades into the story of a 51-year-old man who was having a heart attack. He had arrived at the emergency room of one Quebec hospital only to find it had closed at midnight. He died en route to another emergency department a 30-minute drive away. The editorial criticizes doctors for not staffing the emergency department.

One report from a former CMAJ board member says the CMA's president demanded a retraction; the CMAJ editorial board reportedly reminds the CMA of the journal's editorial independence.

September 2002
The CMA establishes a five-member Journal Oversight Committee to review journal content and to "assist in maintaining harmonious relations between CMAJ and the association [CMA]," according to a CMAJ writer.

November 2005
CMAJ journalists ask the Canadian Pharmacists Association for comment about a story they're working on. The journalists say their research shows some pharmacists are asking women for their names, address, and sexual history before handing over Plan B, an over-the-counter drug used for emergency contraception. That raises privacy concerns. The Canadian Pharmacists Association complains to the CMA, which agrees with the pharmacists group that the article is "scientific research" and should therefore by governed by the ethical requirement to obtain informed consent from the pharmacists who were being observed. The CMA asks the journal's publisher for changes, which the editors reluctantly agree to make. In December, editor Hoey writes an editorial critical of what he calls the CMA's interference.

February 2006
A CMAJ news story that quotes concerns about new Health Minister Tony Clement's stance on privatization is replaced with one more supportive of the minister and adds quotes from the CMA president.

Feb. 20, 2006
The CMAJ publisher, Graham Morris, fires the CMAJ's editor, Dr. John Hoey, and the journal's senior deputy editor, Anne Marie Todkill. Morris denies that the firings were related to concerns over specific stories or Hoey's criticisms. Morris says the Journal wanted to make "some changes in emphasis."

Feb. 24, 2006
An editorial signed by seven editorial staff at the CMAJ protests the firings of Hoey and Todkill.

Feb. 28, 2006
An ad-hoc committee of the CMAJ editorial board (appointed by Hoey) concludes that the CMAJ's editorial autonomy is "to an important degree illusory" and finds that the CMA's "interference" with the Plan B story "was a clear and overt infringement of editorial independence."

Feb. 28, 2006
Stephen Choi, who replaced Hoey as editor, quits along with editorial fellow Sally Murray. Sources say Choi walked out after his demand that editorial independence of the editor-in-chief be "absolutely protected and respected" was rejected.

Late February and early March 2006
Criticism of the CMAJ firings grows. In an editorial, The Lancet calls the editorial dismissals "deeply troubling." The New England Journal of Medicine publishes an article called "The Collapse of the Canadian Medical Association Journal." A former editor of the NEJM (also a CMAJ editorial board member) calls for the firing of the CMAJ publisher. The International Council of Science Editors, which includes prominent medical journals in the United States and Britain, criticizes the CMA for suppressing or ordering changes to stories and editorials.

March 7, 2006
The CMA appoints retired Supreme Court chief justice Antonio Lamer to head a panel that will make recommendations on the future governance structure of the CMAJ.

March 16, 2006
Fifteen members of the CMAJ's editorial board submit their resignations and write of "our loss of trust in the CMA leadership in relation to the CMAJ." The former board members say the CMA's "recent actions and pronouncements regarding establishing editorial autonomy are largely cosmetic and unlikely to lead to an independent and free voice for health related issues in Canada."

March 17, 2006:
The CMA tells the former editorial board members it "takes great exception to your characterization of our organization and its leadership." CMA president Ruth Collins-Nakai says the CMA's leadership remains committed to editorial independence at the journal and said to the resigning board members "your subsequent actions appear aimed at undermining it." She ends the letter by saying the CMAJ "will publish long after we have left the stage. It was built to last."

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TRIBE Member
yeah, this is of particular interest to me & my job -- I work in research at an Ontario hospital & CMAJ was considered by many to be one of the top 5 medical journals internationally.

the tipping point of the Editorial Board's pissiness was considered to be the article discussing Plan B, the OTC morning-after pill, and concern over pharmacists asking patients to disclose personal information when purchasing the product. It's one thing for a pharmacist to ask the purchaser questions that could relate to safety-of-use with the product, ie. 'are you on any conflicting medications', etc; it's completely another to ask these women how often they have unprotected sex & other personal-choice questions.
And then entering this info into a database.

A member of Hoey's staff sent women into pharmacies around Canada & had them report on their experiences when trying to purchase this OTC drug. [By the way, if something's avaiable OTC there should be NO interference by anyone in your choice to buy it. Nobody asks you about your choices in deodorant or toothpaste, and this, in the eyes of CMAJ, should be no different (outside, of course, safety or drug conflict issues).]

The article CMAJ was to publish indicated that the Canadian Pharmacists Association was asking their members to make these inquiries. Hoey was asked to exclude this information in the published article, which he did, and then followed it with a scathing letter about editorial freedom & pressure by his publications' board of governors.

Since then multiple replacement editor's and others at CMAJ have tendered resignations. The journal as an institution is in huge trouble now, having completely lost its reputation as a leading medical journal and a valued source of balanced writing, editorial content, and research integrity.


TRIBE Member
Originally posted by David Suzuki on 03.17.06

Science Matters: Medical journal fracas makes everyone look bad

Depending on your point of view, what's been going on at the Canadian Medical Association Journal (CMAJ) is either a strange squabble between the academic elite and their bosses or a tense drama about freedom of the press and the role science plays in the media.
Sign me up for the latter.
It started last month when two editors of CMAJ, Canada's leading medical journal, were abruptly fired by the publisher. The journal's editorial board promptly wrote a letter to the publisher requesting that they be reinstated. In the meantime, an acting editor was hired. He agreed to take the position, but only if the publisher accepted a governance plan that would ensure he and his staff would maintain their editorial freedom. A week later, he quit. One can only guess why.
It turns out that the original editor, John Hoey, and the publisher, CMA Holdings, have been engaged in an increasingly public battle over editorial independence. In a January 3, 2006, editorial, Dr. Hoey wrote: "While the December 6, 2005, issue was in preparation, the editorial independence of the journal was compromised when a CMA executive objected strenuously to a news article we were preparing on behind-the-counter access to emergency levonorgestrel (Plan B). The objection was made in response to a complaint from the Canadian Pharmacists Association, who had learned about the article when they were interviewed by our reporters. The CMA's objection was conveyed to CMAJ's editors, and to our publisher, who subsequently instructed us to withhold the article."
The publisher denies firing Dr. Hoey because of his actions, and instead wrote in a letter posted on the CMAJ web site, that it was merely looking for a "fresh approach." Others say that the recent resignation of the acting editor is proof that Dr. Hoey was fired for his insistence on editorial freedom.
It gets stranger. In response to the firings, an ad-hoc committee of the editorial board published a commentary piece entitled Editorial autonomy of CMAJ, again on the journal's web site. In it, the committee reviewed the events leading up to Dr. Hoey's firing and concluded: "We view the episodes as raising serious concern about the integrity of the journal, its reputation, and its viability in the community of top medical journals." This is on the journal's own web site. Talk about dirty laundry!
On one hand, such a public airing of grievances could be said to be beneficial to maintaining public trust in important institutions such as the CMAJ because it lays all the cards on the table. On the other hand, it could be said to be making matters worse by making internal squabbles public and decreasing public trust in journals, research, and science in general.
One can only hope that something good comes out of this mess. It would be näive to think that the CMAJ's tension between management and editorial staff is an isolated incident. Indeed, with so much research being funded by corporations with a profit motive, and journals relying increasing on advertising, the issue of editorial independence is becoming more and more pressing.
Editorial freedom in a science journal, as in the media in general, is essential. With science journals, this freedom must be especially transparent, as editorial interference could have profound repercussions. Based on information from the CMAJ web site, the publisher of the journal appears to have crossed the line on more than one occasion.
Let's hope this is sorted out before the CMAJ is relegated to the backwaters of journal rankings. It deserves better. A warning published on the journal web site by the editorial committee says as much, although it is overly optimistic: "In our view, any attempt by the CMA to impose its influence on the editors would be catastrophic for the CMAJ's reputation as well as damaging to the reputation of the CMA."
It's a little late for that.