Tuesday, March 24, 2009

Medical journal primadonnas - the end (not)

I have reported a short while ago (you might want to re-read this before continuing this blog posting) how editorial staff at the Journal of the American Medical Association (JAMA) seemingly bullied Dr Leo after he disclosed in the British Medical Journal (BMJ) an undisclosed conflict of interest of authors of a study JAMA published.

Here now, without further ado, the end of the saga. It's been reported on the websites of the WSJ, JAMAs as well as Dr Leo's. My analysis will make use of content (analysis) provided by subscribers to a bioethics discussion list hosted by the Medical College of Wisconsin.

JAMA's editors have not exactly helped their case. They effectively admit contacting Leo's Dean to complain about his conduct (ie publishing his conflict of interest allegations - 5 months after bringing them to the attention of JAMA's editorial staff) on the BMJ website. They deny having bullied the Dean as well as Leo. However, the Dean confirmed that the gist of the JAMA editors' complaint about Leo contained a threat to the school. Here's an excerpt from said bioethics discussion list: '"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 email exchange. In a March 11 email, 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 email.'

The JAMA editorial suggests, mistakenly, that Leo was under confidentiality related obligations not to publish his letter to the BMJ until after JAMA had completed its investigation. It's entirely unclear why this should be the case. Leo is perfectly entitled to publish anywhere (as he did) allegations of conflict of interest. After all, everything he reported is a matter of public record (accordingly there were plenty of others who would have been witness to the conflict of interest). What is particularly amusing, perhaps, is that the journal objecting to Leo blowing the whistle on the conflict of interest it omitted to report, had not hesitation to blow the whistle on him (by calling his superior, the Dean of the school). Obviously, one standard for authors, another for editors...

JAMA claims in its editorial that Leo's disclosure of his allegations would hamper its ability to undertake its own investigation. As it happens, however, according to JAMA's own reported timeline, it actually completed its investigation some time before Leo's letter in the BMJ was published. The journal claims, however, that it was unable to publish the subsequent 6 line conflict of interest declaration (even on-line) that it received some time in January until some time in March due to space considerations. Of course, there are no on-line space considerations, as everyone knows. In addition to this, the editors were capable of rushing their above mentioned editorial on-line within about a week. Not overly credible the editorial explanation of space constraints here...

JAMA's new policy on this issue is truly pointless. It aims to enforce censorship on people reporting potential omissions of conflicts of interest declarations to the journal and expects them to keep quiet until it has investigated the matter. Anyone who goes instead directly to the news media would accordingly be in the clear as far as the new JAMA policy is concerned. The solution then would be, instead of waiting for JAMA's breathtakingly long 'investigation' of a simple matter (did you omit to declare a potential conflict of interest?), to issue a press release straightaway, or to write a letter to a different medical journal (as Leo did).

Significantly, the BMJ that published Leo's complaint has refused to withdraw his letter, because, according to the BMJ editor, the complaint was factually accurate.

It is deeply disconcerting that a leading biomedical journal such as JAMA tried to bully an academic as well as a medical school dean for doing nothing other than report the omission of a conflict of interest declaration. A clear abuse of the powers that journal editors are invested with by virtue of the job they hold. This is what really is at issue here!


  1. Thanks for reporting this, Udo - very important stuff. Given the importance to academic careers of publishing in peer-reviewed journals, it's surely worth considering how accountable, responsible and, yes, fundamentally ethical are the editorial staff of these journals.

    I'd be intrigued to know where the got the 'confidentiality' assertion; did Leo have some sort of relationship with the journal that could give rise to such a duty? Had he voluntarily agreed to say nothing, or received some sensitive information from them? Otherwise, it sounds like the sort of scary-sounding but ultimately meaningless term bandied around by desperate lawyers.

  2. it seems as if JAMA editors imposed unilaterally confidentiality and leo declined (as he was well within his rights to do).

  3. I sure hope that Senator Grassley is adding the players in this saga to an upcoming Senate hearing. If what Leo says is true, the editors should be on the receiving end of a beat down by Grassley.

    I'd also like to see them hit with a racketeering suit on behalf of patients/consumers. They appear to have conspired with drug companies to commit a fraud against US consumers.


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