Editorial Independence & Integrity - Shouldn't this be our Norm?

Dr David KL Quek


Dr George Lundberg, long-time (17-year) editor of JAMA and Editor-in-chief of AMA's Scientific Information and Multimedia, was fired on Jan 15, 1999 for "inappropriately and inexcusably interjecting JAMA into the middle of a debate that has nothing to do with science or medicine."

Dr Lundberg apparently sanctioned the publication of a study on college students' attitudes towards oral sex by Dr June Renisch of the Kinsey Institute, which seemingly coincided with the ongoing impeachment trial of President Clinton."... The timeliness and publication of this represents a serious breach in the integrity of JAMA," says executive vice-president Dr Ratcliffe Andersen, who added that he acted personally on his own administrative and executive capacity.

This apparent interference of the executive arm of the medical profession into the jealously guarded halls of academic freedom and independence has created a huge wave of near-unanimous protests and sharp criticisms from the medical profession and more importantly from the medical editors all across the world (including those from the BMJ, Lancet, New England Journal of Medicine, Medical Journal of Australia, as well as editors of all the various publications of the American Medical Association – JAMA, Archives Journals). The present leadership of the AMA has been conspicuously silent on this issue.

In protest, another JAMA editorial board member, Dr Donald AB Lindberg (also director of the National Library of Medicine), resigned. The following JAMA issue (JAMA 1999;281:460) carried a stinging editorial rebuke for the arbitrary actions of Dr Ratcliffe Andersen, whom they castigated as having challenged JAMA's editorial freedom and JAMA's historic tradition and integrity. They credited Dr Lundberg's editorship for having raised JAMA into an international world-class scientific publication of consistently high quality – publishing important "articles that advance medical science, improve patient care, protect public health, and inform health policy". This editorial was signed by everyone of the editors and editorial board of JAMA, and the AMA Archives Journals.

Further, while they acknowledged Dr Andersen's authority to act as he did, the editors strongly disagreed with the summary dismissal of Dr Lundberg. They stated that while "some members of the AMA's leadership or its members may disagree about the scientific merit or propriety of particular articles, as inevitably they will, from time to time," JAMA's hard-earned reputation of editorial independence and integrity has always remained intact and has been consistent. They reminded that JAMA has always upheld and will continue to re-commit to the values, goals and objectives previously endorsed by the AMA House of Delegates, in 1993 (American Medical Association. JAMA editorial freedom. Board Report Resolution 904, I-92 adopted by the House of Delegates; June 1993.).

Why indeed did Dr Andersen act as he did? As executive Vice-President of the AMA, he has been given the task to liaise directly with the lobbies of both Congress and the Senate pertaining to multifarious medical and health-related issues. Many if not all of these are partisan and require joint efforts of both sides to carry through. Thus, it is conceivable that Dr Andersen's task could have been perceived as having been put at jeopardy with the recent publication of this purportedly mis-timed article. It implied also that the AMA leadership must have sanctioned such a drastic action, which now carries worldwide recriminations and condemnation. This, clearly, the AMA could have done without.

Our own recent experience here at the MMA News has offered some food for thought. The sociopolitical discussions that originated with the October 1998 issue has shown how fragmented and divided our membership and even our leadership has been, when this involves politics and preferences. Emotions often run high, and can be highly volatile when one takes on a partisan approach. Choosing and adopting any political allegiance often does this to everyone.

However, this does not mean that one could not make personal choices or even share some of these strong feelings with others. The hallmark of a mature society is one that allows progressively the freedom to espouse one's thoughts and feelings. Similarly, those who feel contrariwise can and should also be allowed to share their convictions, sensibly and without too much rancor and abuse. With the sharing and exchange of such ideas, higher ideals and more consistent moral choices can be made clearer and more rationally.

Of course, one can always argue that some issues are best served outside the scope of any particular organisation or publication – e.g. they should be not be within the purview of our MMA News. Once again, this presupposes that the editor or the board deliberately draws on extraneous issues to pursue a political or personal agenda, which unjustly imputes the integrity and good judgment of the board. Shouldn't the consistency of trying to uplift the MMA and its publications be sufficient proof to refute such snide allegations and effrontery?

Where can our Association draw its strength and moral fibre, if not from its ethical and moral concerns about what goes on in our society and how societal occurrences affect our medical profession and our potential patients? It is true that there are few guidelines as to how much we can encompass in our zeal to publish, and be heard.

From a personal viewpoint, I feel that there is little to be gained from rigid constraints, which would severely limit our ability to disseminate news and opinions, particularly sensitive ones. As an enthusiastic and vanguard body with the good of the medical profession at heart, we should and can all aspire to a higher moral ground, and that this should be our moral compass in helping decide what is newsworthy or right.

It would be presumptuous to put our case on par with that of JAMA, which by the way is a medical journal, and yet has found the editorial integrity and judgment to act as it does. Ours is a newsletter which has been nurtured over the years into a reasonably mature and respected publication – one which has now become not just a voice for the MMA leadership to inform the membership about its actions and directions, but also increasingly as a sounding board for the general membership to participate in. I believe we can make our MMA News even more readable and more vocal in expressing the concerns and aspirations of our membership as well as to serve as a strong advocate for direct or indirect interests of the medical profession.

One must learn to differentiate and discern opinions, which although contentious, also carry an ethical direction and common concern for the future good of the medical profession. If our Association is increasingly seen as a champion of the medical profession, and a strong advocate for justice and fairplay, we can justifiably be recognised more and more for our opinions and concerns. Importantly, our doctors can look towards a more consistent stand and have a moral guide to pursue their professional health-services, without fear or favour.

Perhaps, it is timely for MMA to also have some sort of guidelines as to how it wants the Berita to function. I propose that as a start, we could review and adopt most of what the JAMA has to offer, remembering that we are even less confined as a newspaper than as a journal. These JAMA objectives are well-worth considering and may be applicable even for our local scenario, i.e. for the Berita MMA and/or the Malaysian Medical Journal. (Lundberg GD. House of Delegates reaffirms JAMA's editorial independence. JAMA 1993;270:1248-1249)

The Key and Critical Objectives of JAMA

Key Objective: To promote the science and art of medicine and the betterment of the public health.

Critical Objectives:

1. To publish original, important, well-documented, peer-reviewed clinical and laboratory articles on a diverse range of medical topics

2. To provide physicians with continuing education in basic and clinical science to support informed clinical decisions

3. To enable physicians to remain informed in multiple areas of medicine, including developments in fields other than their own

4. To improve public health internationally by elevating the quality of medical care, disease prevention, and research provided by an informed readership

5. To foster responsible and balanced debate on controversial issues that affect medicine and health care

6. To forecast important issues and trends in medicine and health care

7. To inform readers about nonclinical aspects of medicine and public health, including political, philosophic, ethical, legal, environmental, economic, historical, and cultural

8. To recognize that, in addition to these specified, objectives, The Journal has a social responsibility to improve the total human condition and to promote the integrity of science

9. To report American Medical Association policy, as appropriate, while maintaining editorial independence, objectivity, and responsibility

10. To achieve the highest of ethical medical journalism and to produce a publication that is timely, credible, and enjoyable to read.

I urge the MMA membership to seriously read and consider the objectives of the JAMA, particularly critical objectives, number 5, 7, 8, 9, and 10. A resolution is being contemplated along these lines to be presented for consideration and adoption at the coming AGM in Penang.

It is hoped that our future editorial boards can be spared the agony of acrimonious and uncalled-for personal attacks, and continue to publish independently and with integrity, without fear or favour.

This will invariably strengthen our institution, our association – one that can withstand scrutiny and criticism, and yet one that can continue to shine like a beacon for us, medical doctors, in all fields even those remotely related to our practice. After all, for most of us, the practice of medicine encompasses almost every aspect of our lives and our livelihoods.

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