2002: CMAJ reports
the case of a Quebec heart attack patient who
died after finding his local emergency room closed.
The story angers some Quebec doctors, and leads
the CMA to request a retraction. The editorial
board refuses. The article ultimately leads to
a change in Quebec law on ED opening hours.
November 2005: CMAJ
runs an article on pharmacists' attitudes to the
Plan B contraceptive pill. Reporters conducted
undercover visits to pharmacies to verify rumours
that pharmacists were demanding patient details
as reports suggested. They were. This article,
too, forces a change in practice, as the Canadian
Pharmacists' Association (CPhA) stopped advising
its members to ask for personal information.
But the CPhA also complains
to the CMA, which orders the journal to withdraw
the survey and run the piece without it. Dr Hoey
complies, but writes a strong editorial complaining
February 2006: CMAJ
runs a news piece on incoming Health Minister
Tony Clement. Sources quoted in the piece label
Mr Clement a zealot of healthcare privatization.
The CMA finds the article too hostile, and insists
the journal add comments from CMA president Dr
Ruth Collins-Nakai welcoming the new minister.
Shortly after Dr Hoey and Anne Marie Todkill are
March 7, 2006 Dr Collins-Nakai
tells CBC radio, "You know one side of the story,
we're not at liberty to give you the other side."
March 16, 2006 Most of
the editorial board resigns en masse. The firings,
they say, most certainly were about editorial
March 30, 2006 The acting
editor appoints an interim nine member editorial
The dust is still settling from
the unseemly fracas at Canada's leading medical journal,
the Canadian Medical Association Journal (CMAJ).
The now-familiar scandal followed the firings of editor
in chief Dr John Hoey and deputy editor Anne Marie Todkill.
The fallout, including the subsequent resignation of
most of its editorial board, left some observers wondering
if the journal can survive and a few asking if
it should. There are now rumblings that some old board
members might strike out and start a completely new
The dismissals triggered an uproar. Readers complained
in droves. Several staff editors quit and fifteen of
the 19 editorial board members resigned (see "CMAJ
scandal timeline" right). The international reaction
was swift, with leading medical journals like The
Lancet and the NEJM condemning the CMA's
The CMA continues to insist it
was not motivated by disputes over editorial independence
at all. The journal's publisher and the man who fired
the two editors, Graham Morris, president of CMA Media,
said shortly afterwards that he simply "felt it was
time for a fresh approach."
Now under a transitional editor
and new but temporary editorial guidelines, the CMAJ
is waiting for a new set of rules to be devised by a
governance panel led by former Chief Justice of Canada
With a new editorial board announced
in late March, the haemorrhaging seems to have stopped.
But the CMA may face an uphill battle convincing readers
that it will be a gentle custodian of the 95-year-old
WITH THE NEW?
"If the CMA continues down this road, I think there's
a great chance the journal will just die," says Dr P
J Devereaux of Dalhousie University, one of the board
members who quit. "There's a lot of people who've just
had it with the journal, and they want to create their
own. Many people, bright people with editorial experience,
have been calling me about it I'd be surprised
if it doesn't happen." The CMA, he says, "has a limited
window of time to turn this boat around and fess up,
otherwise there really will be a new journal."
"I really think it could happen,"
says Dr Jerome Kassirer, editor emeritus of the NEJM
and the first member of the CMAJ editorial board
to resign. "The former board is the crème de
la crème of Canadian medicine, and they are really,
really unhappy with the CMA."
Dr Devereaux has little faith in
the new rules or the Lamer governance panel. He says
neither will ensure independence "because the CMA is
looking for an editor who will toe the party line."
The current acting editor, Halifax
paediatrician Noni MacDonald, rules herself out. "I've
already told everyone I won't be sticking around," she
says. "I like the rest of my life too much." She's due
to quit early in June and it's unlikely she'll put the
CMAJ's editorial independence to the test before
that. "The goal of courting controversy is not my style,"
says Dr MacDonald. "Good, evidence-based, hard-hitting
advocacy, yes. But I don't believe in writing things
just to put people's backs up."
Meanwhile Justice Lamer is getting
on with the job at hand. "Right now I'm sitting at home
reading other medical journals, the BMJ, JAMA
and so on," he says. "We're not starting from scratch.
These journals already have governance rules and we
won't be too far out in left field from the norm."
The final rules would need some
"minimal rights" for the publisher, he says, "because
the publisher is legally liable in the event of libel."
While Dr Collins-Nakai probably won't be on many former
board members' Christmas list this year, their leading
bête noire is publisher Graham Morris. Mr Morris,
who formerly published TV Guide and Canadian
Living, was hired by the CMA in 2004 to manage its
transition to a for-profit business model.
Dr Kassirer says the appointment
of someone with no experience in scientific journal
publishing signalled that the CMA was more interested
in turning a profit than in maintaining standards.
Mr Morris outraged the board when
he told The Lancet that, while he supported full
editorial independence, on content, "the last call will
be my call." He was unavailable for comment.
NRM polled several members
of the new editorial board and found them no more supportive
of the firings than their predecessors. "It's particularly
worrisome that it was done without succession planning,"
says new member Dr Judith Hall of UBC of the firings.
Ultimately, she says, "the decision was whether to try
to help salvage what was left. It helped me to make
that decision knowing that it was for 90 days, on an
interim basis, until Justice Lamer reaches his conclusions."
The firings were "deeply troubling"
agrees fellow new member Dr Donna Stewart of the Ontario
Cancer Institute. "But the vital thing is to save the
journal, and it's only fair to give them 90 days."
Two stayed on from the old board.
One of them, Dr Martin Schechter of UBC, says: "The
journal needs to survive. To do that it needs to establish
full editorial independence, and I mean to stay on to
see that that happens."
Professor Paul Armstrong of the
University of Alberta is the other original board member.
"Like everyone else, I was dismayed and perturbed by
the firings," he says. "I don't think we've heard an
adequate explanation. But good people have stepped up
to save the journal, because that's what John Hoey would
No one on the current board we
spoke with was willing to budge on editorial independence.
If Mr Morris were indeed to keep the last word, says
Dr Armstrong, "I could never participate in that."
Justice Lamer invites comments
from physicians by fax (613-230-8877) or email ([email protected])
by May 5.