APRIL 15, 2006


New Canadian medical journal
on the horizon?

Ex-CMAJ editorial board members threaten to
start their own

CMAJ scandal timeline

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 about interference.

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 abruptly fired.

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 independence.

March 30, 2006 The acting editor appoints an interim nine member editorial board.

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 journal.

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 action.

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 Antonio Lamer.

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 journal.

"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 want."

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.



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