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Year : 2006  |  Volume : 38  |  Issue : 3  |  Page : 224--226

Sacking of the CMAJ editor: A revisit on the issue of editorial autonomy

K Satyanarayana 
 Ombudsman, IJP and Editor, Indian Journal of Medical Research, Indian Council of Medical Research, Ansari Nagar, New Delhi - 110029, India

Correspondence Address:
K Satyanarayana
Ombudsman, IJP and Editor, Indian Journal of Medical Research, Indian Council of Medical Research, Ansari Nagar, New Delhi - 110029

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Satyanarayana K. Sacking of the CMAJ editor: A revisit on the issue of editorial autonomy.Indian J Pharmacol 2006;38:224-226

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Satyanarayana K. Sacking of the CMAJ editor: A revisit on the issue of editorial autonomy. Indian J Pharmacol [serial online] 2006 [cited 2022 Nov 27 ];38:224-226
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The sacking of John Huey, editor, Canadian Medical Association Journal (CMAJ), on February 20, 2006 has made headlines. It is a matter of concern because Huey was sacked without notice by his employers, the Canadian Medical Association (CMA). Leading international science journals have condemned the sacking. That Huey was sacked neither due to incompetence nor due to moral turpitude has revived the debate about the fate of editors who do not get along with their publishers. Huey was eased out as he was far too 'independent' and did not toe the line of the CMA. While the CMA acknowledged that Huey significantly contributed to the journal and its circulation, it did not give reasons for his termination. During his 9 year- stint as editor, CMAJ has been rated among the top ten general medical journals. It has 70,000 readers and its web site attracts about two million visitors every month. Both Graham Morris, President, CMA Media Inc. (a subsidiary of CMA which owns the Journal) and Ruth Collins-Nakai, President, CMA, have acknowledged that CMAJ vastly improved in quality and reputation under Huey. Yet, in the official response to the sacking, the CMA publisher carefully avoided giving any clear reasons except saying that "I felt that it was time for fresh approach."

This is not the first time that an editor of a medical journal, owned by a society, has been shown the door. In 1999, the editors of the Journal of American Medial Association (JAMA) and the New England Journal of Medicine (NEJM) were sacked in quick succession. I had predicted: "With the current crop of editors in no mood to yield on 'editorial independence,' the uneasy relationship between editors and owners will perhaps continue in the new millennium".[1] We are back to debating, as we did during 1999-2000, the issue of freedom and space for editors to function, without the fear of vindictive action from owners/publishers. We must discuss the need to build trust and harmony between the two parties. This is more so in the case of journals run by a professional society of medical doctors who, more often than not, have their own agenda that needs to be pushed through politicians. Such associations look to use the column inches of the journal to further their agenda and use the revenue from the journal (many medical journals run by societies are flush with funds thanks to advertisements) to lobby with politicians. Interestingly, editors of all the three journals - JAMA, NEJM and CMAJ - were sacked primarily due to business and/or political reasons and not due to incompetence.

The CMAJ episode is unique in that, unlike the JAMA and NEJM sackings, clear cut guidelines on the roles of editor and publisher, through an editorial governance plan, have been put in place by the AMA and the MMS. Even editors' associations such as the World Association of Medical Editors (WAME) and the Council of Science Editors have clear statements on this issue. Thus, there are fairly clear guidelines on the roles of publisher and editor.[2],[3] As these policy guidelines did not act as a deterrent, it suggests that the CMA was not unduly concerned about such niceties. However, in striking contrast to the earlier episodes, there is overwhelming support for Huey from editors and others across the globe, thanks to technology. Dozens of editors logged on to the WAME web site to take the CMA to task for its insensitive act and express solidarity with the sacked editor. The CMA surely must have anticipated some flak, but may never have expected this kind of unprecedented backlash from medical researchers, from all over the world, even Canada, except perhaps from the physician members of the CMA.

There is another significant difference between the CMAJ and the JAMA/ NEJM episodes. Unlike the earlier dismissals, which may have taken people by surprise, this one was not entirely unanticipated. Perhaps, it was waiting to happen. Even Huey may not have been entirely caught off-guard at his sacking, except perhaps for the timing - he was just back from vacation. The sacked editors were not given any reasons and, due to the contract with their employers, cannot speak out. We may need to wait for a long time to listen to their version.

The battle lines, of course, were drawn years ago with Huey letting the world know his role as editor vis--vis his employer, through his views on the issue of the sacking of fellow editors - Jerome Kassirer (NEJM) and George Lundberg (JAMA) by their respective associations. Huey observed that the CMAJ belonged to not just its owners, the CMA and its membership, but to the world. "the dissemination of medical science is or should be, ultimately a humanitarian project and not merely the special preserve of professional associations".[4],[5] Huey was bold enough to express his views. His editorial team consistently exercised freedom to comment on various issues that, in their opinion, impacted the public health of Canada and the rest of the world. The sacking was thus waiting to happen.

The series of confrontations between the editor and the CMA may have started as early as 2001 when the CMAJ supported the medical use of marijuana, which contradicts the official position of the CMA. The CMA General Council took serious exception to this article and conveyed its displeasure to Huey. Tempers ran high when, in 2002, the CMAJ criticised the doctors of Quebec for not staffing an emergency room during the night. A patient with myocardial infarction brought at midnight to the hospital died as the ER was shut. This editorial, which triggered a lot of media attention, led to a major policy change in the province that ensured the presence of general practitioners in the ER, round the clock. Quebec physicians, most of whom were members of the CMA, were not amused by the criticism from their own organ - CMAJ. The CMA considered the editorial 'irresponsible journalism'.[6] The CMA President insisted on its retraction. The Editorial Board, however, intervened and cautioned the CMA that their action amounted to editorial interference.

The CMA then set up a Journal Oversight Committee (JOC) with members from the editorial board. In fact, Kassirer was taken onto the editorial board and the JOC. That the CMA was not serious about the JOC was clear as, for almost a year, it was virtually non-functional. Even its mandate was unclear. The then president of the CMA said that the JOC would address the CMA members' 'valid concerns' about the CMAJ. The first chair of JOC, Larry Erlick, opined that the JOC was expected to resolve disputes among editors, publishers and the CMA; while the CMAJ hoped that the JOC would help it maintain 'harmonious relations' with the CMA. The JOC was thus stillborn. Erlick said that Huey would not work with the committee. Other members of the JOC such as Kaisserer considered the JOC not just unresponsive to the feelings of the editors, but added that it was used as an organ to keep a watch on and filter out politically inconvenient news and comment from the CMAJ. Moreover, two members of the JOC were also members of the CMA board and one of them is the chair in 2006, which clearly is a conflict of interest.[6], [7] The bickering between the editor and the publisher continued, while a non-functional JOC merely watched.

The simmering discontent again surfaced with the publication of a new report on Plan B in November 2005 (see [6] for details). The CMAJ carried a story on Plan B, an emergency contraceptive that has gained over-the-counter status in Canada. The investigative report claimed that pharmacists were seeking personal information from women before dispensing the drug. Reporters sought clarification from the Canadian Pharmacists Association (CPA). As the CPA enjoyed a good relationship with the CMA, the pharmacists complained to Bill Tholl, Chief Executive Officer, CMA. Tholl sided with the pharmacists and, in turn, spoke to Morris. The publisher asked the journal not to run the story. It was the first time in the history of the CMAJ that an editor was asked to kill a story. To avoid a confrontation, the reporters offered to modify the story and a revised version was eventually published in the journal's print edition. The Canadian Government directed pharmacists not to seek personal information. Yet, that the publisher could get a story modified amounted to direct (perhaps, successful) interference in the running of the journal. The episode left everyone - the CPA, the CMA and the editor unhappy.

A stung Huey wrote, in January 2005, that editorial independence was being compromised and informed the JOC. As there was no response from the JOC, Huey asked Kassirer to lead an ad hoc committee to assess the events that had led to increased tensions between the editor and the publisher. The ad hoc committee submitted its report on February 27, 2006.[7] It found fault with both the editor and the publisher. The editor was chided for succumbing to pressure from the management to modify the Plan B report and for not pursuing the matter vigorously with the JOC. The management was taken to task for blatant interference in trying to kill the Plan B story. The committee categorically stated that the 'editorial autonomy' (at the CMAJ) was to a large extent 'illusory'. It made some far-reaching recommendations to the CMA that called for, among other things, transparency in the dealings between the editor and the publisher. It also stated the need for specific policies on editorial independence, besides a re-examination of the purpose, structure and governance of the JOC.

What lit the fuse was the news report on the appointment of Tony Clement as the new federal minister of health in the conservative government of Canada. The CMAJ carried a critical write-up, 'Two-tier Tony Clement appointed new minister of health' on February 7, 2006. Clement, a 45-year-old lawyer, was earlier health minister in Ontario. He was ideologically committed to privatising the delivery of the public health care system. The news item appeared on the CMAJ web site and was promptly picked up, by the British Medical Journal and others and widely publicised. The management took serious exception to the tone and tenor of the article's criticism of the new federal health minister and asked the journal to pull out the story. The editor refused, but carried a watered down version, 'Tony Clement appointed as Canada's new health minister' that was published on February 22, 2006, excluding many critical references to his earlier stint as health minister in Ontario, especially his push for privatisation and deregulation of the public health care system. And for good measure, the revised report carried several words of praise for Clement (see[7] for details). The reaction of the CMA was swift. Huey and Anne Marie-Todkill, a senior deputy editor, were shown the door on February 20, 2006, setting off an unprecedented crisis in the CMAJ.

The CMA clearly underestimated the backlash of their action in sacking Huey and Todkill. A senior editor, Stephen Choi, was chosen to succeed Huey. Choi immediately submitted a draft proposal that guarantees editorial independence as a pre-condition,[8] which was promptly refused. Choi quit. Meanwhile, the CMA also disregarded the editorial board's request to reinstate Huey and Todkill and put an editorial governance plan in place. There was more to come. Scrambling to find a substitute for Huey, the CMA sought the services of Bruce Squires, a former editor-in-chief of the CMAJ. Squires initially agreed and later withdrew, apparently due to pressure from editors of other journals, urging the CMA to put an editorial governance plan in place.[6]

After dithering for a while, the entire editorial board also quit in protest. At the time of writing, the CMAJ has appointed Noni MacDonald as the acting Editor-in-chief and Bruce Squires as Editor-emeritus. The reasons, as they explained, were due to concern for the journal and Canadian medicine. The CMA assured the transition team of freedom and autonomy.[9] A former chief justice of Canada, Antonio Lamer, heads a governance review committee that is expected to submit a report in about six months to the CMA. The JOC has also been reconstituted, somewhat akin to the one AMA put in place after the dismissal of Lundberg.[9] But the acting editor has expressed doubts about the implementation of the recommendations of these panels by the CMA.[10]

The resentment and anger toward the CMA for being singularly insensitive to repeated appeals, from the global research community, to reinstate Huey and put in place an editorial governance plan has reached such a crescendo that there is talk of starting an open access medical journal from Canada.[11] It is not clear whether the CMA has learnt its lesson. The only silver lining may be the impending governance plan for the CMA, which, if implemented, would avoid yet another dismissal of a yet another editor. [12]

There are some basic questions that beg answers, at least from journals owned by scientific societies. Who should have 'editorial control' of the journal? Editor or publisher? Their loyalties may not be similar. Should the primary obligation of a society journal editor be to his employer or readers? Should the editor primarily serve the interests of his employer, even if means compromising the freedom to criticise the actions of the society, if the editor perceives such action to be against overall public interest? This kind of conflict is perhaps unique to medical journals with physicians as members (in Canada, an estimated 90% of practising physicians are CMA members) as they almost universally look to politicians to help further their professional (and commercial) interests.Will any governance plan work if the publisher is not serious about putting larger societal concerns over the interests of the membership? Graham Morris, a former media veteran and publisher of the CMAJ, said that while he supports editorial independence, he would like 'the last call will be my call'.[13]

In my opinion, the last word on editorial autonomy is not yet out. Journal editors are becoming more vocal and those, with strong public interest, do not hesitate to take on their associations. But what is more interesting (perhaps, troubling as well) is that the line between a scholarly journal editor and a journalist is getting increasingly thinner. Should a scholarly journal limit itself to publishing only scholarly articles, leaving out 'news' and 'comment,' especially of the investigative kind, to newspapers? In fact, editors of major global medical journals such as Lancet, NEJM, JAMA, BMJ, CMAJ et al seem to clearly believe that it is their legitimate duty to publish news also. That widely circulated medical and science journals such as nature and science carry large news sections is a clear pointer that the battle will continue. Featuring such news and comment increases the readership and perhaps circulation, subscription. It also increases the impact factor as people do cite from journals they frequently consult.


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