Jerome P Kassirer: A Canadian purge

Earlier this week the Canadian Medical Association (CMA) fired the editor in chief of the Canadian Medical Association Journal (CMAJ), citing slipping journal revenue and declining reputation as a cause.

The journal’s oversight committee (JOC)—set up in 2006 to safeguard the journal’s editorial independence against political and economic transgressions—negotiated with both the CMA and the CEO of the corporation that runs the journal, hoping that a compromise could be reached.

But now the JOC exists no more. Simultaneous with the firing of the CMAJ editor, members of the JOC were invited to attend a conference call where they, too, were dismissed.

This act was a shocking breach of faith, in direct contravention of the processes that the CMA had put in place and repeatedly reaffirmed over the years.

In an Orwellian form of logic, the CMA, having dismissed both the editor and the committee, asserted that it was strengthening and reaffirming editorial independence. Given that a new editor will report to the CMA Board or some other entity appointed by the board, it is difficult to imagine how a new editor’s independence could be preserved.

Journal oversight committees are no panacea, and there are circumstances that justify dismissing a journal editor, but the expertise of the JOC volunteers cannot be assailed.

By design, it included a tenured professor of journalism with decades of experience as a professional journalist, a generalist physician who has spent 30 years in rural practice and founded a rural medicine journal, an academic clinical investigator with publishing experience for a national organization, a former dean of a medical school who had also been editor in chief of a cardiology journal and had served on the Pound Committee, and one American (myself).

Medical journals are no longer as profitable as they were when I was an editor of a major journal. Many young physicians no longer subscribe and they get their medical information online. Smartphones are rapidly overtaking many other information sources.

Advertising revenues, which made up most of the profits in the past, have declined and online revenues have not kept up. If the CMAJ is not considered sufficiently profitable, CMA members have a choice, namely to support the journal from membership dues or not. But to expect the journal to publish high quality work, improve its web presence, and continue to comment on the critical issues facing Canadian medicine on a bare bones, depression-scale budget was never a realistic option.

Medical journals, like the scholarly exchanges of academia, are a public good. Whether journals are owned or operated by industry or medical societies, they share a tight bond with academia. Their editors are recruited from academia, their content is derived from the research and opinions of academic physicians, and academic institutions evaluate their faculty based on where their papers are published.

Given these attributes, journal owners are expected to abide by some basic precepts: fairness, openness, and dedication to editorial independence.

CMA members should question their allegiance to an organization that fires its journal editor when expedient, treats its professional advisors with disdain, and bends so readily to corporate and financial influences.

A history of the journal oversight committee

In 2006 I was a member of the journal’s editorial board. At the time I presided over a denunciation of the Canadian Medical Association for creating an organizational structure which, critics argued, threatened its editorial independence and led to the firing of editor John Hoey and deputy editor Anne Marie Todkill.

In an invited article in the Journal of Ethics in 2006, I quoted my letter to the CMA President in which I resigned from the CMAJ editorial board, saying: “You have demonstrated unequivocally that the current leaders of the Canadian Medical Association are incapable of allowing a first-class academically credible journal to flourish, and that the CMA is unfit for ownership.”

In the aftermath of the brouhaha over their firing, Richard Pound, a distinguished Canadian lawyer, was selected to examine the relationship between the CMA, its corporate branch, and its journal editor.

A critical recommendation of the Pound Committee, implemented nearly a decade ago, established a Journal Oversight Committee (JOC) to safeguard the journal’s editorial independence against political and economic transgressions.

The JOC’s mandate was to involve itself in all matters of conflict between the editor and the journal’s owner, not only in issues that involved editorial independence.

In 2014 I joined the JOC.  At my first meeting the CMA announced that the title would become a separate for-profit corporation, and that the editor in chief of the journal would report to the corporation’s CEO.

Given that a new editor will report to the CMA Board or some other entity appointed by the board, it is difficult to imagine how a new editor’s independence could be preserved.

It feels like a recurrent bad dream.

Jerome P Kassirer, distinguished professor, Tufts University School of Medicine, and editor in chief emeritus, New England Journal of Medicine

Competing interests: None declared, apart from Jerome Kassirer’s position on CMAJ‘S JOC, as stated in the blog.