When the Wall Street Journal called attention to a claim that the Journal of the American Medical Association called a whistle-blower a “nobody” and a “nothing,” a claim JAMA denied, I didn’t know what to think. I was inclined to give JAMA the benefit of the doubt. Whatever dealings I’ve had (and they are few) with JAMA’s editor in chief, Dr. Catherine DeAngelis, she’s been pleasant and has a reputation for being a tough and intelligent editor. It sounded as if someone had gotten a little irritated and maybe said things in a way that wasn’t quite appropriate, but these things happen. But now what was just dumbass is being elevated to the level of policy.
First some background.
JAMA published a paper on Lexapro, an anti-depressant a year ago. Papers evaluating drugs have been a constant source of conflict of interest problems, since the studies are often bankrolled by the drug company. Jonathan Leo, a neuroanatomy professor at Lincoln Memorial University (very small; I never heard of it) wasn’t happy with it. For one thing, he said, it didn’t acknowledge that behavioral therapy worked as well as the drug. For another, the senior author hadn’t disclosed he had a relationship (of the money kind) with the maker of Lexpro, Forrester Labs. And he complained via a letter on the website of the BMJ (aka, the British Medical Journal). What happened next is contested. Here’s the Wall Street Journal’s account:
Leo says he received an angry call from JAMA executive deputy editor Phil Fontanarosa last week, shortly after Leo?s article was published on the BMJ Web site. ?He said, ?Who do you think you are,? ? says Leo. ?He then said, ?You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.? Fontanarosa referred a call for comment to a JAMA spokeswoman, who said Leo?s retelling of the conversation was ?inaccurate.? (WSJ, MARCH 13, 2009; no link)
Ewww. There’s more. The Editor in Chief, DeAngelis then called Leo’s superiors to pressure him to retract the BMJ piece. So Leo called DeAngelis directly to find out what it was she was so concerned about. He says she didn’t make any specific complaints, only acted “very upset.” Maybe he was exaggerating. But the WSJ also called DeAngelis and reported this:
In a conversation with us, DeAngelis was none too happy to be questioned about the dust-up with Leo.
?This guy is a nobody and a nothing? she said of Leo. ?He is trying to make a name for himself. Please call me about something important.? She added that Leo ?should be spending time with his students instead of doing this.?
When asked if she called his superiors and what she said to them, DeAngelis said ?it is none of your business.? She added that she did not threaten Leo or anyone at the school.
Leo says he went to JAMA 5 months earlier with his concerns but nothing happened until the week after his disclosure at BMJ, when JAMA published a letter from the author fessing up to the conflict but denying the sponsors affected the work in any way. It appears the disclosure letter published by JAMA and Leo’s submission to BMJ “crossed in the mail” so that JAMA was indeed taking the appropriate action, even without Leo’s BMJ letter. So an unfortunate combination of circumstances combined with some bad personal interactions seemed to produce this unhappy outcome. Too bad for everyone concerned, but JAMA can take it. Or so most of us thought.
Instead of letting what sounds like some bad behavior just die a quiet death, the two JAMA editors (Editor in Chief DeAngelis and Deputy Fontarosa) decided to make their bad behavior journal policy:
The Journal of the American Medical Association, in an editorial published on Friday, has warned that anyone raising a conflict-of-interest complaint about one of its authors should do so in private to the editors, without telling any outsiders.
In its editorial, JAMA affirmed the need to guard against conflicts of interest. Yet JAMA said that, in the future, anyone suspecting a conflict involving one of its authors should tell JAMA and ?should not reveal this information to third parties or the media while the investigation is under way.? JAMA said it could be trusted to handle the matter fairly. (Chronicle for Higher Education)
The Editorial seems to confirm Leo’s allegation that he was told that henceforth he shouldn’t expect to publish in JAMA, although a decidedly more benign version is given:
Leo also was informed that, if his actions represented his apparent lack of confidence in and regard for JAMA, he certainly should not plan to submit future manuscripts or letters for publication. (Editorial, JAMA)
Ewww, a third time.
The record is muddy, so we won’t pass judgment on what happened here. But JAMA’s policy response is stupid and smacks of arrogance. JAMA’s Editor was upset that Leo contacted the press instead of letting the journal pursue an investigation on its own. It’s a point, but in the circumstances a weak one. The value of the press is to shine a light on a situation that has been kept in the dark, pernicious conflicts of interest in medical science. JAMA may say they have mended their ways and we should just trust them, but trust has to be earned, and the track record of major journals like JAMA, the New England Journal, and others doesn’t inspire it and the trust that was lost has yet to be earned back. That’s too bad, but JAMA will have to live with the consequences.
JAMA can try to make this poorly managed brouhaha a matter of principle, but the fact is that it is just plain, well . . . ewww.