Respectful Insolence

Last week, there was a bit of a scandal of sorts over an editorial published by the Journal of the American Medical Association (JAMA), which I blogged about in a rather long post. The short version is that a flawed study that tested using Lexapro that neglected to report a rather important comparison that would have changed the conclusion to finding no difference between cognitive therapy and Lexapro in relieving the symptoms of depression after a stroke resulted in a complaint by Dr. Jonathan Leo of Lincoln Memorial University in Harrogate, TN. Dr. Leo wrote a letter pointing inquiring about the “oversight” in the paper, while at the same time inquiring privately of the editors of JAMA about an undisclosed conflict of interest (COI) of the corresponding author that he had discovered with a simple Google search. It turned out that that author had been on the speakers’ bureau of Forest Laboratories, the manufacturers of Lexapro. Taking the lapse in reporting of a result that would have undermined the paper’s conclusion that Lexapro was the most efficacious means of treating post-stroke depression with the undisclosed COI, the whole paper smelled fishy. After five months, having heard nothing, Dr. Leo wrote a letter to BMJ “outing” the undisclosed COI.

The result? In a blatant display of intimidation more suited to the “guys named Guido” that she likes to joke about than to the editor of a major journal, Catherine DeAngelis, editor-in-chief of JAMA came down on Dr. Leo like a ton of bricks, with the assistance of her deputy Phil Fontanarosa. Her call to the dean was along the lines of, “Nice university ya got here; be a shame if something bad happened to it.” Meanwhile, Fontanarosa’s call to Dr. Leo was along the lines of, “You’ll never work in this town again,” as in threatening to ban him from JAMA for life. Now it appears that even the American Medical Association is fed up:

The American Medical Association said it has asked an oversight committee to investigate charges that the top editors of its well-known medical journal threatened a researcher who publicly faulted a study in the publication.

The move by the AMA follows criticism of the actions of top editors at the Journal of the American Medical Association, known as JAMA.

The AMA, in a statement, said JAMA operates with editorial independence. However, the association said it has “formally referred” the matter to a seven-member Journal Oversight Committee, comprised primarily of medical academics, to investigate the actions of JAMA editors. The oversight committee is a standing body that has editorial responsibility for JAMA, including evaluating the performance of the editor in chief.

It’s about time. Thuggish behavior such as that demonstrated by Catherine DeAngelis. coupled with her hypocrisy in bragging about how well JAMA polices its COI policy while leaning on an investigator who expressed legitimate concern about it is unacceptable. Worse, this appears to be a pattern of abusive behavior that risks completely undermining all the good she’s done in terms of pushing for more openness in reporting COIs.

Unfortunately, it’s highly unlikely that any such investigation will lead to the ouster of DeAngelis and Fontanarosa for the following reason:

Dr. DeAngelis declined to take the job as editor until an independent oversight committee was created and a two-thirds vote was required to dismiss her. Now, she said, she feels comfortable, saying that being editor requires someone “tough-minded, thick-skinned and tender-hearted.”

“Whaddatheygonna do? Take my job?” she asks, slipping back into schtick. “Go ahead. Take it.”

Anyone want to make any bets on what the findings of this independent review board will be or whether it will take any action?

Comments

  1. #1 DLC
    March 30, 2009

    If they can document abuses from DeAngelis or her subordinates, or third parties acting on her behalf, then she needs to be dismissed. It’s a blue pencil, not a bully pulpit and not a sword of vengeance.

  2. #2 Bertha
    March 30, 2009

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  3. #3 Uncle Dave
    March 30, 2009

    This reminds me of the line from Shakespeare,

    “The lady doth protest to much”

  4. #4 Chris
    March 30, 2009

    I was confused by Bertha’s comment, and then I realized it is SPAM!

  5. #5 Phoenix Woman
    March 30, 2009

    Let’s see how many more of CDA’s victims step forth. This may be rather interesting, especially as she’s talking like someone with photos of key AMA members with dead goats stashed away in various places.

  6. #6 Prometheus
    March 30, 2009

    Yet another nail in JAMA‘s coffin.

    I was surprised to see that it was still rated so highly – most serious medical researchers I know think of it as a “society journal”.

    Prometheus

  7. #7 Adam Cuerden
    March 30, 2009

    Eh, Orac, you have spam in reply 2.

    But, aye, as someone about to start my career (in Biology) I’d never want to publish in JAMA after this. Why should I seek out a journal known to be unprofessional and abusive to people?

  8. #8 antipodean
    March 30, 2009

    Prometheus

    It’s rated very highly in clinical medicine (usually 2nd or 3rd). People who call themselves medical researchers tend to be basic scientists much of the time. JAMA is much less relevant to them in the same way that Nature Science and Cell are usually irrelevant to the practice of medicine.

  9. #9 alex
    March 30, 2009

    Antipodean:

    It’s more than that. JAMA tends to have a much more political slant to it; the articles are heavily biased towards messages the editors want to get out into the media, i.e. minorities receive inferior care, American health care would be better as single payer, etc. They tend to favor database mining (we trolled 100000 medicare claims…) over prospective clinical trials, which I find unconvincing. NEJM is much better both in being less overtly politicized and in being more clinically relevant. Most of my colleagues try to at least flip through NEJM to find some interesting articles; almost none will admit to doing the same with JAMA.

  10. #10 SLC
    March 31, 2009

    Apropos of this thread, even the MSM has discovered this scandal.

    http://www.washingtonpost.com/wp-dyn/content/article/2009/03/30/AR2009033002765.html?sub=AR

  11. #11 epador
    March 31, 2009

    As a clinician, my vote goes for JAMA not being worth the paper its printed on. It’s political agenda is so transparent its ridiculous. Another reason for me to not join the AMA. Even the ads in the back are useful mainly as a warning: don’t take these jobs, they are desperate enough to advertise in JAMA. I skim through it only to see what the “dark side” is pushing, rather than to find truly elucidating articles.

  12. #12 antipodean
    March 31, 2009

    “A political agenda” as it’s called in the states is not automatically a bad thing for a journal that wants to be a major organ of public health.

    Public health solutions usually require political policy solutions.

    The fact that you think that a message that minority healthcare is worse and that a single payer health system is more efficient are bad examples of this ‘political agenda’ simply illustrates how far away from public health your thinking has become.

    The fact that JAMAs impact factor puts it above all but two of the world’s medical journals means that it is clearly worth the paper it has been printed on. However, I think could all agree that JAMA’s senior leadership has not heaped further glory on the name this month.

  13. #13 Anon*
    April 1, 2009

    anti,

    Agreed but I’d be slacking if I didn’t clarify that impact factor measures impact, not worth. So JAMA could still be worthless, but with a large impact in the publishing community**

    *normally I post with a real pseudonym that makes me identifiable, but I’m at work and have a COI in that I work at ISI (the guys behind impact factors) and I’d rather not get my boss in trouble; I like her.

    **yes yes, there are other measures of impact, but they all tend to converge; all of the alternatives I’m familiar with leave JAMA in the top 3 or 5 among General & Internal Medical journals

  14. #14 alex
    April 1, 2009

    “The fact that you think that a message that minority healthcare is worse and that a single payer health system is more efficient are bad examples of this ‘political agenda’ simply illustrates how far away from public health your thinking has become.”

    No, I don’t think a medical journal should have a political agenda to advance. Whereever you are from this may be crazy talk, but here in the US that is a rather mainstream opinion. If there are papers on minority health care that are relevant to medicine and ought to be accepted, then accept them. My objection is that such papers are disproportionately favored by JAMA due solely to the editors biases.

  15. #15 Carolyn
    April 5, 2009

    NEJM has its own politics too. For instance, they will publish almost any junky analysis on weight and health outcomes that starts out with a large sample size and then has to delete most of the data and fiddle around with the rest to get the politically correct results. For those kind of studies they totally ignore the recommendations for subgroup analyses that their own journal published just a year or two ago.

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