Another defining issue for the AMA; What does editorial
independence mean?
By Tim Jones, Tribune Media Writer
Copyright 1999 Chicago Tribune
January 17, 1999
People who know George
Lundberg say the end didn't have to come this way. Surely, they
say, in a profession
where soothing bedside manner is valued, there could have been a
quieter, less
conspicuous way to shove the 65-year-old doctor out the door.
But in dealing with the well-respected editor of the
Journal of the American Medical Association, the AMA
performed a fast and public amputation. And, in the process of
ridding itself
of
Lundberg over an editorial dispute Friday, the nation's biggest
medical lobby group
called into question its own stated commitment to JAMA's editorial
independence.
"It's bothersome," Dr. Jerome Kassirer,
editor-in-chief of the Boston-based New England Journal
of Medicine, said of
Lundberg's sudden firing.
"I know they (AMA) say this has nothing to do with politics,
but it will be
perceived widely as having something to do with that."
Lundberg's undoing was this week's publication in
JAMA of a research article about college students' sexual
attitudes, attitudes
that seem to coincide with President Clinton's definition of sexual
relations.
The publication of the article also coincides with the Senate's
impeachment
trial of Clinton.
The timing
"threatened the historic tradition and integrity" of the
journal, said the AMA's executive vice president,
Dr. E. Ratcliffe Anderson.
Editorial independence, the stock in which many publicly
held and privately
owned publications claim to trade, has always been easier said than
done. And
the sacking of George D.
Lundberg MD, editor of JAMA since 1982 and also editor-in-chief of
Scientific
Information and Multimedia
for the AMA, is a case in point of just how tenuous the claim of
publishing
independence can be, especially with publishing arms of powerful
lobbying
groups.
"JAMA has certainly been one of the two most highly
respected medical journals
for more than a decade, and it's sad to see
a public act like this," said Ellis Rubenstein, editor of
Science magazine, a monthly publication of
the American Association for the Advancement of Science.
Lundberg was out not because of what he published, but
because he chose to publish
something that proved to be timely, potentially influential in the
political
arena and--apparently--in
conflict with the political leanings of the AMA's governing
members.
"Sounds like he got a little too relevant,"
observed Mike Hoyt, senior editor at Columbia Journalism Review.
"I don't quite understand the mission of a magazine that
doesn't try to be
relevant. Medicine and science often intersect with
politics. . .and if it's a solid study that sheds light on a
current situation,
(publishing) it sounds like a reasonable decision."
Sound journalism, however, doesn't always sell when it
conflicts with the
economic, personal or political interests of publishers,
associations or
advertisers. Popular magazines are under
continuing pressure from advertisers to have stories cleared by
advertisers
before publication. At trade publications, which by their very
nature represent
a particular interest, the presence of the owner is unavoidable.
Gary Hengster, editor and publisher of the ABA Journal, the
magazine of the
American Bar Association, said he
"wrestles with" the magazine balancing
act of being in tune with the association and maintaining
journalistic
integrity. The ABA is the nation's largest lawyer lobby, and the
ABA Journal is
the group's flagship magazine, much like JAMA is to the AMA.
Independent Counsel and Clinton nemesis Kenneth Starr
served on the magazine's
board of editors until last
August, which Hengster said caused some uneasiness as editors
weighed the
handling of Whitewater investigation stories and
conflict-of-interest
allegations against Starr stemming from the Paula Jones civil suit.
Hengster
said the magazine handled the issues fairly.
"I can't think of any story where we purposely put
it in to try to affect a result on the behalf of the ABA,"
Hengster said.
"But the difference between an association publication
and a privately owned
publication is only a matter of degree and who is putting the
pressure on," Hengster said.
"The private, commercial, independent press
isn't pure. . . .If you (anger) the owner, you're gone, whether
it's a single
owner or a collective owner."
The American Medical Association is hardly a wallflower
when it comes to
exerting political pressure. It describes itself as possessing a
strong
advocacy agenda, and it has shown no reluctance to
slug it out in the political demolition derby of health-care
reform, gun
control and tobacco regulation. Last month the AMA urged the
Department of
Justice to block Aetna's $1 billion acquisition of Prudential
Insurance Co.
And campaign finance records show the American Medical
Association
Political Action Committee has given more than $14 million to House
and Senate
candidates since 1989, favoring Republicans over Democrats by
nearly $2 to $1.
Arnold Relman, editor-in-chief emeritus at the New England
Journal of Medicine,
said
Lundberg erred by
publishing the report because it is based on 1991 data.
"It was a bad mistake," Relman said.
"But if they (AMA) truly believe what they say, that
the journal has a
hard-earned reputation based on independence and integrity, what
they've just
done is a very peculiar and odd way of demonstrating that
fact. By firing the editor, isn't this a very political way of
conveying just
the opposite message?" Relman asked.
"It's clear that the AMA is going through some
wrenching changes and will be
making more," said Science's Rubenstein. While Rubenstein said
it is critically important
that editorial
independence be preserved, Friday's firing of
Lundberg
"doesn't mean that they're incorrect in this particular
situation."
"Obviously, if the editor-in-chief chooses to print
bad science or is incapable
of helping the financial goals of the organization or hurts the
magazine's
financial underpinnings, there has to be someone in the institution
accountable. One would think,
though, there would have been easier ways to resolve this than a
very public
firing," Rubenstein said.
June Machover Reinisch, a co-author of the JAMA article and
former director of
the Kinsey Institute for Research in Sex, Gender and Reproduction,
said the sex
research should have been published last year because it would have
been timely
in the political debate. Reinisch, in a telephone interview, said
she and her
co-author, Stephanie A. Sanders, contacted JAMA in November with an
article on
its findings.
"We wanted to get it published in a major
journal," said Reinisch, who added she is
"shocked"
by
Lundberg's firing.
"This paper is not on anybody's side. It's
science," she said.
But there is an important distinction between having rights
and exercising
them, Hengster said, and that may have been at work in the
Lundberg situation.
"Even if you are of the mind that you have a right to do
things as an editor, it
doesn't
necessarily mean you have to do it," Hengster said.
"Editorial judgment is highly subjective."
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