|
|
| Volume 46, Number 3, Fall 1998 |
by Howard J. Lewis
The JAMA story started off as local news: Andrew A. Skolnick—associate editor of the Medical News and Perspective section of the Journal of the American Medical Association, a member of NASW since 1983, and a frequent contributor to ScienceWriters—informed friends and associates that he had suddenly been fired. Within a matter of days, however, the JAMA story went international: Andrew’s editor, George Lundberg, MD was also fired—just as suddenly and much more noisily.
The reverberations from Lundberg’s
ouster were still crashing around as this issue went to press—and
will be addressed in some detail below.
But first attention must be paid to Andy. His role on JAMA was an odd one. He was a dragon-slayer on a journal published by one of the most conservative professional bodies in America. One of his targets, Deepak Chopra, a hugely successful writer of reassuring medical books, was so offended by Skolnick’s reporting on Chopra’s activities with the American Association for Ayurvedic Medicine that the association sued Andy, Editor Lundberg, and the Journal for $194 million plus expenses. And lost.
Skolnick always sought every possible audience for his exposés, sometimes including the readers of SW—e.g., follow-up articles on Chopra, on the scoundrels in the tobacco business, and his failed effort to teach a journalism class in Shanghai why plagiarism was unacceptable. His last expose for JAMA grew out of an investigation, supported by a Rosalynn Carter fellowship in Mental Health Journalism, of medical care in prisons.
Featured in the October 28, 1998 issue of JAMA Medical News & Perspectives were three articles whose headlines indicated Skolnick’s point of view: “Prison Deaths Spotlight How Boards Handle Impaired, Disciplined Physicians,” “Only the Tip of the Iceberg?” and “Critics Denounce Staffing Jails and Prisons With Physicians Convicted of Misconduct.”
Dr. Louis Tripoli, head of Correctional Medical Services, which had been the principal subject of Skolnick’s articles, complained to Editor Lundberg as a “loyal member of the AMA,” but apparently that was not the primary cause of Skolnick’s dismissal. A month before Skolnick’s articles appeared, the St. Louis Post Dispatch published a 12-page section on the same subject, which thanked Skolnick handsomely for his contributions to the research. And, wrote Michael Miner in the November 27, 1998, Chicago Reader, Skolnick received a memo from AMA employee relations informing him that he had been terminated because “You did not inform your supervisor or receive consent to work on [the Post-Dispatch] articles which were on subject matters very similar to that which you were currently working on for JAMA.”
According to Miner’s exegesis, Skolnick argued that he had done the background research as a Carter fellow, that he had helped the Post-Dispatch on leave from JAMA, and that the articles he had done for JAMA were supposed to have been published four days before the P-D special. The timetable was apparently scrambled when JAMA decided to show the articles to their lawyers before publication.
JAMA editors have refused to talk to SW about
the incident, but Skolnick may not have lost all. He recently
notified friends that the P-D had entered the series in
the Pulitzer Prize competition and, in a later bulletin, “On
March 11, as finalists for the Goldsmith Prize for Investigative
Reporting, my colleagues at the St. Louis Post-Dispatch
and I will be attending the award ceremony at Harvard University’s
John F. Kennedy School of Government in Cambridge, Mass., where
the $25,000 Goldsmith Prize will be presented.” Whether the
prize will go to the P-D group was not known as SW
went to press.
Closemouthed as JAMA was about Skolnick’s dismissal,
Lundberg’s firing was as public as the Academy Awards—and
drew almost as much attention.
A chronological account follows, partly to carry out SW’s responsibilities as a journal of record and partly because the contending elements in Lundberg’s dismissal contain some of the elements of a Feydeau farce.
The news broke in major dailies on January 16, attributing the firing to a paper scheduled to appear in the January 20 JAMA. The offending paper reported that in a study of college students, 59 percent did not consider oral sex as “having sex.” Dr. E. Ratcliffe Anderson, executive vice president of AMA, said that Lundberg had been fired because he “has threatened the historic tradition and integrity of the Journal of the American Medical Association by inappropriately and inexcusably interjecting JAMA into a major political debate that has nothing to do with science or medicine.”
At a news conference, Anderson said that “there was an acceleration of the timing” in the publication of the paper. He added: “I don’t question the material in there, but I do very clearly question the judgment in publishing that article in the middle of the congressional proceedings. I happen to believe that Dr. Lundberg was focused on sensationalism here, not science. It grieves me greatly that a magnificent journal that should be about science and medicine has been used to extract political leverage.” He added that, “over time…I have lost confidence and trust in Dr. Lundberg’s ability to preserve that high level of trust and credibility.”
Gina Kolata, in the New York Times, reported that “Lundberg, reached at his home, where he is recovering from a broken elbow, said he could not comment other than to say that Anderson called him at 8:15 a.m. on Friday [Jan. 15] and told him he was no longer editor of the Journal.”
Kolata was also able to track down Dr. Richard Smith, the editor of the British Medical Journal, who emphasized that although he admires and supports Lundberg, “I had almost been waiting for it to happen.” Dr. Marcia Angell, managing editor of the New England Journal of Medicine told Kolata that NEJM would never have published the sex survey paper because “it is trivial—who cares what a bunch of college students say…It also is irrelevant to the Clinton case.”
But, Angell added, Lundberg’s decision to publish “is not a reason to fire an editor who’s been there 17 years and by almost anyone’s estimation has put a small society that no one took seriously on the map.”
David Brown, in the Washington Post, emphasized political aspects of the event, recalling that the “firing came slightly more than a year after AMA administrators ignited controversy by signing a deal with the Sunbeam Corp. that for the first time would have allowed the association’s logo to be placed on commercial products. The deal was swiftly rescinded, but led to a round of high-level firings within the organization and a lawsuit by Sunbeam that only recently was resolved.”
Brown also tracked down Dr. Raymond Scalettar, a Washington physician, who last summer mounted a strong insurgent campaign to try, unsuccessfully, to defeat the heir apparent to the association’s presidency. “If the AMA shot itself in the foot over Sunbeam, they may be committing hara-kiri over George Lundberg,” Scalettar told him. Brown also reminded his readers that Lundberg “angered many in the AMA when he asserted in an interview on CBS’s 60 Minutes that one reason for the low rate of autopsy in the United States is that ‘some doctors, some medical staffs, are afraid to find out what happened in people who died.’”
Judy Mann, a Post columnist, had no problem speaking her mind on the issue. Of the AMA’s executive officer, she said, “It’s a good thing Anderson isn’t editing anything: He wouldn’t know a good story if it bit him like a rat.”
Scalettar also had comment for Bruce Japsen of the Chicago Tribune: “This has now been politicized into a Republican-Democrat thing. The AMA seems to have placated the Republicans to get more Medicare reimbursement, and now they have placated the Republicans and fired George Lundberg.”
It took only a week for Lundberg’s counterparts on international medical journals to add their voices. Thundered the British Medical Journal: “In sacking its editor the association is reverting to type. Editors used to be regularly browbeaten, sacked, or edged out for upsetting the deeply conservative membership of the association, and as a result the Journal had little international respect. Lundberg turned a journal that was an embarrassment into a respected major journal. Yet while JAMA has flourished the AMA has withered. Its membership has fallen steadily to 38 percent of American doctors, and it is perceived as a reactionary organization concerned only with self interest. (The BMA, in contrast, has over 80 percent of British doctors in membership and is seen as more than a doctors’ trade union.)”
Larry Tye, of the Boston Globe, writing on January 25, found other international journals ready to join the outcry. “[The AMA move] is a demonstrative example of bare-faced and open censorship,” said Dr. Saveli Bashinski, editor of Russia’s International Journal of Medical Practice, and the AMA’s argument that Lundberg had improperly embroiled the association in impeachment politics, reminded Bashinski of “our recent totalitarian past.”
Tye also quoted Dr. Richard Horton, editor of the influential British journal Lancet, who said in an editorial that the Lundberg firing had “brought the AMA to what most observers thought was impossible—a new and sinking low in its history…There is only one way to begin the repair of the AMA’s most important asset. Anderson must now go, voluntarily or by the decisive action of the association’s Board of Trustees.”
Early in February, the AMA was moved to react. An embargoed release made public an editorial signed by JAMA editors, editors of the AMA Archives Journals, and members of the JAMA editorial board. It appeared in the February 3 issue of JAMA. Acknowledging Anderson’s complaint, the editors declared their admiration for Lundberg:
“Under his editorship, JAMA has become a world-class scientific publication. Dr. Lundberg has been an international leader in the development of a scientifically and ethically sound peer-review process. He has also bridged the gap between clinical researchers and health services researchers by focusing on issues of public policy that directly or indirectly touch the health care and health of the American people. His efforts developed a respected, successful medical journal and family of Archives journals that publish important, high-quality articles that advance medical science, improve patient care, protect public health, and inform health policy.
“While we acknowledge Dr. Anderson’s administrative authority to act as he did, we, the Editors of JAMA and AMA Archives journals and members of the JAMA Editorial Board, strongly disagree with the decision to summarily dismiss Dr. Lundberg. Editorial independence is the lifeblood of the Journal. The editorial independence that JAMA has enjoyed has been the essential foundation on which the publication built its current prestige and, in the process, lent so much prestige to the AMA in the biomedical and health-services research community. For the world-class status of JAMA to continue, its editorial independence must be preserved by the AMA, even if some of the AMA’s leadership or its members may disagree about the scientific merit or propriety of particular articles, as inevitably they will, from time to time. Dr. Anderson stated that ‘JAMA’s hard-earned reputation is based on its editorial independence and integrity, and we intend to keep it that way.’ We wholeheartedly agree and endorse this pledge. We, the undersigned, reaffirm and recommit ourselves to upholding the values, goals, and objectives of the Journal. We hope that all who value what Dr. Lundberg, many of us, and so many others have built will stand by the Journal and support its foundation of editorial independence as key to its mission of promoting the science and art of medicine and the betterment of the public health.”
But he was still fired.
Then the top management of AMA declared its admiration for Lundberg, joining with him February 3 in a remarkable joint statement declaring that “The renown and prestige that JAMA now enjoys are the results of the devoted service and tireless efforts of Dr. Lundberg and the Journal’s highly-qualified staff, editorial board, thousands of outstanding medical and scientific contributors, peer reviewers and readers… The AMA wishes Dr. Lundberg well in his future endeavors and expresses sincere appreciation and thanks for his many contributions to JAMA and the medical profession.”
But he was still fired.
The Associated Press, in its account, added, “The Association said it would not elaborate. Dr. Lundberg and his lawyers did not return calls.”
The editor of the New England Journal of Medicine, however, was more than willing to elaborate. In the February 11 issue, Dr. Jerome Kassirer declared, “I believe that medical editors have an obligation to publish not only articles that are well reasoned, informative, and carefully reviewed, but also ones that are sufficiently timely to contribute to the development of public policy. Expediting a review and advancing the date of publication of a study or opinion piece is often justified. Firing an editor for doing so is an irrational decision and an ominous precedent.”
In Physicians Weekly, Mark Bloom and Howard Wolinsky wrote: “Several editors felt Dr. Lundberg’s personality—some say pompous, others irritating—undoubtedly contributed to his undoing. It wasn’t always clear, they said, when he was promoting JAMA and when he was being self-aggrandizing.”
“Some journal editors,” they added, “including Dr. Richard Horton of Lancet, called for Dr. Anderson’s scalp. Dr. Anderson has a history of firing precipitously—three department chairs at the University of Missouri at Kansas City in 1997, an act that led to his own replacement as dean.”
Dr. Lundberg broke his press silence February 24 with an announcement that he had accepted the position as editor in chief of Medscape, www.medscape.com, which calls itself “the leading medical site on the Web for physicians, healthcare professionals, and consumers.”
“The Web is revolutionizing access to healthcare information, and Medscape has set the standard of excellence in the medium,” says Dr. Lundberg. “I am joining a team that is as passionate and dedicated as I am about improving healthcare by providing the highest quality information possible. Medscape’s authoritative Web site and its talented team of editors and executives were the critical factors in my decision.”