The Journal of the American Medical Association Does a Fine Impression of Vito Corleone (or is it Fredo?)

by Henry on March 23, 2009

Via Kathy G., this WSJ article has to be read to be believed. Since most of it languishes behind teh paywall, I provide the selected highlights below.

The Journal of the American Medical Association, one of the world’s most influential medical journals … , says it is instituting a new policy for how it handles complaints about study authors who fail to disclose they have received payments from drug companies or others that pose a conflict: It will instruct anyone filing a complaint to remain silent about the allegation until the journal investigates the charge. … comes after JAMA was criticized for taking five months to acknowledge [a previous lapse] … AMA editors, in a rare online editorial posted Friday, criticized the actions of a Tennessee researcher, Jonathan Leo, who first wrote about the disclosure problem in another medical journal. Dr. Leo, a professor of neuro-anatomy at Lincoln Memorial University in Harrogate, Tenn., alerted JAMA to the disclosure problem last October. …

The JAMA editors said Dr. Leo was guilty of a “serious breach of confidentiality” by writing about the problems with the JAMA study while the medical journal was still investigating the matter. After Dr. Leo wrote the letter to BMJ alleging flaws in the JAMA stroke study, JAMA editors contacted both Dr. Leo and the dean of his medical school, seeking a retraction. In an interview with The Wall Street Journal, JAMA editor-in-chief Catherine DeAngelis called Dr. Leo “a nothing and a nobody.” In the editorial Friday, Dr. DeAngelis and co-author Phil Fontanarosa, JAMA’s executive deputy editor, said her comment about Dr. Leo “was erroneously reported” and that Dr. Leo “certainly is somebody doing something very important.” The dean of the medical school where Dr. Leo teaches said Dr. Catherine threatened in a telephone conversation earlier this month that she would “ruin the reputation of our medical school” if he did not force Dr. Leo to retract the BMJ letter and stop talking to the media.

In an interview Friday, Dean Ray Stowers said Dr. DeAngelis “flat out” threatened him and attempted to bully him during the conversation. The telephone call was followed by an email exchange. In a March 11 email, Dr. DeAngelis wrote to Dr. Stowers: “As I’ve already expressed to you, I don’t want to make trouble for your school, but I cannot allow Jonathan Leo to continue to seek media coverage without my responding. I trust you have already or soon will speak with him and alert me to what I should expect.” Dr. Stowers responded the next day by saying he couldn’t find any fault in Dr. Leo’s actions and pressed JAMA editors for more specifics on what they believed was wrong with Dr. Leo’s writing or actions. “I think this can be worked out without your continued threats to our institution which are not appreciated and I believe to be below the dignity of both you and JAMA,” he wrote. Dr. Stowers says he has not heard from JAMA since sending that email. Dr. Godlee said BMJ would not retract Dr. Leo’s letter because “there are no factual inaccuracies.”

Dr. DeAngelis, through a spokeswoman, denied threatening the dean. Dr. Leo said he received an angry call from Dr. Fontanarosa after his BMJ letter was published. “He said, ‘Who do you think you are,’ ” Dr. Leo said. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.” Dr. Fontanarosa said Dr. Leo’s retelling of the conversation is “inaccurate.”

{ 32 comments }

1

John Emerson 03.23.09 at 8:27 pm

Biz is biz.

2

Trey 03.23.09 at 8:43 pm

Perhaps apropos of this kind of revelation is the most recent episode of EconTalk, in which two GMU economists rack their brains trying to figure out a reason for the FDA’s existence.

3

ingrid robeyns 03.23.09 at 9:01 pm

thanks for getting this from behind the paywall. Scary, Scary stuff. And I keep being (positively, of course!) amazed at these brave people who speak up against fraud, nepotism, corruption, discrimination and similar problems, knowing that the chances are real that they will be bullied or otherwise personally harmed in some subtle or not so subtle way.

4

Sam Hankins 03.23.09 at 9:27 pm

5

Sam Hankins 03.23.09 at 9:30 pm

Apologies. The url I sent doesn’t pull up the entire article. However, the first url that comes up after googling “Catherine DeAngelis” provides the entire text of the WSJ article.

6

James Wimberley 03.23.09 at 9:43 pm

Is the unexpected spine shown by the BMJ a rare occasion for justified British flag-waving, Britons never never never shall be slaves of Big Pharma?

7

Devo 03.23.09 at 9:46 pm

“Biz is biz.”

I dunno … JAMA is supposed to be the American equivalent of The Lancet. It’s a corollary of the crisis in confidence America has toward the media generally, in that we *have* to hold such journals, along with other sources of news, to a higher standard. Without that, they can’t speak with authority (and do things like save lives by informing doctors and the public). This news is very disappointing.

8

Josh K. 03.23.09 at 10:42 pm

The JAMA editorial by DeAngelis and Fontanarosa about this incident (“Conflicts Over Conflicts of Interest”) basically admits that they told Leo that he shouldn’t expect to publish in JAMA:

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.

9

Steve LaBonne 03.23.09 at 10:47 pm

Vito Corleone? The Mafia is a bunch of amateurs compared to the health care / industrial complex.

10

regulararmyfoola 03.23.09 at 11:02 pm

The first rule of regulating anyone or anything is YOU DO NOT LET ANYONE regulate themselves. It does not matter if they are teachers, lawyers, dentist, chemical workers, or doctors. They cannot regulate themselves. Period and forever.

11

lemuel pitkin 03.24.09 at 3:32 am

Could this WSJ article perhaps be considered the kind of thing that daily newspapers provide that, pace John Q., may be hard for new media to replace?

12

Matt Brown 03.24.09 at 5:28 am

The state of corporate corruption in medical research is absolutely a disaster, and it’s getting a lot of attention in philosophy of science these days. James Robert Brown has written several interesting articles about this lately. Here are some examples (may be behind pay-wall for some):

http://www.journals.uchicago.edu/doi/abs/10.1086/594521

http://www.sciencemag.org/cgi/content/summary/290/5497/1701

(also, I think post 8 may have broken the code on the page. It’s quotation-mark city!)

13

John Quiggin 03.24.09 at 5:29 am

Reposting from the other thread:

Lemuel, that thought occurred to me also, and I don’t have an immediate answer either way. I’m guessing that the story originated with those that JAMA tried to gag. Suppose they had gone instead to, say, Chris Mooney or Inside Higher Education. Would things have been much different?

14

John Quiggin 03.24.09 at 5:32 am

Quote-mixup fixed!

15

Zamfir 03.24.09 at 8:12 am

Is it normal in English to refer to people as Dr. Catherine, or were they confused after a lot of Dr. Leos?

16

mpowell 03.24.09 at 9:19 am

11: Why would a local newspaper be better at this sort of thing? My understanding of events is that Dr Leo was concerned about the study and wrote to the BMJ describing his concerns. It seems to me that the web will always provide a better forum for individuals wishing to highlight some concern they have (circulation will still be an issue of course, but the gatekeepers are still more distributed than with the corporate media). The strength local newspapers bring is the employment of people whose job it is to do the original research themselves. But in this case, that was Dr Leo, and I’m pretty sure that newspapers don’t employ anyone really capable of this type of original research (eg: questioning a medical study)

17

Bill Gardner 03.24.09 at 10:14 am

De Angelis is not a shill for the pharmaceutical or device industry. She has been one of the people trying to promote stricter standards concerning conflicts of interest (here is an example outside JAMA‘s paywall). I do not think she is trying to protect Forest Labs or lexapro. JAMA, NEJM, and BMJ have for some years been leaders in fighting this kind of medical industrial corruption (see, for example, the series of International Conferences on Peer Review and Biomedical Publication that they have organized).

What appears to have happened is that she imagined that her journal could investigate itself (as regulararmyfoola notes @ 10), and keep the investigation in house, when one of its articles was questioned. That is wrong and she seems to have behaved in an arrogant way.

18

mpowell 03.24.09 at 11:32 am

17: I’m sorry, if you’re willing to blacklist people because they call you out for failing to uphold your ethical duties regarding reporting conflicts of interest, you’re not one of the good guys. That’s more than just arrogance. She may not be protecting Forest Labs, but she is trying to protect the parochial interests of JAMA, the maintenance of which makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things. It’s nice that she’s trying to cleanup in house, but maintaining the perogative of a leading publication to blacklist it’s critics has the same kind of perverting effect on the literature.

19

Bill Gardner 03.24.09 at 12:13 pm

mpowell @18:
My point concerned De Angelis’s ( & Fontarosa’s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That’s what I had in mind when I wrote “that is wrong”, but I could have made it clearer by spelling it out.

I think we disagree only on details. I think De Angelis is wrong here, but that on the issue of medical-industrial corruption, she and the JAMA editorial board have historically been on the right side. Also, I’m skeptical whether “the maintenance of [the parochial interests of JAMA] makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things”. Phama isn’t that subtle. It’s like what Susanna says to the Contessa in Figaro: “He [the Count] doesn’t flatter women of my station. He offered to pay.”

20

mpowell 03.24.09 at 1:07 pm

19: Okay, I don’t think I really have any disagreement with you regarding the issue at hand in that case. I would like to point out that JAMA’s proposed course of action, forbidding contributors who point out potential sources of conflict from speaking publicly on them until JAMA has conducted their own investigation (with no timeline attached), does privilege the parochial interests of JAMA above those of rooting out corruption in medical research publications.

21

eudoxis 03.24.09 at 1:43 pm

One has to wonder if patients were harmed because of this published study. Doctors reading JAMA would notice that the original authors, Robinson et al., concluded that problem-solving therapy and antidepressants were both effective at reducing depression in stroke patients. In a letter to the editor by Lacasses and Leo, the question was raised if there was a statistically significant difference between the two therapies, to which Robinson replied that there wasn’t.
Robinson took his story on the road, and a flurry of media articles appeared, for example:

http://www.usatoday.com/news/health/2008-05-27-stroke-depression_N.htm

There is possibility for harm. Leo and Lacasses were right to raise the issue in BMJ after they were rebuffed by JAMA. Journals are all to happy to point out failures of rivals. Maybe, JAMA is concerned that any osteopath or social worker could destroy a medical researcher’s career with letters to rival journals and ruin JAMA’s reputation in the process. The authors of the original study have publicly apologized for failure to disclose conflict of interest and have confirmed that drugs are not a superior treatment. But the strong arming by JAMA continues. Is there more to this story? Note that DeAngelis is a psychiatrist.

22

Barry 03.24.09 at 2:15 pm

Bill Gardner 03.24.09 at 12:13 pm

“My point concerned De Angelis’s ( & Fontarosa’s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That’s what I had in mind when I wrote “that is wrong”, but I could have made it clearer by spelling it out.”

De Angelis might have been attempting to suppress the publicization of wrongdoing for purely egotistical reasons; however (a) that in itself is reason for her to ‘seek career opportunities elsewhere’; (b) after somebody successfully asserts that sort of control, it’s childsplay for the next editor to continue that policy for money.

23

Barry 03.24.09 at 2:18 pm

James Wimberley 03.23.09 at 9:43 pm

“Is the unexpected spine shown by the BMJ a rare occasion for justified British flag-waving, Britons never never never shall be slaves of Big Pharma?”

I don’t mean to be harsh, but if *I* were a Briton, I’d still feel that we were slaves to the USA (e.g., policies allowing British citizens to be handed over to the CIA upon request). I’d also feel that it’d be reasonable to take Mr. Blair on an experiential tour through the old, unsavory, highly public forms of the British criminal justice system for that.

24

self exile 03.24.09 at 2:34 pm

JAMA has an interesting history in itself. For the first 50 years it was run by and for the profit of a shakedown artist. Forbes Magazine was run the same way under the founder. Rolling Stone did the same thing when they were in San Francisco.

I think that the New England Journal of Medicine is quite a bit better.

25

Bill Gardner 03.24.09 at 2:58 pm

eudoxis @ 21:
It is possible that patients were hurt, even though SSRIs are not super-dangerous drugs. Without knowing the details of this case, I do think that it is important to protect the accused in ethics investigations until their cases have been investigated. If you believe Kevles, Imanishi-Kari and Baltimore were falsely accused of data fraud in their famous case. I don’t have a proposal for how best to balance the need to protect the public and the accused.

By the way, DeAngelis is a pediatrician.

26

Rich B. 03.24.09 at 5:49 pm

Technical note regarding the WSJ Paywall:

It only exists on the WSJ page, or in direct links to the article. It does not exist on Google.

They want their articles indexes on Google News for advertising revenues. Go to (almost) any article you want to read on WSJ, and type the headline into Google News, and you will get the full article, without a paywall.

27

Barry 03.24.09 at 7:24 pm

Thanks, Rich! Sweeeeet.

28

Ray Davis 03.25.09 at 1:32 pm

Matt Brown’s link to James Robert Brown’s Philosophy of Science piece sheds light on the pragmatic ethics of Dr. DeAngelis:

Leveling sanctions against an author who fails to disclose financial interests by banning publication of his or her articles for some time period would only encourage that author to send his or her articles to another journal; it cleans our house by messing others. So what about all editors, or at least a group, such as the International Committee of Medical Journal Editors, agreeing to share the information and jointly to ban the offending authors? Those who suggest this approach have not considered the risk of antitrust suits.

Embarrassing external whistleblowers can be blacklisted, but ethically dubious research is Too Big to Fail.

29

James Wimberley 03.25.09 at 1:48 pm

Barry’s reply to me in #23: I did say a rare occasion for flagwaving. eudoxis (#21) is probably more to the point in suggesting that “journals are all too happy to point out failures of rivals”.

30

Mike 03.25.09 at 6:30 pm

Sounds more like Moe Greene than any of the Corleones. And we all know what happened to Moe.

31

Barry 03.25.09 at 6:45 pm

James, I didn’t mean to poke fun at the U.K.; rather, I find the failure of democracy there to be an unfortunate and dismaying parallel to the failure here in the USA.

32

Danielle Day 03.25.09 at 7:28 pm

My dad was a physician. He didn’t have a lot of respect for JAMA. His main take, though, was “Jesus. Who has time to write an article anyway?!”

Comments on this entry are closed.