Insights (Essays)

Insights (Essays) March 2009

AMA, BMJ, and the Innovator's Transparency Rule

Neil Seeman


As of the time of writing, we do not know all of the facts in the current controversy surrounding the Journal of the American Medical Association (JAMA). Reportedly, JAMA editors threatened a researcher, Jonathan Leo, who had criticized the author of a 2008 JAMA research paper. Dr. Leo's rebuke appeared in an online letter in the British Medical Journal (BMJ).

The American Medical Association has asked an oversight committee to investigate the events. Dr. Leo, a neuro-anatomy professor at Lincoln Memorial University, alleges that senior JAMA editors threatened him and his dean following his publication of the BMJ letter. Dr. Leo's BMJ letter criticized how results were reported in the 2008 JAMA study that looked at the use of Lexapro, an anti-depressant medication, in stroke victims. Dr. Leo claimed that JAMA did not appropriately disclose the author of the JAMA study's financial relationship with Forest Laboratories Inc., the maker of Lexapro. Forest disclosed that it had indeed paid the author for speeches, but maintained that his Lexapro research was independent.

According to Dr. Leo, based in Harrogate, Tennessee, JAMA editors insisted that Leo retract the BMJ letter. Further, in an explosive allegation, he reportedly claims JAMA's executive deputy editor, Phil Fontanarosa, told him, "You are banned from JAMA for life. You will be sorry." Dr. Fontanarosa has disputed this version of events. Ray Stowers, the dean of Dr. Leo's faculty, claims JAMA editor-in-chief Catherine DeAngelis told Stowers during a telephone conversation that she would "ruin the reputation of our medical school" unless Stowers forced Leo to retract the BMJ letter and stop speaking to the media. Dr. DeAngelis has denied this.

Further, in an online editorial on the JAMA Web site, Drs. DeAngelis and Fontanarosa accused Dr. Leo of a "serious ethical breach of confidentiality" by wading into alleged problems with the JAMA study whilst the medical journal was investigating the controversy. The JAMA editors said that, in future, anyone complaining of an author failing to report a conflict of interest would "be specifically informed that he/she should not reveal this information to third parties or the media while an investigation is under way." Here is Dr. Leo's response to the JAMA editorial.

Is the JAMA policy even possible to enforce? Does it serve the interests of innovation and the scientific process? Leaving aside the potential worries about free expression (both for the critic making the allegation, and for the journal publishing it), keep in mind that in the age of health 2.0, most critics of scientific research are not academics. They are patients and their families. In the days since this story emerged, my quick search on Google and online health blogs suggests that at least several dozen bloggers have echoed Dr. Leo's concerns about conflict-of-interest in the original JAMA article. It can get tricky to try to discipline every research critic on the Web.

The time when editors knew best is passé. Whether or not the army of reader/critics on the Web is right or wrong, they cannot, and will not, be silenced. Transparency governs.

Ignore criticism at your peril

The JAMA controversy reminds me of another industry that failed to heed the transparency rule. When I worked in the newspaper business in the pre-Internet era, we had space for roughly 10 letters, yet 10-15 times that number flowed in by fax or letter every day.

Today, print newspapers are suffering heavy revenue declines (and in some cities, have disappeared altogether) because of not taking criticism and openness seriously. The venerable Rocky Mountain News is defunct. The Tribune Co., owner of the Los Angeles Times and the Chicago Tribune, has filed for bankruptcy. The Seattle Post-Intelligencer is now online only. And just two weeks ago, the San Diego Union-Tribune was sold to a private-equity firm.

Notably, mainstream newspapers such as the Wall Street Journal that were among the first to embrace aggressive reader criticism via blogs, early amid the ascendance of the Internet, are the only ones today that enjoy sustained readership and continued influence. For anyone in the information business, the new mantra is no longer "content is king". It's "transparency rules."

The demise of mainstream newspapers should be a lesson to the titans of research and innovation. Heed the transparency rule: embrace openness or wither on the knowledge vine.

About the Author(s)

Neil Seeman, a Longwoods essayist and Director and Primary Investigator of the Health Strategy Innovation Cell, based at the University of Toronto's Massey College. He is also an adjunct professor of health services management at Ryerson University and writes the "Second Opinion" health innovation column for the National Post.


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