JAMA is having a personality conflict with itself. After publishing 3 very strong articles on the ethics in guidelines development, it has asked those who question ethics violations in JAMA’s publications to keep quiet about them. In JAMA’s view, conflict violation in its journal should be discussed only if and when JAMA decides to discuss them. This sounds like a policy designed to silence whistle blowers at a time when we need more whistles and fewer muzzles. Not surprisingly, the Association of Health Care Journals has come out against JAMA on this one.

The problem with relying on medical journals like JAMA to police failures to disclose conflicts of interest of authors is that  the  journal has a reputational dog in the hunt so to speak—a point which JAMA makes in explaining that disclosures of these conflicts by others “potentially damages our ability to complete a fair and thorough investigation … [and]  potentially damages JAMA’s reputation by the insinuation that we would fail to  (investigate).”  A case in point is Gostin’s recent JAMA article on the IDSA Attorney General investigation into antitrust violations by the Infectious Diseases Society of America (IDSA) in the development of guidelines for the treatment of Lyme disease. Gostin’s article was a polemic piece that assumed two things: first, that the IDSA was “right” on the science of Lyme disease, and second, that antitrust law could not apply to the case.  This is not just “assuming a lot;” it is “assuming everything.”  Predicating an argument on broad stroke assumptions like these without critical examination of them should have no place in responsible journalism.

This article, written by two attorneys, did not refer to the law review articles analyzing the applicability of antitrust law to the case.  Moreover, in law (unlike medicine?!), the failure to cite an opposing viewpoint or case is considered an ethical breach (in a brief before a judge there might actually be sanctions for this type of trying to “run one past” the court).

The Gostin article did not, in short, smack of good journalism.  JAMA knew the issue was hotly debated (I had sent in a letter to the editor on the Sniderman article calling for guidelines reform).  But the journal elected not to run both sides of a hotly contested issue, and it seems highly doubtful that the article would have passed peer review in its published form.

More letters to JAMA, one submitted for publication regarding the Gostin article (summarily rejected), and the other to their editor (not for publication) but pointing out that the Gostin article looked like an IDSA “plant” with no peer review and noting that the article was written by the editor of the health and ethics section of JAMA.  Hence, he selected and published and controlled the editing of his article?  No response again.  Back of the hand.

I do not think the editors of medical journals are “above the fray.”  They are part of the problem.  And, JAMA’s new policy merely underscores the type of high-handedness that is giving medicine a bad name.