A Medical Journal's Problematic Rule on Public Disclosure of Complaints

Tuesday, March 31, 2009

THE EDITORS of the Journal of the American Medical Association (JAMA) surely appreciated that Jonathan Leo, a professor at Lincoln Memorial University, made them aware of an undisclosed conflict involving a pharmaceutical company and the author of a study published in the journal. The JAMA editors did not, however, appreciate that Mr. Leo sent a copy of an e-mail to them to a reporter at the New York Times. Nor did they like his airing of his allegation in an article on the Web site of the British Medical Journal (BMJ) -- almost five months after Mr. Leo sent his initial inquiry to JAMA. As a result, the esteemed medical journal has instituted a new set of complaint compliance rules that leave us wondering whether it cares more about its reputation than the integrity of its articles.

The controversy surrounds a May 2008 study on the effects of an antidepressant drug on stroke patients by Robert Robinson and colleagues. JAMA requires disclosure of any financial relationships and other potential conflicts of interest by its authors. But Mr. Leo discovered that Mr. Robinson failed to disclose that he was on the speakers bureau of the company that made the drug that was the subject of his study. On March 5, six days before the journal was to publish the details of its investigation into Mr. Robinson's incomplete disclosure, Mr. Leo went public with his piece for BMJ.

The new rules from JAMA, announced in its March 20 edition, discourage such third-party disclosure from happening again. "The person bringing the allegation will be specifically informed that he/she should not reveal this information to third parties or the media while the investigation is under way," the editors wrote. Cathy DeAngelis, editor of JAMA, told us that the journal "can do nothing if the 'accuser' goes public, and we do not intend to try." But her insistence that concern for "[p]rotecting the accused person and thereby assuring due process" while the journal conducts its review misses the larger point of Mr. Leo's going public. This is a matter of transparency: If the information in scientific journals and studies is not free of conflicts, its value is diminished and its authors and the publications become suspect.

JAMA's commitment to keep those who bring allegations informed of the investigation's progress and its completion helps with transparency. So does its commitment to immediately put its findings on the Web, instead of waiting until the magazine's next publication date. Muzzling whistleblowers might help JAMA control its image -- but it's a disservice to the public.

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