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Critics decry Canadian medical journal’s ‘Orwellian’ revamp

The Canadian Medical Association announced Monday it fired editor-in-chief John Fletcher and disbanded the editorial oversight committee of the Canadian Medical Association Journal.

Cindy Forbes, president of the CMA, said the changes are being made to help modernize and reinvigorate the journal at a time when its reputation and revenue are slipping.

"We don't look at the journal as a profit-making product for our members, so that isn't the motivation, or it's not, certainly, the sole motivation," Dr. Forbes said in an interview.

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"The motivation really is to turn this into a world-class journal."

From now on, the editor-in-chief will deal directly with the CMA's board of directors on issues relating to editorial independence, Dr. Forbes said.

She said the new reporting structure is the "highest level of oversight that we can offer."

But others see the move as a dangerous encroachment on the editorial independence of Canada's leading medical journal – one that's reminiscent of a scandal that unfolded a decade ago.

In 2006, the CMA fired the journal's editor-in-chief and deputy editor after several clashes, including a request by the CMA to water down a journal story about women being denied access to the morning-after pill at pharmacies across Canada.

The firings led most of the remaining editorial board to resign.

The controversy led to a governance review headed by Dick Pound, former head of the World Anti-Doping Agency, that made several recommendations, including the creation of a strengthened journal oversight committee that would report to the CMA board.

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Dr. Fletcher declined to comment about his departure.

But Elly Alboim, a member of the now-defunct journal oversight committee, said he has serious concerns about the CMA's decision.

"It's slightly Orwellian to remove the editor, disband the [oversight committee], which is charged with maintaining editorial independence, and then suggest you're enhancing editorial independence," he said.

The underlying fear is that removing the people in charge of protecting the editorial independence of the CMAJ will hurt the quality of the publication, which is widely read by health professionals across Canada. Articles published in the CMAJ can influence how a doctor treats his or her patients.

Claire Kendall, one of the CMAJ editors who resigned in 2006, said the CMA is making the same mistakes it did a decade ago.

"My question would be how the CMA plans to organizationally and operationally commit to editorial independence when they are dissolving the very committee that is meant to protect the interests of the journal's independence and integrity," Dr. Kendall said in an e-mail.

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Jerome Kassirer, former editor of the New England Journal of Medicine who was fired over a dispute with the publisher, was more blunt in his assessment on Twitter: "The CMAJ will now be run by a for-profit; the editor will report to the CEO, with no academic oversight. Shortsighted and retrogressive."

Dr. Forbes clarified that the editor-in-chief will report to the CMA board, not the CEO. She added that Chris Simpson, past president of the CMA, will lead a task force looking at a new mission statement and objectives for the CMAJ. If the task force recommends the journal have its own oversight committee, that's still "a possibility," she said.

Part of the reason for the change in governance at the CMAJ is that a new subsidiary of the CMA is performing more of the administrative functions of the journal, Dr. Forbes said. The subsidiary, established in 2014 and referred to as NewCo, is responsible for the revenue-generating aspects of the CMA.

According to a person familiar with internal discussions at the CMAJ, members of the journal oversight committee raised objections with the CMA board in recent months about the relationship with NewCo, which they feared was undermining the editorial independence of the journal.

There were also concerns that too many of the CMAJ's responsibilities were being transferred to NewCo.

The oversight committee was scheduled to discuss the issue with the CMA board Monday morning.

But instead of a discussion, the oversight committee was told it was being disbanded and that Dr. Fletcher had been dismissed.

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About the Author

Carly Weeks has been a journalist with The Globe and Mail since 2007.  She has reported on everything from federal politics to the high levels of sodium in the Canadian diet. More

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