Could CMAJ happen at CFP? Report on editorial independence from a former scientific editor.

Events at the Canadian Medical Association Journal (CMAJ) have prompted Canadian Family Physician (CFP) to examine its relationship with the College of Family Physicians of Canada. Fortunately, our Editorial Advisory Board recently met to discuss this issue, and, despite the fact that I have officially resigned, I thought readers should know how this issue was handled during my tenure. The controversy surrounding the Canadian Medical Association’s dismissal of John Hoey and Anne Marie Todkill appears to focus on editorial independence; whether an association journal can offer complete independence to its editors; and what, precisely, is meant by that term. The World Association of Medical Editors defines editorial independence in fairly black-and-white terms: the editor has complete control over material that goes into the journal, whether or not it conflicts with the commercial success of the journal.1 The only restraint they cite is that views expressed in the journal should be “responsible,” although this term is not defined. Most editors believe that they should have complete control over “scientific articles,” although George Lundberg was fired from the Journal of the American Medical Association for publishing a “research” article that was interpreted by some as biased political commentary. Gray areas begin to appear, however, in news or editorial sections of journals. If editorials constantly reflect a limited philosophical or political point of view, then the interests of the readers and the organization are not well served. News items, including investigative journalism, fall into a category that could, conceivably, be manipulated by an editor who wishes to promote a specific philosophical viewpoint. According to the Public Broadcasting Service guidelines in the United States, “content evaluation is an art, not a science, requiring professional judgments about the value of the content in relation to a broad range of informational, aesthetic, technical, and other considerations.”2 If it is an art, then it is subject to bias. Given these circumstances, should an editor of an association journal have complete editorial independence? Should the owner of a journal, especially one that purports to represent a spectrum of physicians, just hand over the reins of editorial power to a person who might use them as he or she pleases? Can an editor be fired only for gross failure of editorial judgment, theft, or sexual harassment? Could the CMAJ breakdown occur at CFP? The structure of governance is somewhat different here. The Scientific Editor is hired by the College, with the approval of the Chief Executive Officer and Executive Committee, and is responsible to the Publisher, who is also hired by the College. At CFP the Publisher has overall responsibility for the journal and the Scientific Editor is responsible for the content. Editorial Advisory Board members are appointed by the College Executive Committee and are ultimately responsible to it. They are not appointees of the Scientific Editor or Publisher. Although their work for the journal puts them in contact with the publishing staff, they also have a responsibility to represent the College during regular meetings. Given the shades of gray in interpreting what is a responsible position for an editor to take on non-scientific material, I believe that editorial independence cannot be rigidly defined. It boils down to a respectful relationship between editor and publisher or owner. The editor should be free to publish articles about topics that might be sensitive for the association, but needs to be cognizant of the politics of that organization. When publishing controversial material, opposing perspectives should be balanced and the editor should encourage the organization to submit editorials or rebuttals to published material so that readers can see multiple points of view. This is true for any controversy. The publisher or owners should feel that the editor will respect the association and not abuse editorial power. This is a delicate balance. When the relationship between editor and publisher or owner deteriorates, for whatever reason, a mechanism must be available to deal with the consequences. It is difficult to prescribe a respectful relationship, but I suggest, as a starting point, that the definition for editorial independence proposed by the World Association of Medical Editors be adopted as the main guideline for CFP. When Scientific Editors are hired, they should be informed of these guidelines and be given specific criteria by which their performance will be evaluated at regular intervals. When the Publisher takes exception to the Scientific Editor’s choice of material, and when agreeing to disagree is not an option, the Chief Executive Officer should be the first level of consultation. If that fails, then the Editorial Advisory Board should be consulted, given its joint responsibility to the College and to the journal. Should this process still not produce a resolution of the crisis, I propose that an independent, ad-hoc group be formed to mediate between the College and the Scientific Editor, just as the Journal Oversight Committee was meant to do at CMAJ. This process offers a mechanism to resolve serious issues before they reach crisis levels. What has been my experience as Scientific Editor at CFP? I am very pleased to report that during the last 11 years I have never had any interference with editorial content for the journal. We have published editorials and occasionally other articles that were critical of the College, but there was no censure from the College. There were times when I was asked about certain content, but after I had justified its publication and offered the College space to address the issues, there was never any pressure to alter an article. While there were times when I would notify College staff of upcoming articles, so they would have time to be prepared, I never had to obtain their permission and I never had to have an article preapproved. After Jerome Kassirer left the New England Journal of Medicine, I asked then-Publisher of CFP, Peter Taylor, “What would it take to get me fired?” “Quite a lot,” was the answer. “Don’t worry, Tony. The bullet would have to pass through me first.” In summary, I have had complete editorial autonomy at the journal during my tenure as Scientific Editor. The new Scientific Editor has been hired with more specific evaluation criteria that will be used regularly, and a dispute-resolution mechanism has been worked out and is awaiting final approval. I am confident that these steps will preserve editorial independence at CFP. Thank you, CMAJ, for stimulating us to examine this important question, and thank you, College of Family Physicians of Canada, for maintaining editorial integrity.

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