National Post

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Thursday, September 02, 1999

Journals search for own cure-all
Money, science and politics don't mix at medical publications. One editor was fired over a report on whether oral sex is 'having sex.' His rival quit over what he saw as a cash grab
Brad Evenson
National Post


Dave Chan, National Post
Dr. John Hoey says publishers of medical journals are raking in big money.

As light reading, The New England Journal of Medicine falls far short of Talk magazine. The prose is surgical, dry and obscure. The pictures are appalling; the "art" in today's issue includes a liver biopsy, the skin wound of a pig and blood specimen from a man with AIDS. Yet with 240,000 paid subscribers and an estimated $20-million (US) a year in profits, the staid journal has clearly found a market.

Increasingly, however, it's a crowded and fractious market.

The number of scientific journals has exploded in recent years. More than 250,000 publications now cover topics as esoteric as tropical venereal diseases and suicide intervention, and all of them compete fiercely for pharmaceutical advertising dollars.

And in the past year, economic pressures have raised some disturbing issues that threaten the 300-year-old tradition of scientific scholarship.

On Jan. 15, the distinguished editor of the Journal of the American Medical Association, Dr. George Lundberg, was fired over oral sex. Dr. Lundberg's sin was to publish a report by two Kinsey Institute researchers that found 60% of college students polled did not think engaging in oral sex amounted to "having sex."

As science, the article was impeccable; doctors need a clear understanding of what people think of as "having sex" when they do medical exams.

As politics, it was a mistake.

The issue appeared as Bill Clinton, the U.S. president, was facing impeachment, in part over his contention that his sexual activities with Monica Lewinsky did not amount to "having sex." The American Medical Association said Dr. Lundberg had thrust the journal "into a major political debate that has nothing to do with science or medicine."

Medical editors at the journal protested, saying Dr. Lundberg's firing was a gross violation of editorial independence. Some pointed out that the AMA is a political organization, which just happens to donate twice as much money to Republicans as Democrats.

"It is perhaps idle, but irresistible, to speculate that had the college students taken a view of oral sex that was more convenient to the Republican cause, the AMA might not have objected," suggested a Canadian Medical Association Journal editorial.

Dr. Lundberg's critics, however, argued that he published the oral sex article solely to win publicity for a corporation that already draws $54.7-million (US) a year in advertising revenue.

(The wry joke in medical circles was that president Clinton kept his job despite having sex without thinking, while Dr. Lundberg lost his for thinking about sex.)

But Dr. Lundberg was not the only editor of a prestigious medical journal to wind up on the wrong side of a controversy.

Six months later, his former competitor at the New England Journal of Medicine, Dr. Jerome Kassirer, was forced to quit.

Dr. Kassirer's dispute with the journal's owner, the Massachusetts Medical Society arose over the society's use of the New England Journal of Medicine logo to promote products, and its plans to launch spin-off journals with such names as "The New England Journal of Cardiology."

This precedent began in 1992, when the journal Nature created a family of specialty journals, such as Nature Medicine and Nature Genetics. Critics say up to two-thirds of such journals could be cut, since much second-rate research is published, and many scientists now break the results of their experiments into multiple parts so they can publish more papers, a sign of prestige in the research community.

Since the New England Journal of Medicine rejects more articles than it publishes, the Massachusetts Medical Society felt it could use the rejected articles to fill specialty journals, cashing in on the New England Journal of Medicine's 187-year-old name and reputation.

Dr. Kassirer objected to what he saw as a cash grab and quit. Only when the journal's editorial staff threatened a mass resignation did the society's leaders relent, and agree not to use the logo without the permission of the journal's new permanent editor. The new policy is outlined in a New England Journal of Medicine editorial today.

Once run as non-profit enterprises, science journals now bring in big money.

In terms of percentage return on investment, "a lot of the medical publishers are up in the range of Microsoft, a monopoly kind of range," says Dr. John Hoey, editor of the Canadian Medical Association Journal.

But this success is creating rifts in the scientific community, which is torn between its need for research funds and the requirement to publish its work to have it recognized.

Consider the issue of copyright.

When they publish studies, most major journals force the scientists to grant them full legal rights to the words.

"It's not just for one-time use -- it's for everything," says Dr. Hoey.

"If we make money on it, none of that goes back to the author. So we pay them nothing, and they give us an article."

Not surprisingly, many scientists are now lobbying for copyright on their work.

The central issue is who is the moral owner of a particular journal. Scientific journals trace their roots to The Philosophical Transactions of the Royal Society, in England, and the Journal des Savants, in France, which both began publishing in 1665.

Dedicated to disseminating science that had been rigourously reviewed by experts, such journals were seen as public documents.

Today, the publishers in many cases are wealthy medical or trade societies. For example, the American Society for Microbiology publishes 12 journals; the American Physiological Society puts out 14.

Scientists say it's not fair that their brilliant research is used to attract billions in advertising revenues and subscriptions without them receiving a share.

On the same front, university and college librarians are balking at the high subscription rates of many specialty journals, which can run upward of $15,000 a year.

"Our researchers are contributing to the journals and then we have to buy the stuff back," said a University of Alberta librarian. "And we don't have the money."

Now, however, the battleground appears to be shifting in a manner that could turn scientific journals into paper relics.

On June 6, Harold Varmus, the director of U.S. National Institutes of Health, touched off a huge debate by proposing a massive biomedical Internet site.

Called E-biomed, the site would provide the full text of scientific reports at no cost to anyone with a computer anywhere on the globe. It is scheduled to begin operating Jan. 1.

Not surprisingly, the journal publishers are up in arms.

The head of the American Physiological Society, Martin Frank, said patients could be killed or injured if doctors treated them using methods posted on E-biomed that had not been reviewed by an expert panel.

They warn this site could become the world's largest repository of junk science.

None of this sways Dr. Varmus, who predicts E-biomed will "revolutionize the way in which biomedical scientists carry out their work." He says scientists will be motivated to post their research on E-biomed because it would be more widely disseminated.




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