INDEPTH: JOURNALISM
The CMAJ firings
Crisis at Canada's most influential medical journal
CBC News Online | Updated May 3, 2006
The Canadian Medical Association Journal (CMAJ) has developed a worldwide reputation as one of the leading general medical journals. In terms of international "impact", it is ranked fifth, behind only the New England Journal of Medicine, The Journal of the American Medical Association, The Lancet, and the British Medical Journal.
The CMAJ is a mix of peer-reviewed research articles, reviews, commentary, editorials, and health news. It has been published since 1911 and reaches the vast majority of Canada's doctors. It is also the main source for some of the most influential medical stories that get reported in the Canadian media.
But recently, the Journal has been making news for another reason. Its well-earned reputation has been tarnished by a dispute that erupted publicly in February 2006 with the firings of its editor-in-chief and senior deputy editor. In the days and weeks that followed, several other editors resigned. The majority of the Journal's editorial board also quit. Other prestigious medical publications weighed in with critical comments of their own.
The main issue in the dispute has been portrayed as one of editorial independence. Since the main players are largely keeping mum about the specifics, the details have primarily come from other sources close to the parties.
One thing is clear: On one side are the CMAJ's editors. On the other side are the Canadian Medical Association (which represents more 85 per cent of Canada's doctors) and Graham Morris, who, as president of CMA Media Inc., is the Journal's publisher.
Editorial independence is a vital part of any respected medical journal and the CMA says it "recognizes the necessity of editorial independence of the Editor-in-Chief." As mentioned above, the content of a journal goes beyond peer-reviewed medical research. It includes commentary, reviews, letters, editorials, and investigative pieces that have the potential to generate controversy among the many stakeholders in the medical community – hospitals, drug companies, governments, regulatory bodies, and lobby groups like the Canadian Medical Association itself.
The idea of editorial independence is to prevent a medical journal (like the CMAJ) from buckling to political pressure or becoming a mouthpiece for the organization that publishes it (the Canadian Medical Association).
In this case, editor and publisher parted company in a way that made big waves in the medical community around the world.
Here are the key developments in the dispute:
1996
 John Hoey (file photo)
May 2001
The CMAJ publishes an editorial calling for the decriminalization of possession of small amounts of marijuana for personal use. That runs counter to the CMA's position. A former member of the CMAJ's editorial board says the CMA's general council complained to Hoey, the Journal's editor.
September 2002
A CMAJ editorial wades into the story of a 51-year-old man who was having a heart attack. He had arrived at the emergency room of one Quebec hospital only to find it had closed at midnight. He died en route to another emergency department a 30-minute drive away. The editorial criticizes doctors for not staffing the emergency department.
One report from a former CMAJ board member says the CMA's president demanded a retraction; the CMAJ editorial board reportedly reminds the CMA of the journal's editorial independence.
September 2002
The CMA establishes a five-member Journal Oversight Committee to review journal content and to "assist in maintaining harmonious relations between CMAJ and the association [CMA]," according to a CMAJ writer.
November 2005
CMAJ journalists ask the Canadian Pharmacists Association for comment about
a story they're working on. The journalists say their research shows some pharmacists are asking women for their names, address, and sexual history before handing over Plan B, an over-the-counter drug used for emergency contraception. That raises privacy concerns. The Canadian Pharmacists Association complains to the CMA, which agrees with the pharmacists group that the article is "scientific research" and should therefore by governed by the ethical requirement to obtain informed consent from the pharmacists who were being observed. The CMA asks the journal's publisher for changes, which the editors reluctantly agree to make. In December, editor Hoey writes an editorial critical of what he calls the CMA's interference.
February 2006
A CMAJ news story that quotes concerns about new Health Minister Tony Clement's stance on privatization is replaced with one more supportive of the minister and adds quotes from the CMA president.
Feb. 20, 2006
The CMAJ publisher, Graham Morris, fires the CMAJ's editor, Dr. John Hoey, and the journal's senior deputy editor, Anne Marie Todkill. Morris denies that the firings were related to concerns over specific stories or Hoey's criticisms. Morris says the Journal wanted to make "some changes in emphasis."
Feb. 24, 2006
An editorial signed by seven editorial staff at the CMAJ protests the firings of Hoey and Todkill.
Feb. 28, 2006
An ad-hoc committee of the CMAJ editorial board (appointed by Hoey) concludes that the CMAJ's editorial autonomy is "to an important degree illusory" and finds that the CMA's "interference" with the Plan B story "was a clear and overt infringement of editorial independence."
Feb. 28, 2006
Stephen Choi, who replaced Hoey as editor, quits along with editorial fellow Sally Murray. Sources say Choi walked out after his demand that editorial independence of the editor-in-chief be "absolutely protected and respected" was rejected.
Late February and early March 2006
Criticism of the CMAJ firings grows. In an editorial, The Lancet calls the editorial dismissals "deeply troubling." The New England Journal of Medicine publishes an article called "The Collapse of the Canadian Medical Association Journal." A former editor of the NEJM (also a CMAJ editorial board member) calls for the firing of the CMAJ publisher. The International Council of Science Editors, which includes prominent medical journals in the United States and Britain, criticizes the CMA for suppressing or ordering changes to stories and editorials.
March 7, 2006
The CMA appoints retired Supreme Court chief justice Antonio Lamer to head a panel that will make recommendations on the future governance structure of the CMAJ.
March 16, 2006
Fifteen members of the CMAJ's editorial board submit their resignations and write of "our loss of trust in the CMA leadership in relation to the CMAJ." The former board members
say the CMA's "recent actions and pronouncements regarding establishing editorial autonomy are largely cosmetic and unlikely to lead to an independent and free voice for health related issues in Canada."
March 17, 2006:
The CMA tells the former editorial board members it "takes great exception to your characterization of our organization and its leadership." CMA president Ruth Collins-Nakai says the CMA's leadership remains committed to editorial independence at the journal and said to the resigning board members "your subsequent actions appear aimed at undermining it." She ends the letter by saying the CMAJ "will publish long after we have left the stage. It was built to last."
May 3, 2006:
The National Press Club in Ottawa announces it will give two fired editors of the CMAJ this year's
World Press Freedom Award. In a separate development, the Canadian Medical Association
announces that former Supreme Court judge Antonio Lamer will step down from the panel looking into how the CMAJ is run because of ill health.
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 QUICK FACT |
Who owns the CMAJ?
The Canadian Medical Association Journal (CMAJ) is owned by the 70-thousand member Canadian Medical Association (CMA), through CMA Holdings Inc. (CMAH), a wholly owned subsidiary of the CMA.
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