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This Article Full Text (PDF) All Versions of this Article: cmaj.051608v1 174/1/9    most recent Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Related Collections Research & Publication ethics CMAJ editorial policy

The editorial autonomy of CMAJ

Journal owners should not interfere in the evaluation, selection or editing of individual articles either directly or by creating an environment that strongly influences decisions.

Editors and editors' organizations have the obligation to support the concept of editorial freedom and to draw major transgressions of such freedom to the attention of the international medical, academic, and lay communities.

We have a transgression to report. While the Dec. 6, 2005, issue was in preparation, the editorial independence of the journal was compromised when a CMA executive objected strenuously to a news article we were preparing on behind-the-counter access to emergency levonorgestrel (Plan B).¹ The objection was made in response to a complaint from the Canadian Pharmacists Association, who had learned about the article when they were interviewed by our reporters. The CMA's objection was conveyed to CMAJ's editors, and to our publisher, who subsequently instructed us to withhold the article.

The stated objection was to our reporting method; as one component of the story, we had asked 13 women from across Canada to attempt to purchase Plan B from a pharmacy in their community and then tell us what the experience was like. The CMA questioned the propriety of our investigation and the boundary between news reporting and scientific research. Our story was not scientific research, however, but legitimate journalism.

The regulatory change in April 2005 that moved Plan B from prescription to behind-the-counter status has improved access to the drug, but concerns remain that cost, privacy issues and the requirement for counselling might still impede access.² Indeed, the privacy issue is now being addressed by privacy commissioners.³ Our news story was intended to test those concerns; presenting patients' experiences was crucial. That perspective was lost in the published version.

We felt that we had a choice between pulling the entire story, or getting most of it out by publishing a negotiated revision. We opted for the latter: what our readers saw omitted the results of our informal survey. This transpired without the story having been read by those who were raising the objection.

Our objective in making this incident public is to set in motion a process to ensure the future editorial independence of the journal. Readers expect CMAJ editors to select content without interference, and authors expect their work to be judged without regard to the interests of any third party. Readers and news media who rely on our reporting need to know that our journalists are not subject to censure.

As a serious vehicle for science, news and opinion, CMAJ cannot avoid the discussion of contentious issues. It is not unexpected for tensions to arise between the association and the journal from time to time, for our mandates are not the same. The question becomes: How do we manage this? The journal does not speak for the CMA, nor are its readers and contributors limited to CMA members; it has a wider scope and responsibility as a peer-reviewed scientific publication of international standing.

Against the backdrop of these tensions, the Journal Oversight Committee (JOC) was established in 2002 to "assist in maintaining harmonious relations between CMAJ and the CMA." Since then the JOC has acted as an intermediary in response to complaints about CMAJ content, but it has not managed to entrench within the CMA Board an unwavering acceptance of CMAJ's editorial autonomy as part of its commitment to the journal's quality and integrity. In 2003, the JOC recommended to the CMA Board that every issue of the journal contain the following endorsement of editorial independence:

The CMA will protect the editorial freedom and independence of the CMAJ and is committed to continually striving to maintain CMAJ's excellence in the science and art of medicine and its mission to uphold the ideals of the medical profession and to promote the health and well-being of the public.

To date this statement has not been approved by the CMA Board.

The issue of CMAJ's editorial independence needs to be resolved. We have established an advisory group to examine CMAJ's editorial autonomy and governance structure. The committee, chaired by Jerome Kassirer, Distinguished Professor at the Tufts University School of Medicine and former Editor in Chief of the New England Journal of Medicine, includes Donald Redelmeier, Professor of Medicine at the University of Toronto, and André Picard, Health Reporter for the Globe and Mail. In addition to these CMAJ editorial board members, the committee will also include Frank Davidoff, Editor Emeritus of the Annals of Internal Medicine. The committee will report to the full editorial board of CMAJ; we will publish their report soon thereafter. — CMAJ

The CMA has declined an invitation to present its views.

REFERENCES

1. Eggertson L, Sibbald B. Privacy issues raised over Plan B: women asked for names, addresses, sexual history. CMAJ 2005;173(12):1435-6.[Free Full Text]
2. Sibbald B. Nonprescription status for emergency contraception. CMAJ 2005;172(7):861-2.[Free Full Text]
3. Information and Privacy Commissioner / Ontario. Controversial morning-after pill screening form scrapped in Ontario [news release]. 2005 Dec 7.

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