When journals are branded, editors get burnt

Medical journal editors have been looking over their shoulders again these days, this time on account of the forced retirement of Dr. Jerome P. Kassirer as editor-in-chief of the New England Journal of Medicine. A terse statement issued by the Massachusetts Medical Society on July 25 said that Kassirer and Dr. Jack T. Evjy, president of the Society, "were unable to find common ground" in resolving their "differences of opinion over . . . administrative and publishing issues." Those differences, already well known to insiders, were given a more public airing in a further statement from the Society on August 4, which announced the appointment of Dr. Marcia Angell as interim editor-in-chief (and her intention to retire when a replacement was found for Kassirer). The crux of the matter was the Society's use of the NEJM's name, logo and reputation to market other publications of the Massachusetts Medical Society and plans to launch spin-off specialty journals (e.g., "The New England Journal of Cardiology") to publish papers rejected by the flagship journal. [2] In their statement, Angell and Evjy agreed that "the Editor-in-Chief will have authority over the use of the name, logo and content of the New England Journal of Medicine, in print or any other form. Consumer versions of the content will also be subject to her approval or that of her staff. There will be no use of the name, 'The New England Journal of . . . ' for other products." [3] It remains to be seen whether the journal's new editor will be able to hang on to these conditions.

The NEJM is wholly owned by the Massachusetts Medical Society, just as the CMA owns CMAJ. For a minimal investment (probably almost nothing) the Society reaps the NEJM's profits, now estimated at over US$20 million. [4] For a small medical society struggling to retain members and membership dues, this is, in the words of one Society member, "the ultimate cash cow." [4] The Society succumbed to the temptation to milk even more profits by marketing a range of other journal, magazines and consumer newsletters under the NEJM "brand." The various versions of Journal Watch, for example, are distributed free of charge by pharmaceutical companies to many physicians in Canada. Although Journal Watch is neither written nor endorsed by the staff of the NEJM, the prestigious journal's logo is displayed prominently on the cover. Even discerning readers might be forgiven if they believed that the publication was at least approved by the editors of the NEJM.

Interbrand, a marketing consultancy, notes that until recently the value of an enterprise was measured by what could be totted up on a balance sheet: "real estate, plant, facilities, equipment, inventory, stock investments and cash." But now, the most valuable assets are frequently intangible; they include things like copyrights and patents, technical expertise, experience, and trademarks or brands. [5] This is precisely the case for the NEJM. Its reputation is an asset that can be traded on in the marketplace.

It is easy for marketing and its sometime accomplice, greed, to slip under an editor's door. The spectre of economics is always standing at an editor's shoulder anyway. All medical journals must be profitable - or at least break even - if they are to last. Editors know this and work with their publishers to ensure the financial survival of their publications. But any honest intellectual enterprise must proceed on the optimistic and disinterested premise that excellence is not only its own reward but is also the best guarantor of healthy circulation figures. Medical journal editors improve the viability of their publications by improving their quality: attracting the best papers, inviting interesting and relevant commentaries, soliciting review articles and practice updates that are genuinely to readers, and so on. When publishing is driven by the bottom line, however, intellectual value becomes a mere epiphenomenon of a marketable product. Here the most obvious hazard lies in advertising: the pragmatic virtues of increasing revenues from nonsubscription sources, mainly pharmaceutical companies, can create pressures to make editorial decisions that will not alienate advertisers. But the interests of advertisers and the interests of readers are not the same. Any worthy publisher protects editors in their struggle to serve the needs of readers - and the public - first.

The international medical community was reminded of the perils of - and necessity for - editorial independence with the firing of Dr. George Lundberg as editor of JAMA in January of this year that followed his fast-tracking of a politically sensitive article. [6] Editorial freedom does not appear to have been a problem at the NEJM. In the July 25 press release, Kassirer commended the Society for its "staunch support for the Journal's complete editorial independence." [1] The difficulty that Kassirer faced - the "branding" of the NEJM - was more subtle. Nonetheless, the principle that safeguards the editorial independence of a medical journal is also the one that should prevent the abuse of that journal's reputation. This is the notion of intellectual custodianship. In a prescient editorial written a month before he was sacked, and echoing, perhaps, our own thoughts, [6] Kassirer wrote: "When a membership society's journal gains international respect, . . . the journal in some sense transcends its local ownership and becomes the property of the worldwide professional community and the public. In such instances, the journal's owners have a formidable public responsibility as stewards." [7]

That stewardship includes the responsibility to ensure, on the one hand, that a journal's reputation for reliability and scientific rigour is not diluted by specious association with other "products" and, on the other, that readers are not mislead by such associations. The reputation of the NEJM was built on the intellectual contributions and just plain hard work not only of its editors but also, and more importantly, of the authors who report research that is, directly or indirectly, funded by the public and of the reviewers, correspondents and many others who contribute to the journal without financial compensation. Kassirer is right to insist that trading on this reputation for mercenary motives is intolerable.

Dr. Hoey is Editor-in-Chief of CMAJ.