A letter from CMAJ's editorial board to the CMA

On Sept. 17 an editorial entitled “Quebec's Bill 114” appeared in CMAJ addressing the appropriateness of physician staffing of a Quebec emergency department.1 The editorial considered implications for patient care and the resultant provincial legislation mandating certain physicians to report to the emergency department for periods of duty as specified by chief hospital administrators. In a response on Oct. 29 in CMAJ, Dana Hanson, President of the Canadian Medical Association, suggested that the editorial had “serious flaws,” and went further to indicate that the editorial's conclusion was “repugnant” and called for a retraction.2 Other comments by members of the CMA board and provincial associations conveyed to the editor indicated that the editorial was unacceptable.

These actions are a threat to the editorial independence of the journal and represent a clear and present danger. As the principal peer-reviewed national medical publication in Canada, CMAJ provides a unique and independent forum for high-quality peer-reviewed work and an opportunity for debate and dialogue around central issues relevant to health policy, medical practitioners, other health care providers and a general public readership. Arising from this independence and the competence and integrity of the editorial staff comes well-deserved trust and respect. Excellent journals should be at the heart of medical debate and provide thoughtful, informed synthesis and both balanced and prudent opinion.

Whether or not one agrees with the opinions stated in the Sept. 17 editorial is not the fundamental issue here: rather, it is the right to articulate such an opinion without concern for retribution by an organization or corporation that holds ownership or operating responsibility for the journal. Regrettably, editorial independence has been at centre stage in the past 3 years given the disputes between the medical associations who are owners of the Journal of the American Medical Association and the New England Journal of Medicine, and their editors. In both instances, these disputes led to the dispatch of the then editors.3^,4

We hope that this path can be avoided for CMAJ. The journal has prospered under the leadership of John Hoey and his excellent editorial staff. We admire and strongly support the high quality of their work and reject the suggestion of Dr. Hanson that the editorial deserves censure or retraction. Yet we also fully support and acknowledge the appropriateness of spirited debate on this and other subjects.

As members of the editorial board of the Canadian Medical Association Journal, we write to vigorously uphold the need for unequivocal editorial independence of CMAJ. We wish to express our concern about the demand of the President of the organization (of which many of us are members) concerning editorial retraction. As is evident from other communication and the correspondence on this issue, there is confusion about the relationship between the Canadian Medical Association, which owns and operates the journal, and the editorial content of the journal. To quote from the masthead:

all editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association (CMA). The CMA assumes no responsibility or liability for damages arising from any error, omission or from the use of any information or advice contained in the CMAJ including editorials, studies, reports, letters and advertisements.

As was articulated by one of us previously,

when a membership society's journal gains international respect because of the sound scientific material it publishes, its rational, thoughtful commentaries and the editor's freedom to select the content, 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.”5

The CMA has a right to be proud of CMAJ's reputation achieved under Dr. Hoey's direction. We believe that preserving editorial independence is key to its continuing success.

Nota : la traduction française de cette lettre est affichée sur le site www.jamc.ca.