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Editorial independence at medical journals owned by professional associations: A survey of editors


The purpose of this study was to assess the degree of editorial independence at a sample of medical journals and the relationship between the journals and their owners. We surveyed the editors of 33 medical journals owned by not-for-profit organizations (“associations”), including 10 journals represented on the International Committee of Medical Journal Editors (nine of which are general medical journals) and a random sample of 23 specialist journals with high impact factors that are indexed by the Institute for Scientific Information. The main outcome measures were the authority to hire, fire, and oversee the work of the editor; the editor’s tenure and financial compensation; control of the journal’s budget; publication of material about the association; and the editor’s perceptions about editorial independence and pressure over editorial content. Of the 33 editors, 23 (70%) reported having complete editorial freedom, and the remainder reported a high level of freedom (a score of ≥8, where 10 equals complete editorial freedom and 1 equals no editorial freedom). Nevertheless, a substantial minority of editors reported having received at least some pressure in recent years over editorial content from the association’s leadership (42%), senior staff (30%), or rank-and-file members (39%). The association’s board of directors has the authority to hire (48%) or fire (55%) the editor for about half of the journals, and the editor reports to the board for 10 journals (30%). Twenty-three editors (70%) are appointed for a specific term (median term =5 years). Three-fifths of the journals have no control over their profit, and the majority of journals use the association’s legal counsel and/or media relations staff. Stronger safeguards are needed to give editors protection against pressure over editorial content, including written guarantees of editorial freedom and governance structures that support those guarantees. Strong safeguards are also needed because editors may have less freedom than they believe (especially if they have not yet tested their freedom in an area of controversy).

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  1. Sanders S.A. (1999) Would you say you “had sex” if …? JAMA 281: 275–277.

    Article  Google Scholar 

  2. American Medical Association. (1999) AMA announces change of leadership at JAMA (press release). American Medical Association, Chicago (January 15).

    Google Scholar 

  3. McCormick B. (1999) Removal of JAMA editor draws fire. American Medical News. (February 1).

  4. Dickey N.W. (1999) Commentary by Nancy W. Dickey, M.D., president, American Medical Association, attached to a “Dear Colleague” letter from Randolph D. Smoak Jr., M.D., chair, Board of Trustees, American Medical Association, dated January 22, 1999.

  5. Smith R. (1999) The firing of Brother George. The AMA has damaged itself by sacking JAMA’s editor. Br Med J. 318: 210.

    Google Scholar 

  6. Horton R. (1999) The sacking of JAMA. Lancet 353: 252–253.

    Article  Google Scholar 

  7. Kassirer J.P. (1999) Should medical journals try to influence political debates? N Engl J Med. 340: 466–467.

    Article  Google Scholar 

  8. Kassirer J.P. (1999) Editorial independence. N Engl J Med. 340: 1671–1672.

    Article  Google Scholar 

  9. Angell M. (1999) AMA wrong to oust editor. Boston Globe A15 (January 21).

  10. Davidoff F. (1999) The making and unmaking of a journal. Ann Intern Med. 130: 774–775.

    Google Scholar 

  11. Hoey J., Caplan C.E., Elmslie T., Flegel K.M., Joseph K.S., Palepu A. and Todkill A.M. (1999) Science, sex and semantics: the firing of George Lundberg. Canadian Med Assoc J. 160: 507–508.

    Google Scholar 

  12. Van Der Weyden M.B. (1999) The Lundberg affair: editorial independence under attack. Med J Australia 170: 151.

    Google Scholar 

  13. Nylenna M., Chapman S., and Carnall D. (1999) JAMA’s editor sacked (letters). Br Med J. 318: 394.

    Google Scholar 

  14. JAMA editors, AMA Archives journals editors, JAMA editorial board members. (1999) JAMA and editorial independence. JAMA 281: 460.

  15. Bologna M., Gherardi C.R., Goto Y., Kantemir E., Khan A.J., Kim J.-P., Kumana C.R., Livaditou A., Vilardell-Tarres M., Vidmar I., Yurenev A.P., Foege W.H., Fulginiti V.A., Fihn S.D., Basnyat B., Pokhrel G., Legere J.B., Lincoln T.L., Van Gerpen J.A., Scalettar R., Zinner E., Balon R., and Manganiello P. (1999) The firing of Dr Lundberg (letters). JAMA 281: 1789–1793.

    Article  Google Scholar 

  16. Huston C. (1999) Council of Biology Editors condemns firing (BMJ rapid response, January 20).

  17. Godlee F., Fletcher S., Squires B., Overbeke J., and Ncayiyana D. (1999) World Association of Medical Editors condemns sacking (BMJ rapid response, January 19).

  18. Roberts J. (1999) George falls for Bill. Br Med J. 318: 406.

    Google Scholar 

  19. Electronic responses to: JAMA editor sacked. (1999) (BMJ rapid responses, January 19 – February 13).

  20. Massachusetts Medical Society. (1999) Press release. Massachusetts Medical Society, Waltham, Massachusetts (July 25).

  21. Tye L. (1999) Medical journal’s top editor is fired. Dispute over marketing policies is cited. Boston Globe A1 (July 26).

  22. Angell M. (1999) The Journal and its owner — resolving the crisis. N Engl J Med. 341: 752.

    Article  Google Scholar 

  23. Knox R.A. (1999) Fired medical journal editor refused spinoff idea. Boston Globe A3 (July 27).

  24. Mitka M. (1999) NEJM editor Jerome P. Kassirer, MD, loses post over “administrative issues.” JAMA 282: 622–623.

    Article  Google Scholar 

  25. Kassirer J.P. (1999) The departure of Jerome P. Kassirer (reply to letters). N Engl J Med. 341: 1312.

    Google Scholar 

  26. Smith R. (1999) Another editor bites the dust. Trust is needed to balance editorial independence and accountability. Br Med J. 319: 272.

    Google Scholar 

  27. Horton R. (1999) An unwilling exit from the NEJM. Lancet. 354: 358.

    Article  Google Scholar 

  28. Rennie D. (1999) Editors and owners — stretching reputation too far. JAMA 282: 783–784.

    Article  Google Scholar 

  29. Relman A.S. (1999) Money corroding medical journal’s prestige. Boston Globe D3 (December 12).

  30. WAME protests forced departure of NEJM editor. (1999) Statement by Bruce Squires, vice president, World Association of Medical Editors, for the executive committee of the board (September 7). (accessed November 11, 1999)

  31. A medical journal’s integrity (editorial). (1999) Boston Globe A12 (July 28).

  32. McNamara E. (1999) Medical society’s mission falls ill. Boston Globe B1 (July 28).

  33. Garceau A.J., Dieterich C., Furth E., Lentnek A.L., Stern D.T., Schwarz MR, Matthias H.-D., Tormey W.P., Carpenter A.F., Kassirer J.P., Evjy J.T., Latham V.T., Rockett F.X., Greene H.L., and Arky R.A. (letters). (1999) The departure of Jerome P. Kassirer. N Engl J Med. 341: 1310–1312.

    Article  Google Scholar 

  34. Wenzel R.P. (1999) Medical journalism: costs and values. Boston Globe A13 (July 28).

  35. Evjy J.T., Latham V.T., Rockett F.X., Greene H.L., and Arky R.A. (reply to letters). (1999) The departure of Jerome P. Kassirer. N Engl J Med. 341: 1312–1313.

    Google Scholar 

  36. Booth B. (1999) Use of NEJM name at center of latest editor sacking. American Medical News 19–20 (August 16).

  37. Rosenberg R.N., and Anderson E.R. (1999) Editorial governance of the Journal of the American Medical Association. JAMA 281: 2239–2242.

    Article  Google Scholar 

  38. Mitka M. (1999) Catherine D. DeAngelis, MD, is named new JAMA editor. JAMA 282: 1609–1610.

    Article  Google Scholar 

  39. Massachusetts Medical Society. (1999) Massachusetts Medical Society appoints esteemed committee to search for new editor of the New England Journal of Medicine (press release). Massachusetts Medical Society, Waltham, Massachusetts (September 15).

  40. Massachusetts Medical Society. (1999) Jeffrey M. Drazen, M.D., named editor-in-chief of the New England Journal of Medicine (press release). Massachusetts Medical Society, Waltham, Massachusetts (May 11).

    Google Scholar 

  41. Booth B. (1999) Physicians, academics battle for control of NEJM. American Medical News 19, 22 (December 6).

  42. Knox R.A. (1999) Doctors’ groups feud over control of medical journal. Boston Globe B1 (November 6).

  43. Smith R. (1991) Editorial freedom: empty slogan or holy grail? In: Delamothe T., Smith J., Smith R., eds. Balancing act: essays to honour Stephen Lock, Keynes Press, London: 36–48.

    Google Scholar 

  44. Davies H.T.O., and Rennie D. (1999) Independence, governance, and trust. Redefining the relationship between JAMA and the AMA. JAMA 281: 2344–2346.

    Article  Google Scholar 

  45. Pellegrino E.D., and Relman A.S. (1999) Professional medical associations. Ethical and practical guidelines. JAMA 282: 984–986.

    Article  Google Scholar 

  46. Institute for Scientific Information. (1997) Journal citation reports on CD-ROM. 1997 Science edition. Institute for Scientific Information, Philadelphia.

    Google Scholar 

  47. Garfield E. (1996) How can impact factors be improved? Br Med J. 313: 411–413.

    Google Scholar 

  48. Smith R. (2002) Editor’s choice: A bonanza for the NHS. Br Med J. 324 (7344) (April 27) (available at

  49. World Association of Medical Editors. (2000) The relationship between journal editors-in-chief and owners. WAME Statement on Editorial Independence. Posted June 19, 2000. (accessed November 3, 2000).

  50. Woloshin S., and Schwartz L.M. (2002) Press releases: translating research into news. JAMA 287; 2856–2858.

    Article  Google Scholar 

  51. Smith R. (1999) Could it happen here? (January 19).

  52. Davidoff F. (2000) Email from Frank Davidoff on the World Association of Medical Editors (WAME) listserve (March 28).

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Correspondence to Ronald M. Davis M.D. or Marcus Müllner.

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Davis, R.M., Müllner, M. Editorial independence at medical journals owned by professional associations: A survey of editors. SCI ENG ETHICS 8, 513–528 (2002).

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  • editors
  • editorial independence
  • editorial freedom
  • medical journals
  • scientific journals