In the latest episode in the ongoing saga that started as a simple report of a missing conflict of interest disclosure in a JAMA paper, JAMA editors Catherine DeAngelis and Phil Fontanarosa have released an updated and far less contentious version of an editorial that was originally published in March. [Please note that the March document has been removed from the JAMA site. This link is an archived copy.] It appears the pitbulls of March have been tamed and have now become the lapdogs of summer.

Although the JAMA editors and the AMA are not speaking about the issue, a statement from the AMA (see below) offers the strong suggestion that the revisions to the JAMA editorial were strongly influenced by the dog whistle of the AMA’s Journal Oversight Committee.

By way of background, the saga began when Jonathan Leo, a professor of neuro-anatomy at Lincoln Memorial University, published a letter on the BMJ website. The letter pointed out that a study on Lexapro in stroke patients published in JAMA failed to disclose a conflict of interest of one of the authors, Robert Robinson. Leo had initially reported his finding to JAMA. After waiting several months without any action from JAMA he sent his letter to BMJ. The story’s focus soon shifted to the JAMA editors for their pitbull-like response to events, especially after they had a series of contentious conversations with their critics and Wall Street Journal reporter David Armstrong. In March the JAMA editors published their combative editorial. Following a great deal of negative publicity, the AMA announced that its Journal Oversight Committee would review the affair.

CardioBrief has put together a detailed chronology of the controversy.

The new editorial is a highly edited version of the March editorial. In the March version the JAMA editors took a strong stance against both conflict of interest and free speech. According to the editorial, it was acceptable to accuse JAMA authors of conflict of interest, but it was unacceptable to tell anyone except the journal editors until the editors themselves reported their final determination of guilt or innocence. The editorial also included combative remarks about Leo and denied reports by the Wall Street Journal’s David Armstrong of abusive language and harrassing behavior stemming from DeAngelis.

The new version contains no direct reference to the Robinson and Leo affair. The only remaining shadow of the authors’ earlier hostility to Leo and the media is contained in these sentences near the end of the editorial:

“Pressures to publish rapidly, reports in the news media, and comments on blogs and advocacy sites must not overwhelm the process of thorough and fair investigation when reputations are at stake. A rush to judgment may spark heat and controversy, but rarely sheds light or advances medical discourse.”

However, the JAMA editors fail to consider that the “heat and controversy” was provoked not by Leo or Armstrong but by their own intemperate reaction to the Leo letter in BMJ.

The editorial states a new policy regarding allegations of unreported conflicts of interest. In distinct contradiction to the earlier version, the new editorial does not require confidentiality from the person making the allegations. But it does, somewhat strangely, strongly recommend that confidentiality be maintained. Here is the relevant paragraph:

To avoid misunderstanding about our policies and procedures, we are clarifying certain aspects regarding our approach for investigations into allegations of unreported potential conflicts of interest. JAMA requires that the individual bringing the allegations provide a written detailed explanation of the unreported conflicts of interest and provide documentation to support the allegation. We will explain to the person bringing the allegation that gaining full cooperation of all parties with knowledge of the facts is likely to be enhanced by maintaining confidentiality while the investigation is under way. This approach has proven to be vital in delicate situations, such as those requiring the assistance of deans. Furthermore, the person making the allegation will be informed about progress of the investigation and will be notified when the investigation is completed. In addition, once the investigation into unreported conflicts of interest is completed and the letter of explanation and the correction (if necessary) are finalized, those documents will be immediately posted online and linked from the article, and then subsequently published in the print journal.

The new version of the editorial contains no reference to the previous version and includes no discussion of the larger context. It also fails to disclose that the remaining text is almost identical to text in the previous version published online. (Most journals have explicit policies against the reuse of previously published content. But perhaps those rules don’t apply to editors.) The authors also fail to disclose that the editorial is apparently a response to recommendations from the the AMA’s Journal Oversight Committee. A statement issued by the AMA (the complete statement is reprinted at the bottom of this post) hints that the AMA has not chosen to publicly rebuke DeAngelis and Fontanarosa, though the newer version suggests that the combat-ready pitbull editors have indeed been tamed for now.

CardioBrief asked Jonathan Leo to comment on the editorial:

“Under JAMA’s new policy, an investigative reporter who notices a problematic unreported conflict-of-interest in JAMA needs to first contact JAMA, not to verify the facts but to let JAMA have the first chance to write about it.   In a society that prizes freedom of the press, a policy that puts constraints on the open and free exchange of publicly available information needs to be carefully evaluated.”

Leo also disputed the assertion by DeAngelis and Fontanarosa that the investigation into their initial complaint required a lengthy investigation: “Our letter to the BMJ required very little investigative work. A 60 second google search pointed out the undeclared conflict and in an email Dr. Robinson graciously confirmed the facts.  I’m not sure I would call it an investigation.”

Here is the complete AMA statement:

AMA ACTS ON JOURNAL OVERSIGHT COMMITTEE RECOMMENDATIONS

CHICAGO, IL –  The American Medical Association announced today that its Board of Trustees has reviewed and acted on recommendations put forth by the Journal Oversight Committee (JOC) charged with examining concerns raised over how Journal of the American Medical Association (JAMA) senior editors responded to a report that a study author had failed to comply with the journal’s editorial policies regarding conflicts of interest.

“The Board  discussed the JOC’s recommendations thoroughly,” said AMA Board Chair Rebecca Patchin, M.D. “We thank the JOC for its diligence and have reviewed the JOC’s recommendation with the JAMA editors. We anticipate JAMA’s procedures for resolving undisclosed conflicts of interest by journal authors will be improved as a result going forward.

“The AMA considers the JOC’s recommendations and the Board’s actions to be an internal matter and we will not be offering further comment on them or their implementation,” Dr. Patchin said.

The July 8th issue of JAMA includes an editorial authored by its editor-in-chief Catherine D. DeAngelis, M.D., M.P.H. and executive deputy editor Phil B. Fontanarosa M.D., M.B.A., clarifying and strengthening the Journal’s procedures for resolving unreported conflicts of interest.

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