“Dr Nobody” in JAMA editors flap speaks his mind

Jonathan Leo, the “Dr. Nobody” in the JAMA editors flap, has delivered a long and thoughtful response to the entire sorry episode in an article in the journal Society.

Among many issues, Leo discusses the academic freedom concerns raised by the case. (Recall that the JAMA editors initially demanded that Leo– along with any other JAMA letter writers– had no right to publish without permission from the editors.) Here is what Leo has to say:

Drifting into First Amendment issues, they essentially argue that I had no right to write about JAMA without JAMA’s permission. I, on the other hand, thought I had the academic freedom to write about matters in the public record. I think most people believe that once a written body of work, such as a scientific article, is in the public record, it is fair game for others to write about it. Isn’t this idea essential to the free exchange of ideas? By creating new stipulations regarding the content of comments made on its papers, as well as when those comments could be made, JAMA’s editors essentially separated themselves from the rest of the intellectual world, placing themselves in a unique class with their own set of rules. If other organizations ever adopted this JAMA policy and applied it to themselves the free exchange of ideas would be sharply curtailed.

Leo also reports new problems with the Lexapro trial. He notes that the protocol was improperly altered to test Lexapro instead of Celexa, which was going off patent, and he points out an apparent misuse of www.clinicaltrials.gov:

The Robinson post-stroke trial was registered
in a timely fashion at http://www.clinicaltrials.gov/ but,
according to the registry site, which posts all drafts of the
registration, the primary endpoints were not posted until
August 2008—4 months after the study was published in
JAMA. This appears to be a direct violation of JAMA’s own
stated policy.

(Readers of CardioBrief shouldn’t be surprised. See: Hiding in plain sight: clinical trial registration isn’t working as intended.)

Leo concludes with an important point, that the damage done to JAMA‘s reputation was largely self-inflicted:

With every new chapter in the saga I kept wondering who could possibly be advising JAMA on its course of action. What if the editors had followed a different strategy, perhaps issuing a statement such as: “Authors Beware! We do not have the ability to police all our contributors’ conflictof- interest declarations. In the past we have relied upon the honesty of the authors, but now in the age of the Internet we can also rely upon our loyal readers. As this case shows, our readers are checking up on you.” Case closed. The editors had multiple opportunities to issue such a statement. They could have done so at the very start of these events, or later, in conversations with the WSJ reporter, or when speaking with other reporters. And, in contrast to what did happen, the media would have praised JAMA for once again being in the forefront when it comes to handling conflicts of interest.

Even better, no one would have ever heard of me.

Here’s some background on the case. You can read about it in more detail using our chronology of the controversy):

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 original combative editorial, which took a strong stance against both conflict of interest and free speech. The editors wrote that 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.

Following a great deal of negative publicity, the AMA announced that its Journal Oversight Committee would review the affair. In July JAMApublished a highly edited version of the March editorial. The new version contains no direct reference to the Robinson and Leo affair, and includes no reference to the previous version. 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.

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