JAMA and DeAngelis Respond But DeAngelis Should Resign

In an attempt to whitewash their own actions and responsibility to uphold the highest standards of academic publishing, Catherine D. DeAngelis and Phil B. Fontanarosa — editors of the Journal of the American Medical Association (JAMA) — published an editorial defending their handling of a conflict of interest and blasting the professor who brought it to their attention. In a classic example of shooting the messenger, it’s my opinion that DeAngelis and Fontanarosa absolve themselves of all blame, and suggest that any reports where they called Lincoln Memorial University Assistant Dean of Students and Professor Jonathan Leo Ph.D., a “a nothing and a nobody” were “erroneous.” (In other words, the editors of JAMA are apparently suggesting that the Wall Street Journal reporter made the quote up.)

But rather than clearing the air and helping to explain their actions, the commentary actually provides additional damning evidence that DeAngelis should resign her post as the editor-in-chief of JAMA.

The core of JAMA’s defense is the claim that once Leo had brought the allegations to JAMA, he was under some sort of confidentiality agreement because JAMA’s internal investigation is confidential:

While the confidential investigation of unreported conflicts of interest is under way, we [emphasis added] consider involvement of third parties — such as Leo had done by his posting on the BMJ site and by contacting the media — to be a serious ethical breach of confidentiality that not only potentially damages our ability to complete a fair and thorough investigation (of the specific issue that Leo had brought to our attention), but also potentially damages JAMA’s reputation by the insinuation that we would fail to do so.

The only people who considered their own investigation confidential was JAMA itself. Did Leo actually sign some sort of confidentiality or nondisclosure agreement? According to Leo himself, he did not, which means he was not under any obligation to JAMA to keep JAMA’s process secret. And JAMA already knew this particular investigation would not be confidential, because Leo copied a reporter on the original email. If anything, that should’ve been a sign to JAMA to resolve this particular investigation quickly and transparently.

This type of expectation of confidentiality when you bring a problem to someone else’s attention has been dealt with in other industries, because it’s not new. For instance, when someone becomes aware of a vulnerability in a piece of software, they bring it to the software maker’s attention. If they receive no response or are asked not to talk about it, they may respect such a request but ultimately it can only be a request because people are free to speak about a fact they know — whether they be a reporter or a professor or an ordinary citizen. Free speech is a fundamental right guaranteed in our Constitution. And they should be allowed to do so without fear of retribution or recrimination. JAMA cannot stop the free flow of information, despite their own internal policies (or delusions). JAMA has only itself to blame for the eventual BMJ publication, because it apparently was not very transparent nor timely in its investigation.

What’s even more disturbing here is all the while DeAngelis claims Leo was under some type of confidentially agreement, DeAngelis and Fontanarosa readily violate Leo’s own privacy by publishing the contents of private emails between Leo and DeAngelis:

Leo sent the following e-mail message to us: “You asked in your previous email why I contacted
the press. At the time, I was highly skeptical that JAMA would set the record straight on this matter. It has been almost five months since this matter was brought to your attention and JAMA has done nothing to correct the record. It seems that my initial skepticism was well founded.”

Wow, nice calling the kettle black there JAMA. Accuse someone of violating your “confidential” process, then go and publish another professional’s private emails to you in the Journal of the American Medical Association. In my opinion, this kind of behavior feels more like a petty attempt to get back at Leo, by a couple of spoiled, angry and petulant children who didn’t get their way.

Oh, and if you don’t like the way we handle things here at JAMA, don’t bother submitting future articles or letters to us (because after this incident, DeAngelis and Fontanarosa are clearly implying that they will not publish anything by Leo in the future):

Leo also was informed that, if his actions represented his apparent lack of confidence in and regard
for JAMA, he certainly should not plan to submit future manuscripts or letters for publication.

But it gets better. After getting no satisfaction from Leo himself in a phone conversation, they go over his head to try and get him under control by going to his boss. Can you imagine? How do they justify this obvious attempt at trying to manipulate Leo’s opinions and behaviors through such apparent intimidation?

However, since Leo apparently did not appreciate the serious implications of his actions, despite our attempts to explain, we felt an obligation to notify the dean of his institution about our concerns of how Leo’s actions were potentially damaging to JAMA’s reputation. We sought the dean’s assistance in resolving this issue involving a member of the faculty of his institution, to assure there would be no need to publicly identify that faculty member. No dean wants his or her institution implicated in a publication reflecting improper behavior by a faculty member.

In other words, since Leo is acting in an independent manner — thinking for himself — and doesn’t respect the sheer awe and power of JAMA, we will try and intimidate him and his boss into changing their tune. This sounds to me like a parent talking about his child, JAMA being the parent and Leo being the child who does not “appreciate the serious implications of his actions.” I’ve never heard of an Assistant Dean of Students treated in such a paternalistic and demeaning manner publicly.

One of the many unanswered questions one could pose to JAMA is why it takes 3 months to get a response from an author about readily-available material that demonstrates an inconsistency about their conflict of interest disclosure. I mean, this isn’t a murder investigation. It’s a simple, “Look, here’s a brochure that shows you were on the payroll for this company. Is this true?” If the wheels of JAMA turn so slowly that they feel it’s okay for 3 months to pass before they even get a response from an author about such a lapse, you can see perhaps why old media is in trouble.

Pressures to publish rapidly, reports in the news media, and comments on blogs and advocacy sites cannot overwhelm the process of thorough and fair investigation when reputations are at stake.

Indeed. But information moves at the speed of light — it always has. What has slowed us down is our imperfect technologies that allow sharing of information — the printing press, the postal mail, and now the Internet. Publications either keep up with the times of information flow, or they get left behind while other more forward-thinking publications (hello BMJ!) take the reins.

I believe that Catherine DeAngelis and perhaps JAMA itself is clearly out of touch with the changing realities of the world around them. DeAngelis should resign as head of JAMA, and JAMA should carefully rethink its future (and future policies) in a world always on, always connected, and far more aware of what its authors and researchers are doing than JAMA itself. How sad (and telling) it is that JAMA can’t police its own conflicts of interest and when such a conflict is brought to its attention, it shoots the messenger and makes only the tiniest of changes to prevent such problems in the future.

Read the full editorial: Conflicts Over Conflicts of Interest (PDF).

Read Leo’s Response to the JAMA Commentary

Read Furious Seasons’ (hat tip) take: JAMA Editors Accuse Wall Street Journal Of Lying About JAMA Editor’s Quotes In Conflict Of Interest Case