JAMA Restricts Scientists
Medical news now flies so quickly from the laboratory to our laptops and newspapers that one prestigious medical journal has decided it’s time to apply the brakes.
In an editorial published last week in the Journal of the American Medical Assn. (JAMA), the journal warned authors who submit papers not to talk to reporters about their work in any detail before it’s published. The editorial, co-authored by Dr. Catherine DeAngelis, the journal’s editor, said that researchers “must refrain from granting interviews with the news media about the information under consideration,” unless the journalist agrees not to report it before JAMA does.
DeAngelis said the editorial was no more than a clarification of existing policy. “We aren’t interested in controlling the information,” she said, “but we are very interested in controlling the quality of the information, and researchers who want to publish in JAMA should know that.”
But some were surprised at the sudden appearance of the policy statement and said its strong language could restrict public access to new medical findings. For example, the editorial is particularly strict about what investigators can and cannot say at scientific meetings, the open forums where new data often are first presented and discussed. “Authors who present information contained in a manuscript that is under consideration by the journal . . . should not distribute complete reports or data presented as tables and figures to conference attendees or journalists,” it says.
“I just don’t agree with that,” says Dr. George Lundberg, who was JAMA’s editor for some 17 years before being fired in 1999, after he approved publication of a controversial sex survey during the Clinton impeachment hearings. “If you give a paper at a scientific meeting, there’s no way you won’t share your data. That’s the whole idea.”
JAMA’s editorial does specify several exceptions to the gag rule on investigators, such as testimony before government agencies and urgent public health news. But overall, said Lundberg, the journal’s newly stated policy is “heavy-handed” and more stifling in tone than the one in effect during his own tenure at the JAMA.
Traditionally, journals such as JAMA, the New England Journal of Medicine and the Annals of Internal Medicine have acted as valuable filters, not only separating good studies from junk science but forcing leading researchers to think through--and sometimes change--their conclusions. These journals still orchestrate coverage of most important medical findings, feeding reporters press releases, original data and sources for comment.
DeAngelis acknowledges that the last 10 years have brought enormous changes. “It’s not only the Internet,” she says. “There are also a lot more of these scientific meetings where researchers discuss their findings before they have appeared in a peer-reviewed journal.” And there are more medical reporters, particularly from online sites, taking that information straight to the public.
That has helped intensify pressure on the print journals to publish more quickly, said Dr. Frank Davidoff, editor of the Annals of Internal Medicine. “There’s been a lot of discussion about publishing stuff ASAP--as soon as it’s publishable,” he said. “We know we can knock about 10 weeks off the time it takes to get studies into print. But we also know that howling errors can slip through when you do that.”
Certainly, most doctors can cite instances in which journalists erred in their reporting of new scientific findings, or when stories and headlines overstated the significance of the research. The “cures” for cancer or AIDS. Hormones that “reverse” aging. Cell phones that “cause” brain cancer. All based on anecdotal or preliminary information.
But doctors can misinterpret new research, too. The JAMA editorial appears in the same issue as a Yale University study demonstrating how surgeons misread bulletins from government researchers. In 1991, and again in 1994, the National Institutes of Health issued clinical alerts informing doctors that an operation called carotid endarterectomy, or CEA, reduced the risk of strokes in people prone to suffer them.
The number of CEA surgeons performed rose significantly after both announcements, according to Dr. Cary Gross, the study’s lead author. Yet despite clear warnings by the NIH that the procedure was not recommended for patients over age 80, says Gross, many doctors operated on such patients anyway.
“It just goes to show you that when you release new information, you have no idea how people are going to interpret it,” says Gross. “I think doctors looked at the new data on this procedure and said, ‘Hey, it looks good, let’s try it,’ without paying much attention to the details.”
Gross said the study offers no evidence that misleading reporting in the popular press resulted in public misunderstanding of the NIH alerts. On the contrary, he said, most news reports about CEA included warnings that the operation was risky in patients 80 years and older. Nonetheless, enthusiasm for the CEA procedure cooled only after the NIH studies appeared in full-text, peer-reviewed journals.
“The primary source journal article is still the best you can do for a given study,” says Lundberg, who now edits the online journal Medscape.com. “There’s been time, reviewers have looked at it, there’s been an opportunity for editors to look carefully at the wording. But all of this is being done faster now, and I believe that JAMA and other journals following these restrictive policies are charting the course toward self-extinction. You can’t stop progress.”
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To read the full text of the JAMA editorial and the Yale study, go to the journal’s Web site jama.ama-assn.org/issues/current.
