CMAJ says it is "open access", too. No so fast, says its upstart, online rival

The Canadian Medical Association Journal (CMAJ) would clearly, really like to put its past problems behind it by using its editorial page to congratulate its upstart rival online journal Open Medicine on its launch.

You may recall that the CMAJ went through a serious crisis last year when the publisher of the journal fired its editor and the second-in-command quit as a result. The crisis came as a result, in part, of a move by the Canadian Medical Association to privatize the journal in an effort to make it a profit centre.

A large part of the magazine's editorial board quit over issues of editorial freedom and integrity. (Ultimately, the CMAJ appointed a new editorial team and effectively agreed to the kind of editorial freedom that the original editor had been asking for.)

One of the outcomes of the affair was that a lot of people who had backed the previous editorial board and team started Open Medicine, an online medical journal.

It would be fair to say that there has been little love lost between the two sides ever since.

Now, however, in the July 3 issue of the CMAJ makes an attempt to mend fences, going so far as to say, in effect, 'We're very much alike' and congratulating Open Medicine for its launch. The CMAJ authors attempt to associate themselves with the upstart as fellow practitioners of "open-access".

Starting up a new medical journal from scratch poses tremendous challenges that are not for the faint of heart. Open Medicine is fortunate to have an experienced editorial team of talented and creative people. We at CMAJ know this first-hand because many of these same individuals, we are proud to acknowledge, are former members of our team. Indeed, it was the prudent decisions and hard work of some of these individuals that made CMAJ the world's leading open-access general medical journal.

We congratulate our friends at Open Medicine on their achievement and wish them the very best of luck with this new venture.

Not so fast, said the editors of Open Medicine in a published response, accepting the praise but making it clear that their definition of "open access" and the CMAJ's are very different.

Although the endorsement by CMAJ’s editors of open access medical publishing is welcome, we would like to take this opportunity to clarify several points raised in their commentary. First, there is an important distinction between open versus free-access publication. Open Medicine has not only adopted the principle of free access, that is,making content fully available online, but endorses the definition of open access publication drafted by the Bethesda Meeting on Open Access Publishing. This definition stipulates that the copyright holder grants to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute works derived from the original work, in any digital medium for any responsible purpose, subject to proper attribution of authorship. Given that CMAJ holds copyright and charges reprint and permission fees, it is not in fact an open access journal.

In comparison, Open Medicine does not assume the copyright of our authors’ work. We believe that it is only fair and just that authors retain the ownership of their work; as such, Open Medicine does not charge reprint or permission fees, and our work is available for reproduction for educational and teaching purposes without copyright limitations or charges. We use a Creative Commons Copyright License that also ensures derivative works are available through an open access forum. It is through this creative and unlimited use of published material, with due attribution, that we believe scientific discourse can flourish. This truly open access forum also has a contribution to make to a journal’s integrity, independence, and freedom.

So, still some fences to be mended, then?

The conversation about the editorial, the CMAJ's interpretation of what "open access" really means and Open Medicine's response is bound to continue. See the comment in the Public Library of Science blog by Chris Surridge.

CMAJ editors speak, guardedly

For the first time, the fired editors of the Canadian Medical Association Journal (CMAJ) have spoken publicly, although they declined to speak in detail about why they were dismissed. At a public lecture at McMaster University on Thursday, as reported in the Globe and Mail, Dr. John Hoey and Anne Marie Todkill spoke about the level of controls publishers and editors and the editorial board should have in deciding what gets published.

Dr. Hoey said: "The owners get to pick the editor, but after that they should leave the editor alone." He spoke in favour of an open-source, online model such as the San Francisco Public Library of Science. "They have the advantage of not being dependent on advertising dollars."

Ms Todkill said: "The purpose of a general medical journal is to tackle a wide range of issues without feeling that there will be some level of censorship. Otherwise, you get self-censorship, then all is lost.

The CMAJ crisis blew up almost immediately after the Canadian Medical Association privatized its medical journal and hired Graham Morris as publisher. (But one of the issues that led to the firing of the editors was a controversial article about privacy concerns surrounding pharmacists demands for personal data in order to prescribe the so-called "morning after" pill. The CMA tried to have the article dropped or significantly amended after complaints from the pharmacists association. )

Since Dr. Hoey and Ms Todkill were fired, most of the editorial board has resigned and a group of doctors who are frequent contributors to the journal have said they will place their articles elsewhere.

UPDATE: The Right Honourable Antonio Lamer has announced a blue-ribbon panel of people to help him review the governance of the CMAJ and to provide recommendations "to further the CMAJ's continued commitment to editorial independence and maintaining excellence in reporting on the science and art of medicine."

The panel, which is to report by June 26, includes:

• Dr. John Dossetor, the current Ombudsman-Ethicist of the CMAJ
• Lise Bissonnette, President and DEO of the Quebec National Library and Archives
• Richard Van Loon, former President of Carleton University
• Dr. Charmaine Roye, an obstetrician-gynecologist and member of the CMA board
• Larry Mohr, Vice-President of CMA Holdings, which owns the CMAJ, and President and CEO of Practice Solutions (a commercial venture of the CMA)
• Dr. Haile Debas, Professor of Surgery and Executive Director, Global Health Sciences at the University of California at San Francisco

Anyone with comments to make to the panel can e-mail it at cmajpanel@governancereview.ca. of telephone them at (613) 566-0552.

"In the interim until the panel reports," the press release stated, "the relationship between the CMA, CMA Holdings and the Journal will be governed by nine editorial principles adapted largely from similar principles govering the relationship between the American Medical Association and the Journal of the American Medical Association (JAMA). The fire principle states: The CMA/CMAH recognizes CMAJ as an editorially independent, peer-reviewed journal and accepts and respects the necessity of edtiorial independence of the Editor-in-Chief. The Editor-in-Chief assumes total responsibility for the editorial content in CMAJ."

Which makes an outsider wonder why this brouhaha blew up in the first place...

Morris dancing at the CMA

The Canadian Medical Association Journal (CMAJ) is now without any full-time staff at all, after the interim replacement editor Stephen Choi (for the Editor and another senior editor who were fired) and another editor resigned last week. (See the earlier posting for background).

Apparently the recent resignees were no more successful in getting undertakings about editorial integrity or independence than their predecessors. This was despite a March 1 statement by the oversight committee that tried, and failed, to clarify the situation.

The recent controversy at the CMAJ has swirled around Graham Morris. He is rarely put in context in mainstream media reports, other than saying that he is President of CMA Media Inc. But is this not the same Graham Morris who was at one time executive vice-president of English-language publishing at Telemedia, publisher of Canadian Living, TV Guide, Select Homes, Western Living, Harrowsmith Country Life and Equinox before that publishing stable was sold to Transcontinental Media? *

Morris was also one of those who formed the well-known national sales group Procom, later operating inside as Telemedia Procom. In the mid-90s, while he was in the executive suite at Telemedia, he was chair of the Print Measurement Bureau. Between departing Telemedia in 2000 (at about the time it was taken over by Transcon) and taking over CMA Media Inc., Morris was Chief Executive Officer of Tucows Inc., an internet service company based in Delaware and with international reach, but maintaining its executive offices at 96 Mowat Avenue in Toronto.

In most press reports the CMAJ has been referred to as though it was a standalone publication, when, in fact, it is part of a fairly robust publishing enterprise, said to be grossing about $10 million a year and over which Morris presides. According to the CMA annual report this division is actively acquisitive of other specialty publications. Right now, it publishes five(in addition to the CMAJ): the Canadian Journal of Surgery, the Journal of Psychology and Neuroscience, the Canadian Journal of Rural Medicine, the Canadian Association of Radiologists Journal and the Canadian Journal of Emergency Medicine. So the ripple effect of this dispute could be larger than it first appears.

Like many such issues that are said to be about principle, this one seems to be about money. A good deal of what's happening follows directly on the CMA's announcement last November that, henceforth, its publications would operate on a for-profit basis.

The decision was made in principle early in 2005 by the CMA board. Then, in April, Morris was hired to execute the plan and CMA Publications, was sold for $4.2 million to the CMA's financial investment arm, CMA Holdings Incorporated. It was renamed and incorporated as CMA Media Inc.

CMA Holdings is the vehicle through which the CMA operates businesses in software, practice management, insurance, financial and private asset management and investment services.

Ironically, Editor John Hoey, the first person fired at the CMAJ, was quoted in the press release at the time of the "privatization" as saying he hoped the for-profit move would generate money for re-investment in CMAJ so it can retain its status as one of the world's leading medical journals: "If we start running it at a profit, some of those profits will go back into the journal and make it stronger."

CMA Secretary-General Bill Tholl said the decision to sell CMA Publications and put it on a profit-making footing was prompted by reductions in postal subsidies and the possible elimination of unspecified federal grants (which collectively amounted, he said, to roughly $500,000 year), as well as the scaling back of brand-name pharmaceutical advertising, could mean that CMAJ might become a long-term financial drain on the association.

Tholl added that profit-making status would allow certain (again, unspecified) tax breaks and the group anticipates exploring new advertising markets and new revenue streams in the form of new electronic products and expanded international sales, particularly in emerging markets such as China. "We think there's a tremendous opportunity to diversify our revenue sources."

At the time, Morris was quoted saying profits will be reinvested in either acquisitions or the creation of new titles and said he didn't see the need to increase staff at present. "But clearly if we decide to add another publication different from the CMAJ on another topic, then we'd have to get more staff."

Another publication? More staff? The rumour is that the next issue of the CMAJ is in jeopardy because there's nobody available to put it out.

*[Note: an early version of this post referred to Morris's role in the death of Equinox magazine; it has been pointed out that, while the magazine started to decline on Morris's watch at Telemedia, it actually expired after it being sold to Malcolm Publishing of Montreal.]

Circling the wagons at the CMA

The Canadian Medical Association (CMA) has been rocked back by the public and professional reaction to recent events at its Canadian Medical Association Journal (see our earlier stories here and here) and there has been considerable circling of wagons in the last day or so.

For one thing, the CMA has drafted a retired Supreme Court judge, the Right Honourable Antonio Lamer, to chair the magazine's oversight committee and "study the relationship between CMAJ and the CMA, and develop principles to govern that relationship".

In the statement released Tuesday, Dr. Ruth Collins-Nakai, the President of the CMA also announced that Dr. Noni MacDonald, a professor of pediatrics at Dalhousie University and a member of the oversight committee, has been appointed acting editor of CMAJ. Clearly her other responsibilities require some backup. Dr. Bruce Squires, a former editor of the CMAJ from 1987 to 1996, has been named Editor Emeritus to assist Dr. MacDonald. Dr. Squires is also the former Vice-President of the World Association of Medical Editors.

In a radio interview on CBC's As It Happens on Tuesday evening, Dr. Collins-Nakai heaped praise on the new acting editor and went out of her way to say the board had full confidence in the President of CMA Media Inc., Graham Morris. But beyond saying that the public was "only hearing one side of the story", she refused to discuss any details concerning the firing of the editor and the departure of the person tagged to be his replacement.

Morris was quoted in the New York Times attributing the firing to his need to take the journal in a new direction. Now, the CMA seems keen to spin the whole affair as an issue of governance and oversight. No comments are coming from anywhere, however, about the issue of the "privatization" of the CMAJ by the CMA, which immediately preceeded the crisis.

Even the gravitas provided by an overworked former Supreme Court judge (who is still working on a judicial inquiry in Newfoundland that is months overdue) may not be enough oil to pour on these troubled waters.

It seems likely, however, that the CMA will now use Mr. Justice Lamer as an excuse to say nothing until he reports back (it is said, by the end of June). Meanwhile, doubtless, severance negotiations are going on between the CMA and Dr. Hoey, the former editor. And Dr. MacDonald has an issue to get out.

Meanwhile, a few days ago (March 3) the prestigious British medical journal The Lancet posited another possible reason for Dr. Hoey's dismissal (assuming the Mr. Morris's "need for a change" argument is not accepted at face value): it says the firings may have been the result of a series of articles, online and in print on health politics, articles that were particularly critical of the new federal Conservative health minister Tony Clement. Read an account of this in The Toronto Star, including the suggestion that a critical passage in an article was changed to its antithesis.

New freedom for new editor-in-chief of Canadian Medical Association Journal

The Canadian Medical Association Journal (CMAJ) has a new editor-in-chief, the outcome of months of dispute and disagreement over editorial independence.

Apparently, the new editor, Paul Hébert of Ottawa, a critical care physician, will be enjoying not only greater freedom from interference by the association, but also an enhanced budget to improve the quality and quantity of the research that the journal publishes, at least according to what he told the Canadian Press. Dr. Hébert called it "the job of a lifetime"

The CMAJ's reputation took a battering when the long-time editor-in-chief, Dr. John Hoey and his deputy, senior editor Ann Marie Todkill, were fired by the CMA board. The magazine had been "privatized" under a separate division and there were serious disagreements between the editors and the publisher, Graham Morris, over editorial integrity. There were more resignations, including most of the magazine's advisory board and serious talk about starting a rival medical journal, possibly online.

The dispute got the CMAJ a black eye on the pages of the New York Times and the New England Journal of Medicine. Finally, it had to strike an expert panel to look into the issue of governance. Even that didn't run smooth, with the panel chairman resigning partway through for reasons of health. Eventually, Dick Pound, perhaps better known as the czar of the organization fighting doping in sport, took the chair and a report was issued that recommended clear guidelines for the editorial independence of the journal.

The journal has, until now, had an acting editor in chief in Dr. Noni MacDonald, who wrote a departing editorial in the December issue. Dr. Hébert , whose appointment was announced in a release by the CMA, praised her work through the difficult interregnum. "My sense is, let's just move on from here," he told CP.

Here are but some of the previous postings about this tangled affair:

CMA Journal editors fired

New England Journal of Medicine looks north
The money elephant in the corner
Follow the money at the CMA...
CMA accepts recommendations for editorial independence at its journal

Canadian Medical Association Journal editor fired, again

What goes around, comes around it seems, at the Canadian Medical Association Journal, which went through a major crisis in 2006 when the publisher of the journal fired its editor and second-in-command as part of a move to privatize it. A large part of the magazine's editorial board quit as a result, as did several members of the board, moving their support to an online journal, Open Medicine. 

Now, 10 years on, the editor in chief, John Fletcher, has been fired and the publication's oversight committee has been disbanded. The magazine's editor will now report to the board of directors on editorial matters. (The matter of editorial integrity and independence were among the key issues in the 2006 crisis.) The president of the CMA, Cindy Forbes, is quoted in the Globe and Mail saying changes to the journal were the result of falling revenue and declining submissions.  

On Monday, the remaining editors at the CMAJ published an editorial criticizing the CMA for the changes and for suggesting that the journal's reputation is in decline. CMAJ's interim editor-in-chief is Dr. Diane Kelsall.

CMAJ Editor speaks out; says he was fired without cause

The New England Journal of Medicine has published a letter (which it solicited) from Dr. John Hoey, the former editor of the Canadian Medical Association Journal. Dr. Hoey says that, while the CMA refused to give a reason for firing him, his exploration of politically sensitive issues may have led to his dismissal. It was the first time he had spoken or written about the dispute. The CBC website has a report.

While Hoey and his former deputy editor, Anne Marie Todkill, are bound by confidentiality agreements not to talk about the circumstances of their dismissal, Hoey said in his letter that a medical journal must address controversial issues, and to do otherwise would be "irresponsible".

"The notion that politically sensitive topics can be expunged from a medical journal is folly," he wrote.

In a comment accompanying the letter, said the CBC, University of Toronto bioethicist Peter Singer and former CMAJ editor Gordon Guyatt argue that the CMA should reinstate Hoey and Todkill unless it can provide a compelling reason for their dismissals. Singer and Guyatt offered 'a second best alternative' in the event that the former editors are not reinstated.

"The CMA should agree to charge an independent body of highly qualified and disinterested individuals with the selection of a new editor," they wrote.

Meanwhile taking over as head of the blue ribbon panel charged with advising the CMA in the matter (after the premature departure of Mr. Justice Antonio Lamer) is Dick Pound, the head of the World Anti-Doping Agency and a member of the International Olympic Committee.

Non-profit route suggested for medical journal

An interesting article in the Globe and Mail on Saturday by Paul Webster suggested that there is a movement afoot to get away from having Canada's leading medical journal run by by an association with a vested and, in the case of the Canadian Medical Association Journal (CMAJ), a commercial interest.

"The time has come, many researchers say, to rethink how to disseminate Canadian medical research. Support is growing for a fully independent, not-for-profit journal, free from owners with vested interests, and not reliant on advertising income.

"One of the ideas researchers are discussing is modelled on a series of journals published by Public Library of Science (PLoS), a San Francisco-based non-profit publisher launched in 2000 with support from almost 34,000 scientists and start-up financing from private foundations. PloS Biology, the most successful of the six Public Library of Science journals, already boasts having achieved more than twice as much measurable impact among scientists as the CMAJ does."

Read the rest of the article here and read past articles on this blog about the Canadian Medical Association and its journal.

Majority of CMAJ editorial board quits

Fourteen of the 19 members of the Canadian Medical Association Journal (CMAJ) editorial board have resigned. See online story at the Globe and Mail and earlier posts in this blog. Here is the story tonight from the perspective of the Toronto Star.

Journal board defies association board

With the 16 person editorial board vigorously rejecting the course of action chosen by the Canadian Medical Association concerning its well-respected, but imperilled, Canadian Medical Association Journal (CMAJ), there seems to be only two possible trajectories for this story: either the editorial board resigns; or the CMA backs down. No odds on what will happen.

For another perspective, see eminent scientist David Suzuki's column about this story.

Graham Morris, the president of CMA Media Inc and Publisher of the CMAJ might also be beginning to wonder about that warm and tingly spot in his back. That would be the place where the CMA (surgically, of course) would insert the knife if it needs to make a sacrificial offering to get out of this mess. (If you missed earlier posts on this, you can catch up here and here.)

Chair of CMAJ governance panel steps down for health reasons

In yet another loose strand of a story that has unravelled steadily over the past few months, the chair of the panel launched by the Canadian Medical Association to recommend a new governance structure for the Canadian Medical Association Journal has resigned, for health reasons. The panel was to have reported back to the association in June, but that now seems unlikely. Mr. Justice Antonio Lamer, 72, a former judge of the Supreme Court of Canada, was brought in to give some impression of stability after two senior editors of the journal were fired in what seems to have been the result of a dispute sparked by the CMA’s decision to privatize the publication. For background, see earlier posts including here and here.

Meanwhile, the two fired editors, Dr. John Hoey and Ann Marie Todkill, have been awarded the 2006 World Press Freedom award by the National Press Club. "Editors should be free to express critical but responsible views about all aspects of medicine without fear of retribution, even if those views might conflict with the commercial goals of the publisher," Spencer Moore of the press club told the Canadian Press before the ceremony Wednesday to present the $2,000 award.

Hoey and Todkill have not spoken publicly about the specific events leading up to their firing. Both had signed confidentiality agreements before the controversy arose.

However, details of the conflict with journal publisher Graham Morris have leaked out, and led almost all members of the publication's editorial board to resign in protest. Several of the departed board members have said they are actively exploring the possibility of setting up a rival journal, possibly online.

Follow the money at the CMA...

Well, well, well...remember the previous item about money and the Canadian Medical Association? It has been reported by Mastheadonline that the CMA has added a couple of key managers from St. Joseph Media in order to launch a consumer medical title later this year.

The man at the eye of the storm at the Canadian Medical Association Journal (CMAJ), Graham Morris, President of CMA Media, has hired a couple of heavy hitters -- Steve Ball, formerly publisher of Ottawa Magazine, as vice-president at CMA Media, and Blair Graham, formerly executive vice-president, corporate sales at St. Joseph Media (he left last week), to be CMA Media’s director of sales.

Ball will be publisher of Canadian Health, a glossy, 60,000-circ bimonthly to launch this September. Canadian Health will be distributed to 26,000 doctors’ offices across the country and will be edited by Diana Swift, formerly editor-in-chief at Canadian Family and before that a senior editor at The Medical Post.

The money elephant in the corner

The Globe and Mail today somehow managed to write a very long editorial about affairs at the Canadian Medical Association Journal (CMAJ) without ever once mentioning money. And, as has been said before here, this whole brouhaha pivots around the decision earlier this year by the Canadian Medical Association to privatize its prestigious medical journal. That's why Graham Morris was hired as Publisher. That's why the pressure is on not to cheese off the pharmaceutical companies who buy advertising. That's why the Editor and Senior Editor were expendable, since they clearly didn't subscribe to the program of commercialization which was so at odds with what a peer-reviewed, trusted, medical journal does. That's why the editorial board resigned and why they, too, were treated as so much flotsam by the President of the CMA. That's why the even-more-prestigious New England Journal of Medicine published a very strongly worded piece about the whole affair. To repeat, when they say it's the principle, not the money...it's the money.

New England Journal of Medicine looks north

The prestigious New England Journal of Medicine (NEJM) has published a detailed article about the uproar at the Canadian Medical Association Journal. The article, called Politics and Independence: The Collapse of the Canadian Medical Association Journal, and which will be published in the print version of the journal on March 30 will doubtless crank up the heat on the CMA's board and its beleagured caretaker editors.

The article is authored by Dr. Miriam Schuchman, of the Department of Psychiatry at the State University of New York (SUNY) Buffalo and Dr. Donald A. Redelmeier, a professor of medicine at the University of Toronto and a member of the CMAJ Editorial Board. It contains details and scene-setting that could only have come from individuals very close to the matter, including one anecdote about a nasty confrontation between the Chair of the CMA and Anne Marie Todkill, the Senior Deputy Editor who, along with Editor John Hoey, was later fired. It also gives background and context to the dispute that has not been published in the newspapers.

For details, read the article and earlier items posted here and here and here. But it is worth noting that yet another editor has resigned from the journal, this time Associate Editor Claire Kendall of Ottawa.

The CMA itself is saying nothing. But if they expected stonewalling on the firing of its two top editors was going to make the matter go away, having chapter and verse reported in one of the world's most widely quoted medical journals makes it a vain hope. The interest of the NEJM is reported at length in the Toronto Star. And around and around it goes...