FYI - JAMA restrictions on new information

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Dr. Lundberg who criticizes JAMA in this article was an editor ofJAMA before he was fired last year. He's now an editor of Medscape. Monday, December 18, 2000JAMA Restricts Scientists Research * Medical association journal bars release of unpublished datato news media.By BENEDICT CAREY, Times Health Writer Medical news now flies so quickly from the laboratory to ourlaptops and newspapers that one prestigious medical journal has decidedit's time to apply the brakes. In an editorial published last week in the Journal of the AmericanMedical Assn. (JAMA), the journal warned authors who submit papers notto talk to reporters about their work in any detail before it'spublished. The editorial, co-authored by Dr. DeAngelis, thejournal's editor, said that researchers "must refrain from grantinginterviews with the news media about the information underconsideration," unless the journalist agrees not to report it beforeJAMA does. DeAngelis said the editorial was no more than a clarification ofexisting policy. "We aren't interested in controlling the information,"she said, "but we are very interested in controlling the quality of theinformation, and researchers who want to publish in JAMA should knowthat." But some were surprised at the sudden appearance of the policystatement and said its strong language could restrict public access tonew medical findings. For example, the editorial is particularly strictabout what investigators can and cannot say at scientific meetings, theopen forums where new data often are first presented and discussed."Authors who present information contained in a manuscript that is underconsideration by the journal . . . should not distribute completereports or data presented as tables and figures to conference attendeesor journalists," it says. "I just don't agree with that," says Dr. Lundberg, who wasJAMA's editor for some 17 years before being fired in 1999, after heapproved publication of a controversial sex survey during the Clintonimpeachment 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 oninvestigators, such as testimony before government agencies and urgentpublic health news. But overall, said Lundberg, the journal's newlystated policy is "heavy-handed" and more stifling in tone than the onein effect during his own tenure at the JAMA. Traditionally, journals such as JAMA, the New England Journal ofMedicine and the ls of Internal Medicine have acted as valuablefilters, not only separating good studies from junk science but forcingleading researchers to think through--and sometimes change--theirconclusions. These journals still orchestrate coverage of most importantmedical findings, feeding reporters press releases, original data andsources for comment. DeAngelis acknowledges that the last 10 years have brought enormouschanges. "It's not only the Internet," she says. "There are also a lotmore of these scientific meetings where researchers discuss theirfindings before they have appeared in a peer-reviewed journal." Andthere are more medical reporters, particularly from online sites, takingthat information straight to the public. That has helped intensify pressure on the print journals to publishmore quickly, said Dr. off, editor of the ls of InternalMedicine. "There's been a lot of discussion about publishing stuffASAP--as soon as it's publishable," he said. "We know we can knock about10 weeks off the time it takes to get studies into print. But we alsoknow that howling errors can slip through when you do that." Certainly, most doctors can cite instances in which journalistserred in their reporting of new scientific findings, or when stories andheadlines overstated the significance of the research. The "cures" forcancer 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 editorialappears in the same issue as a Yale University study demonstrating howsurgeons misread bulletins from government researchers. In 1991, andagain in 1994, the National Institutes of Health issued clinical alertsinforming doctors that an operation called carotid endarterectomy, orCEA, reduced the risk of strokes in people prone to suffer them. The number of CEA surgeons performed rose significantly after bothannouncements, according to Dr. Cary Gross, the study's lead author. Yetdespite clear warnings by the NIH that the procedure was not recommendedfor patients over age 80, says Gross, many doctors operated on suchpatients 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. "Ithink doctors looked at the new data on this procedure and said, 'Hey,it looks good, let's try it,' without paying much attention to thedetails." Gross said the study offers no evidence that misleading reportingin the popular press resulted in public misunderstanding of the NIHalerts. On the contrary, he said, most news reports about CEA includedwarnings that the operation was risky in patients 80 years and older.Nonetheless, enthusiasm for the CEA procedure cooled only after the NIHstudies appeared in full-text, peer-reviewed journals. "The primary source journal article is still the best you can dofor a given study," says Lundberg, who now edits the online journalMedscape.com. "There's been time, reviewers have looked at it, there'sbeen an opportunity for editors to look carefully at the wording. Butall of this is being done faster now, and I believe that JAMA and otherjournals following these restrictive policies are charting the coursetoward self-extinction. You can't stop progress."* * * To read the full text of the JAMA editorial and the Yale study, goto the journal's Web site jama.ama-assn.org/issues/current