A scanadal at a medical journal reflects the longstanding debate over public and private health care systems.
Michael Moore might sing the praises of a utopian Canadian health care system in his latest doc Sicko, but he cheerfully admits fitting his camera with rose-tinted lenses when it comes to those systems outside of his line of fire - that is, anything other than the United States (for purely comparative reasons, he says).
Leaving aside directorial discretion, when it comes to health care, the Canadian system is no stranger to controversy and commentators are cacophonous, rather than harmonious, on the big profit vs. non, private vs. public debate.
The Canadian Medical Association, a national lobby, advocacy and policy group counting thousands of members, came under harsh light in 2006 in a scandal that played out across national media when the association fired the editor-in-chief and deputy-editor of the country's most prominent medical publication, the near-century-old CMA Journal (CMAJ). The CMA, which owns a number of companies that provide services to its members, is also the journal’s publisher.
The battle quickly went from brewing to all-out as 14 of 16 CMAJ board members resigned in protest of the firings, leaving the CMAJ's future and professional legitimacy in question. Accusations of censorship and pressure tactics sprang up, as well as threats of the journal's dissolution without adequate support from the medical community.
The background to the conflict lies in an alleged dispute over editorial independence. The two editors found themselves out of a job close on the heels of conflicts with the CMA over journal content. Coverage at issue included op-ed positions, and stories about controversial issues such as access to the "Plan B" birth control pill and an incident where a man died after finding a local ER closed. The CMA maintained that the firings had nothing to do with editorial content.
Medicine, politics
The CMAJ saga is, in a small way, reflective of the main competing models for health care in North American society. The journal board members alleged that the CMA did not prioritize accurate scientific reporting and best public health interests over other concerns, such as market competitiveness and appeasing advertisers or government health officials (the CMAJ transitioned to a for-profit model around 2004). It’s the same old conflict between the need to be competitive and profit-driven within the North American economy, and the essentially humanitarian presuppositions this same society links to the practice of medicine.
This case resulted in an independent review of CMAJ governance, with a panel that reported in July 2006. The panel issued a final report with 25 recommendations, including
- Ammending the CMAJ's mission statement to include a statement on editorial integrity, independent of special interests, including room for disagreement with the CMA itself
- Proposals for restructuring the Journal Oversight Committee, outlining the process by which the editor-in-chief could be dismissed, saying that "the purpose for inserting this recommendation is to increase the security of tenure of the [editor-in-chief] and to facilitate editorial independence."
The panel also made suggestions about ways the CMA could clearly differentiate itself from editorial opinions found in the journal and recommended that the journal should give the CMA limited notice about upcoming, possibly controversial content.
The conflict also resulted in the creation of the open-access, not-for-profit journal Open Medicine, whose editors include some of the members who resigned from the CMAJ board. Open Medicine's inaugural issue was published in April 2007.
See also: Defining Open-Source
