David Stonehouse News

Doctors, journal in feud over freedom

MDs, Journal in feud over 'independence': Medical association

By David Stonehouse

The editorial board of the country's pre-eminent medical journal is accusing the Canadian Medical Association of threatening its independence by demanding the journal retract an editorial critical of Quebec doctors.

The president of the association, which owns the Canadian Medical Association Journal, demanded the journal withdraw an editorial he called seriously flawed and "repugnant," the editorial board said.

In a letter in the edition of the journal out today, 20 members of the board said Dr. Dana Hanson's demand menaces the fundamental right of the journal to voice its opinion without fear of retribution.

"These actions are a threat to the editorial independence of the journal and represent a clear and present danger," warns the letter.

The journal refused to retract the editorial, an unsigned commentary on legislation in Quebec compelling doctors to serve emergency-room duty. It accused doctors in Quebec of breaking the trust of their patients -- a stance diametrically opposed to the association's vehement opposition to Bill 114 as a violation of physicians' rights.

Although the editorial did not come out in favour of the bill, it criticized doctors in Shawinigan-Sud after a hospital emergency room had to shut down just before the arrival of a 51-year-old man having a heart attack. The ambulance was diverted to another hospital 30 minutes away, and the man died en route.

The Sept. 17 editorial hinted that the Quebec government was forced into legislating emergency-room duty by the doctors' themselves.

"The physician-patient relationship is based on trust, the physician government relationship on necessity," it said. "Physicians broke that trust by not staffing the [emergency department] of such an important regional hospital. Re-establishing that trust will require patience, determination and perhaps some sacrifice."

In a letter to the journal last month, Dr. Hanson called that an " unwarranted attack on the whole profession." The association president criticized the editorial for failing to recognize both the "exceptional efforts" of doctors in Canada's weakened health care system and the demands on ER physicians in Quebec.

"Based on these serious flaws," he wrote, "the conclusion that physicians have betrayed a trust which we all hold at the very heart of medicine is repugnant. Our colleagues in Quebec deserve a retraction."

The letter responding to that demand has launched a debate about improper influence. "Excellent journals should be at the heart of medical debate and provide thoughtful, informed synthesis and both balanced and prudent opinion," the editorial board says.

"Whether or not one agrees with the opinions stated in the Sept. 17 editorial is not the fundamental issue here: rather, it is the right to articulate such an opinion without concern for retribution by an organization or corporation that holds ownership or operating
responsibility for the journal."

Dr. John Hoey, the editor of the Canadian Medical Association Journal, said yesterday the president's demand for a retraction was encroaching on the publication's independence.

"It clearly was a threat. Asking for a retraction is not a threat, but there was some hostility. It is quite interesting -- the editorial was published and I think it was two weeks' later that the CMA noticed it. It wasn't immediate."

But it did provoke anger among the board of directors of the medical association, Dr. Hoey said.

Dr. Hanson denied the association tried to fire or demote senior editors over the article, but the group did set up a committee to oversee journal operations. Both sides say that is not an effort by the association to assert greater control over the publication.

"Actually, it is probably the reverse. But I won't know that until after the oversight committee makes its initial report back to the board," said Dr. Hoey, who will be attending the first meeting of the committee today in Toronto.

Instead of reporting to the association on editorial matters, he will now report to the committee.