Editorial controversies and courage:
pushing the envelope in medical journalism

Andrew A. Skolnick

Standing ramrod-straight behind the podium, the American Medical Association's new CEO, E. Ratcliffe Anderson Jr., M.D., stunned a crowd of reporters by announcing that he had fired the editor of the Journal of the American Medical Association for publishing a study on sex.

Editor George Lundberg, M.D., widely credited with turning a somnambulant house organ into one of the world's top medical publications, was suddenly gone, baffling the reporters at the AMA press conference. On Jan. 15, 1998, five days before the sex study was published, Anderson, a former surgeon general of the United States and an Air Force and Vietnam fighter pilot, explained why he unceremoniously jettisoned Lundberg: for "inappropriately and inexcusably interjecting JAMA into a major political debate that has nothing to do with science or medicine.... JAMA's hard-earned reputation is based on its editorial independence and integrity, and we intend to keep it that way."

Lundberg provided reporters a steady flow of news stories and occasional controversies, which sometimes rocked the boat of the AMA's conservative leaders. Nevertheless, during his 17-year editorship, JAMA rose up to challenge the New England Journal of Medicine and Lancet in importance while generating millions of dollars of advertising revenues.

The study1 that gave Anderson a pretext for cutting off the editorial tail that so often wagged the dog was an analysis of data from a 1991 survey of what students at a Midwest university thought constitutes "having sex." Nearly 60 percent of the students surveyed did not define oral sex as having sex. Like many other timely articles, this study had been "fast-tracked" into print. While such information could help researchers and clinicians who take medical histories, it was of even greater interest to those involved with the impeachment of President Bill Clinton. A main charge was that the president had perjured himself by testifying that he never had sex with Monica Lewinsky. However, according to the study by researchers at the Kinsey Institute for Research in Sex, Gender, and Reproduction, in Bloomington, Ind., more than half the sample population appeared to share the president's definition.

The reaction among journalists, researchers, and academics was almost unanimous condemnation for Anderson and the AMA. Even a former AMA board chairman expressed outrage: Raymond Scalettar, M.D., accused the association of firing Lundberg to appease the Republican-controlled Congress. Although the AMA denies political partisanship, federal campaign finance reports showed that contributions from the AMA's political action committee favored Republicans two to one (donating $9.3 million to Republican House and Senate candidates since 1989, compared with $4.8 million to Democrats).

Several other recent studies also stirred the AMA's waters. On Nov. 11, 1998, JAMA published a theme issue on alternative medicine, which many critics said was soft on science and big on hype for unproven remedies. The journal and Lundberg had been bashed by the other side, too: On April 1, 1998,2 JAMA published a study that tested the ability of therapeutic touch practitioners to feel an "energy field" that surrounds people. Even more unusual than the subject matter, one of the authors was 9 years old when she began the study as a fourth-grade science fair project.

With the advice of her coauthors (her mother, Linda Rosa, B.S.N., R.N.; Larry Sarner; and Stephen Barrett, M.D.), Emily Rosa devised and conducted a simple test. Since she was a schoolgirl doing a science project, she was able to do what no one else could do before or since: induce 21 therapeutic touch practitioners to let her test their ability to sense a purported energy field. The test required the practitioners to sit behind an opaque screen and announce which of their hands was under the child's hand. (Which hand Emily placed hers over was determined by a coin toss.) All the practitioners claimed they could feel her energy field, but under blinded conditions none performed better than chance. Yet millions of dollars are charged each year by more than 40,000 therapeutic touch practitioners in the United States, who wave their hands over patients and claim to induce healing by smoothing out "unevenness" in their energy fields.

The study received widespread publicity with the help of an AMA press conference. Reaction ran from huzzahs for the child who revealed the naked emperor to charges of fraud and media grandstanding. The study was even a subject of derision for a speaker at the "Breakthrough?" conference, Ellen Ruppel Shell. Speaking as a mother, she said, the work of schoolchildren should be placed on refrigerators, not in prestigious medical journals.

Steven S. Ross, associate professor of professional practice at Columbia's Graduate School of Journalism, disagrees. "I think the study was perfectly valid," he says, "although I think AMA's press conference and promotions were theatrical and milked it. It wasn't a huge or sophisticated study, but it was the best that could be done and probably the only one that will ever be done, because therapeutic touch practitioners are not willing to test their claims. Because it is the best study ever done, you publish it. If any critics have a problem with it, they should replicate it and try to prove the findings wrong." While therapeutic touch proponents continue to cry foul,3 no one has come forth to repeat the study.

Ross also defends the sex study as a valid contribution to debate. "It underscored the reality that what some people consider is 'having sex' is not considered having sex by others," he says. "The study helped to raise doctors' awareness of this problem when taking a medical history." Kenneth Goldstein, professor emeritus at the journalism school, agrees. "One important object for medical journals is to help doctors understand their patients' needs and fears better," says Goldstein. "Doctors need to know what is going on so that they're not practicing in a closet."

"Every good editor wants to be interesting, and that often requires being controversial and pushing the envelope," Ross says. "Journal editors have to take chances. But they have to be clear about it when they are standing on firm ground and when there may be a lot of air beneath their feet. Mistakes will be made. But honest mistakes are legal and should not be punished."

"If they don't take chances," adds Goldstein, "they are not being editors; they are being copy editors. They are not using their publication to the full advantage of its readers. Waiting for information to become certain is the job of encyclopedia editors, not the editors of journals."

1. Sanders SA, Renisch JM. Would you say you 'had sex' if... JAMA 281 (1999): 281: 275-277.

2. Rosa L, Rosa E, Sarner L, Barrett S. A close look at therapeutic touch. JAMA 279 (1998): 1005-1010.

3. Freinkel A, Collins SB, Carpenter J, et al. (letters). An even closer look at therapeutic touch. JAMA 280 (1998): 1905-1908; Good RM et al. (letters). A close look at standards for therapeutic touch. JAMA 282 (1999): 135. [N.B.: Changes in the online edition of JAMA have disabled retrieval of full text of pre-1999 articles.]

Related links...

  • Glass RM, Fontanarosa PB, Rennie D, et al., JAMA and editorial independence. JAMA 281 (1999): 460. (Statement by JAMA editors and others in support of Lundberg and disagreement with Anderson's decision to fire him.)

  • Horton R. The Sacking of JAMA (editorial), BMJ 318, no. 7177 (January 16, 1999; supplement in web edition only)

  • Chavkin W. "Science and Editorial Independence, American Style" (editorial), Journal of the American Medical Women's Association 54 (Spring 1999): 59

  • Does Therapeutic Touch Work? (Links pro and con, collected by Eric Krieg, Philadelphia Association for Critical Thinking)

  • "Therapeutic touch" fails a rare scientific test. Press release by the Scientific Review of Alternative Medicine, March 24, 1998.

  • ANDREW A. SKOLNICK, a Forest Park, Ill.-based free-lance science journalist and graduate of Columbia's Graduate School of Journalism, worked as an associate news editor for JAMA for more than nine years. In September 1999, he and two colleagues from the St. Louis Post-Dispatch were awarded Amnesty International USA's "Spotlight on Media" award for their series on bad doctors and deadly health care in jails and prisons.

    Photo Credits George Lundberg, M.D.: AP / Wide World Photos
    E. Ratcliffe Anderson Jr., M.D.: AP / Wide World Photos
    President: AP / Wide World Photos
    Emily Rosa: Scientific American Frontiers Program. Photos used with permission.