Bruce Japsen
Chicago Tribune Staff Writer
February 17, 1999

Ex-Editor Blasts AMA Interference

The former editor of the Journal of the American Medical Association said Tuesday he and his editorial staff endured constant pressure, threats and intimidation from AMA leaders, members and its lobbyists in Washington during his 17-year reign as editor of the Chicago-based medical group's prestigious journal.

In his first interview since he was fired as JAMA's editor Jan. 15, Lundberg described an almost daily struggle to resist pressure from forces at the AMA to strip the journal of its editorial independence.

"I don't think a day went by in considering what to publish that I and my editorial staff didn't have to worry about offending AMA members, AMA politicians and the AMA Washington office by what we published," Lundberg said.

Editorial independence can help imbue a publication with credibility, and it is especially important for a publication like JAMA, which produces articles that are widely reported in the mainstream press and that can affect the practices of doctors and habits of patients.

Speaking from his downtown office at Northwestern University's Institute for Health Services, Research and Policy Studies, Lundberg said there were often telephone calls from irate AMA members and letters from state medical societies and AMA officers "threatening political action against the editor and the Journal for publishing what offended them ideologically, or more likely imposed on (physicians') ability to earn money."

The AMA declined to address Lundberg's comments.

After the AMA summarily dismissed Lundberg last month, the association and Lundberg reached an undisclosed settlement that labeled his departure a retirement. Earlier, the association said it had fired him for "inappropriately and inexcusably interjecting JAMA" into the presidential impeachment proceedings by publishing a study on how Americans define "having sex."

Although Lundberg wouldn't talk about his dismissal, settlement or the article in question, he spoke freely about what he said were regular efforts by the AMA during his tenure to thwart JAMA's independence. He wouldn't provide names or dates of such incidents.

Lundberg said lobbyists called, asking whether he was "on the same team" as the AMA. "They (would) say, I hear you're going to publish a paper on such and such," Lundberg recalled. "My response was we can neither confirm nor deny the existence of such a paper because it's a secret. Their answer was: Aren't you playing on the same team as us?"

AMA public relations staffers would make efforts to obtain copies of JAMA articles prior to publication so they could "spin them for the AMA's corporate interests," Lundberg said.

Lundberg, a pathologist, said JAMA also enraged physicians with articles on physicians doing basic tests in their own offices, where, JAMA reported, errors were more likely than in hospitals or labs. Physicians made money from office tests, so they didn't like those articles, he said.

"The editor's job is to edit the journal for patients," said Lundberg, 65, who commutes weekly to Harvard University, where he is an adjunct professor of health policy, and who is now a lecturer at Northwestern University's medical and journalism schools.

But Lundberg said he was able to scare off threatening forces by telling them that the content of JAMA wasn't their concern.

Lundberg said JAMA went on to challenge Wall Street, the federal government, the tobacco lobby and the auto industry, all of which were at one time subjects of critical articles.

"You start with hard data, and we rarely took anything on in a serious way without data," Lundberg said. "The essence of a general medical journal is, in addition to publishing clinical articles and research articles, to inform the public policy debate with data."

Lundberg said JAMA's editorial independence was protected, in large part, because of support he had of the editorial board and strong peer-review journals.

"The way the editor protects him or herself is (with) an editorial board with the best people who will stand with you," Lundberg said. "Key role of editor in chief is to secure the integrity of the publication by any means necessary."

Lundberg may have been pressured more than other medical journal editors because of his publisher's deep involvement in national politics. The AMA in 1997 spent more money on lobbying than any other organization or business, according to research by the Washington-based Center for Responsive Politics.

Lundberg said that the AMA's political activity and its commercial interests are helping undermine the organization and its credibility with physicians. He asserted that the AMA and its membership is in a "death spiral" since its disastrous 1997 product endorsement pact with Sunbeam Corp. and its decision to support a Republican bill in Congress to ban certain late-term abortions.

Lundberg's firing may be taking a toll, too, according to an internal survey the AMA did of its members and other physicians after his dismissal. The survey said, "The majority of physicians (52 percent) think the dismissal of Dr. Lundberg will have a negative impact on JAMA."

In addition, the survey found that before learning of Lundberg's departure, one in three physicians were "very likely to join or renew" their memberships. Following the flap over Lundberg's ouster, that renewal figure dropped to 24 percent.

"The bottom has dropped out of organized medicine in America, if you measure it by membership in the AMA," Lundberg said. "When more than two-thirds of American physicians say, 'I don't belong,' you have more than a megatrend; you have the definition of futility."

To repair the damage to its credibility, Lundberg said, the AMA should invite all doctors to a national conference to reshape organized medicine.

Lundberg said JAMA and the AMA are important to the public at large because they are better positioned than other organizations to protect the interests of patients.

"Patients must trust their physicians, and the public needs to trust an AMA," Lundberg said. "Who else are they going to trust . . . investor-owned hospitals, the government or managed-care companies? (JAMA) is operating professionally on the side of the patient. That's why they should care."