TORONTO -The upheaval at Canada's internationally acclaimed medical journal continued Thursday with another blood-letting - this time with the en masse resignation of most of the publication's editorial board.
Fourteen members of the Canadian Medical Association Journal's 19-member board tendered their resignations, the latest move in an ongoing battle with the journal's owner, the Canadian Medical Association, over the issue of editorial independence.
The 14 joined Dr. Jerome Kassirer, former editor of the New England Journal of Medicine, who resigned earlier this week. Steve Shumak, a part-time editor at the journal, also quit Thursday.
The latest hemorrhage of personnel not only threatens the CMAJ's continued ability to operate, but also erodes consumer and professional trust in the country's premier vehicle for medical information and reasoned debate on health-care issues, experts say.
In a letter to CMA president Dr. Ruth Collins-Nakai, the departing editorial board members said they don't believe the organization is committed to ensuring the journal's autonomy in the wake of last month's firings of editor Dr. John Hoey and senior deputy editor Anne Marie Todkill.
"We believe your recent actions and pronouncements regarding establishing editorial autonomy are largely cosmetic and unlikely to lead to an independent and free voice for health-related issues in Canada," they wrote.
Dr. P.J. Devereaux, spokesperson for the departing board members, said the CMA and newly appointed interim editor-in-chief Dr. Noni MacDonald have shut out the editorial board, refusing to respond to their attempts to be involved in the rebuilding of the journal.
"We'll keep pushing for our objective," Devereaux, a cardiologist from McMaster University, said from Hamilton. "There's no question they'd love us to go away. We're not saying we're going away, but we don't want to lend our credibility to the journal."
MacDonald said she wasn't surprised by the resignations.
"They look at it as a protest," the pediatric infectious disease expert said from Halifax.
"It's a real shame that some of them have chosen not to want to put their shoulder to the wheel to push this journal up and along while we're waiting for this governance review to happen," she said, referring to a scrutiny of the relationship between the CMAJ and its owners by Antonio Lamer, former chief justice of the Supreme Court of Canada.
Four members of the editorial board did not tender their resignations, including Edmonton cardiologist Dr. Paul Armstrong, who has been involved in the effort to ensure the independence of the journal.
"I think the journal is a very important instrument for the country and internationally," Armstrong said Thursday. "I've often referred to it as the glue that holds the medical profession together in terms of appearing on physicians' desks.
"It's my view that it's too good to let it die and it's premature to call it quits."
Armstrong said he will remain on the board for at least 90 days - until Lamer submits his report and recommendations.
Armstrong said that having a world-class medical journal that can provide timely, unbiased health information is critical for Canadian doctors and their patients.
"The journal reports key scientific information that affects the public and public health - and the public needs to be confident that the quality of the data, the peer-review process, the accuracy, the integrity of the information that's appearing can be trusted."
Amir Attaran, a professor of law and population health at the University of Ottawa, said he fears the journal may be "going down the pipes."
Under Hoey's leadership, the CMAJ earned the reputation as one of the top five scientific journals worldwide, he said.
"This is a jewel in the crown of being Canadian and the CMA has squandered it," accused Attaran, an editorial consultant to the prestigious scientific journal The Lancet.
"Whether it deserves to survive isn't a question of nostalgia or resurrection of the dead. The question is whether it will have the independence and whether the CMA will have the intelligence and sensitivity to grant it the independence so that it could survive.
"If it doesn't get the independence, then of course it will perish."
But MacDonald brushed aside the notion that the CMAJ is at risk of losing its hard-won credibility or of disappearing altogether. She said she has hired two new editors and is in talks with two others to join staff. (After the firings, three editors quit; the three remaining associate editors said in an online editorial Thursday they are staying at the journal.)
"This is a 95-year-old journal," MacDonald said. "It has a national and international reputation. . . And you can't let this flagship founder and fall away just because we've got this dispute going on."
