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You're Nobody 'til You're Snubbed

April 9, 2009

What started as one professor’s spat with an esteemed medical journal has transformed into something of a branding opportunity for a fledgling medical school in Harrogate, Tenn.

The Lincoln Memorial University-DeBusk College of Osteopathic Medicine opened its doors less than two years ago, but in recent weeks it has been getting press in The Wall Street Journal, The Washington Post and The New York Times. The articles concern a Lincoln Memorial professor who exposed conflicts of interest in an article published by the The Journal of the American Medical Association and subsequently provoked the wrath of JAMA’s editors for spreading his story to the media and another journal. Charges that the editors sought to intimidate Lincoln Memorial officials have prompted an investigation by the American Medical Association’s oversight committee, and the university has

Photo: Western University of Health Sciences

Jonathan Leo, an associate professor of neuroanatomy at Lincoln Memorial University, is at the heart of a controversy with JAMA.

garnered some newfound name recognition in the world of academic medicine.

“I have gotten e-mails from people all over the country – professors, researchers, college students – in support of this, saying ‘Thank you for doing this,’ ” said Jonathan Leo, an associate professor of neuroanatomy at Lincoln Memorial, who brought the conflict of interest charges to light.

While the substance of Leo’s allegations have drawn public attention, the ensuing feud between JAMA’s editors and the professor may have broader implications for the reputation of Lincoln Memorial. The university is drawing praise in some quarters for standing behind a professor, even as the editor of one of the most powerful journals in all of academe pressured administrators to silence Leo or risk being “banned” from the journal, according to the his dean.

Ray Stowers, vice president and dean of the college, said he believes that JAMA’s two top editors, Catherine DeAngelis and Phil Fontanarosa, thought they could pressure Lincoln Memorial administrators in part because the medical school is young and eager to have a good relationship with the journal.

“I think that was very much intended to be the strategy there, but it just didn’t work,” Stowers said.

DeAngelis, editor in chief of JAMA, “is not commenting on this story anymore, because the oversight committee is doing their review,” according to Jann Ingmire, spokeswoman for the journal.

Dean, President, Board Backed Prof

Leo notified JAMA editors in October that the author of a journal article published in late May had failed to disclose ties to a drug company he’d written about. Leo took an early interest in the article, which concerned the effectiveness of antidepressants among stroke patients, because the article did not indicate that there were no significant differences between the effects of antidepressants and behavioral therapy.

Along with a co-author, Leo wrote a letter that was published in JAMA Oct. 15 that pointed out the article's omissions. But it wasn't until later, through a Google search, that Leo discovered the author's potential conflict of interest. Frustrated with the pace of JAMA’s response to the allegations he aired about the conflicts, Leo published a piece about his concerns five months later on the Web site of BMJ, a British medical journal.

Leo’s piece in BMJ noted that Robert Robinson, a University of Iowa psychiatrist who wrote about the drug Lexapro for JAMA, had failed to share that he’d received speaking fees from Forest Laboratories, producer of the drug. JAMA editors, who acknowledged the conflict in a print edition six days later, published a subsequent editorial criticizing Leo’s preemptive publication as a “serious ethical breach of confidentiality.”

The editors also unveiled a new policy, noting that persons making conflict of interest claims will be directed to not reveal such allegations to third parties, including the media. Furthermore, the journal will publish the findings of its investigations online immediately, rather than waiting to air them in print, the editors said.

While the editorial published by DeAngelis and Fontanarosa acknowledges the importance of exposing conflicts of interest, much of the piece is devoted to defending the editors’ handling of Leo. The editors acknowledge, for instance, that they contacted Leo’s dean, hoping for his “assistance in resolving this issue. …”

“Our tone in these interactions was strong and emphatic, reflecting just how seriously we take the responsibly to ensure a fair process of investigation and above all, to protect the integrity of science and the reputation of JAMA,” the editors wrote. “We regret if anyone involved in these communications interpreted our intentions any other way.”

Stowers, Leo’s dean, certainly interpreted the intentions differently. He says editors pressured him to force Leo to retract the BMJ letter, even though they couldn’t point to any inaccuracies within it -- and still haven't done so. In a March 11 e-mail, published in The Wall Street Journal and verified as authentic by Stowers, DeAngelis wrote “I don’t want to make trouble for your school, but I cannot allow Jonathan Leo to continue to seek media coverage without my responding. I trust you have already or soon will speak with him and alert me to what I should expect.”

The e-mail followed a phone conversation in which DeAngelis said “she would hate to have to ruin the reputation of our school or us,” Stowers said.

As pressure mounted from JAMA, Stowers says he consulted officials at the highest levels of the university for their opinions. They told him not to budge.

“I discussed this with both the president and the chairman of the board of directors of Lincoln Memorial University here, and both were completely supportive of my stand to back John,” he said. “Because I wanted to be sure -- with LMU and the DeBusk-College of Osteopathic Medicine name going out there -- that I had the administration’s complete support in this.”

There’s been some speculation on campus about whether the whole episode with JAMA might have played out differently if Leo were a professor at another institution – say Harvard Medical School. That speculation was fueled in part by disparaging comments attributed to DeAngelis, who called Leo a “nobody and a nothing … trying to make a name for himself,” according to the Wall Street Journal. DeAngelis denied making the comment in her editorial, but the Journal has made no corrections or retractions.

“We are standing by our story,” Robert Christie, vice president of communications for Dow Jones & Company, said in a Tuesday e-mail.

The cutting remarks attributed to DeAngelis suggest an elitism that’s wholly out of touch with JAMA’s audience, Leo said.

“I do think she insulted her readers with that [comment],” he said. “I think most of her readers would fall under the classification of nobodies. … Most of the readers are not the Harvard, MD, PhD. The authors might be; the readers are not.”

Leo’s fight, and the administration’s defense, has set the campus abuzz. Shane McRaven, a med student who calls Leo “the best professor I’ve ever had,” said he’s glad to know the university acted as it did.

“I think it’s great that they didn’t look [at this situation] and say ‘Hey, it’s a new school and we have to think about reputation,’ ” McRaven said. “Their reputation is about standing up and doing what’s right.”

 

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