Discussing the Future of the Journal

After the two editorials describing the threats to the integrity of the Croatian Medical Journal (CMJ) (1,2), some of our colleagues in Croatia were concerned that it might not have been appropriate to use Journal’s pages to document events surrounding the current disputes about the Journal. Our answer is simple: we followed the practice of the most prestigious medical journals, which are members of the International Committee of Medical Journal Editors (ICMJE).

When the American Medical Association (AMA) dismissed Dr George D. Lundberg from the position of the Editor of JAMA in 1999 (3), the journal published opinions of both the editors (4) and the readers (5). In response to the public interest, the AMA assembled a committee to evaluate the organization of its journal(s), especially the safeguards for insuring editorial independence. The committee came up with a new governance plan for JAMA, which guaranteed “editorial independence, fiscal accountability, and journalistic responsibility” (6). The new editor (7) emphasized the importance of editorial freedom and invited the readers and authors of JAMA to share their expectations and ideas about the journal (8). A few years later, the editors published an update on JAMA editorial governance plan (9).

The New England Journal of Medicine (NEJM) also reported on the departure of its editor, Dr Jerome P. Kassirer, in 1999. Before the owner of the NEJM, the Massachusetts Medical Society, decided not to renew his contract, Dr Kassirer published an editorial emphasizing editorial independence as a critical issue for medical journals (10). The interim editor of the NEJM, Dr Marcia Angell, described the disputes between the former editor and the NEJM's owners about the use of the journal's name to promote other products and about moving the journal's editorial offices to a new location, as well as the agreement reached between the owners and the editors on the terms for ensuring that the NEJM continues to be a “unique and independent institution” (11). The journal also published letters commenting on the departure of Dr Kassirer, together with his reply and the reply from the journal's owners (12).

Based on these experiences, the CMJ formulated a formal agreement on its governance (13), signed by the 4 owners of the journal in 2004.

In 2006, the Canadian Medical Association Journal (CMAJ), another member of the ICMJE, also experienced a serious dispute between the editors and its owner about editorial freedom. The editors reported a breech of the editorial autonomy of the journal, invited the owners to present views, and established an independent advisory group to examine the CMAJ's editorial autonomy and journal's governance structure (14). The editor-in-chief and senior deputy editor were fired by the owners, but this prompted the development of a new governance plan for the journal (15). The statement from the owners was published in the same issue as the statement from the editors (16) and the findings of the advisory committee (17).

When one of the CMJ's owners questioned the quality of the journal and the work of its editors, we decided that the journal would be the best place to discuss the problems and recent developments, as well as the place to record the eventual outcome (1). We followed the advice of the former NEJM's editor, Dr Kassirer: “In the final analysis, the judges of the quality and usefulness of a journal are subscribers, readers, and authors who submit their work for publication.” (10). It can be argued that editors misuse their position if they use journal pages to defend themselves in a dispute with their owners without allowing other participants in the dispute to give a proper response. As our colleagues from other ICMJE journals did in similar situations, we invited all stakeholders to voice their opinions in the journal (1,2). We received many letters, but not any communication from the Dean of the Zagreb School of Medicine, despite our official invitation in the journal and by mail (1).

The CMJ’s position is specific, as it is a journal owned by 4 public institutions and receiving financial support from public funds. It can be argued that the journal’s primary duty is to the public, ie, to tax payers who finance the 4 medical schools and the national funds for scientific publications. We believe that leaving the discussion on the quality of the journal and the work of its editors to a committee of the owners has the serious disadvantage of making it closed to the public, and that such an approach to discussion and the conclusions made in such a way are ethically more questionable than a transparent presentation of the case by all sides in a public forum. This is the reason why we published the two editorials, and why we continue to inform our readers about all developments related to the Journal.

One owner proposes to change the governance agreement on the CMJ

On March 25, 2008, at the Deans' Conference in Split, the Dean of the Zagreb School of Medicine, Prof. Nada Čikeš, formally proposed changes to the Agreement on the Governance of the Croatian Medical Journal to the other three owners of the CMJ (the suggested changes are outlined in the text of the Agreement, in the web-extra material to this article). The deans of other three medical schools decided to first ask the opinion of the Journal's Management Board, according to the procedure outlined in the Agreement (13). The Management Board met on April 9, 2008. At the meeting, all 5 present (out of 8) members of the Board accepted the annual report of the Co-editors in Chief and approved the 38-page report of M. Marušić, Co-editor in Chief, on the specific questions from the deans in their letter from February 25, 2008. The Zagreb Medical School did not authorize its member present at the meeting to take part in the discussion on the proposed changes to the Agreement. The representatives of the other three owners unanimously concluded that the Journal is prospering, that the work of its editors is exemplary, that the proposed changes to the Governance Agreement pose a serious threat to the functioning of the Journal, and that they cannot recommend to its deans to accept such changes to the Agreement. Finally, at the Deans' Conference from April 16, 2008, held in Zagreb, the Dean of the Zagreb School of Medicine again asked other deans to sign the proposed changes, regardless of the advice of the Management Board. The deans decided that the issue should be rather brought before the Councils of the schools.

To provide the forum for open-minded, impartial, and honest discussion, we publish the proposed changes to the Governance Agreement (web-extra material). Some of our owners and colleagues may not like what we did, but, again, we have followed the practices of the most prestigious medical journals: “If editors are truly independent, they will from time to time publish material that offends advertisers or members of the organizations that own their journals.” (10).

During the preparation of this issue of the Journal, the Dean of the Zagreb School of Medicine, Prof. Nada Čikeš, has finally voiced her concerns about the Governance Agreement. Talking to a Science reporter, she stated: “The Marušićs have never been formally evaluated or elected to their positions.” (18). We must respectfully point out that M. Marušić was officially appointed as the Co-editor in Chief in 1991, together with Prof. Mate Granić, the Dean of the Zagreb School of Medicine at that time. A. Marušić was elected at the position of Co-editor in Chief by the Editorial Board in 1994. Finally, the clause 12.1. of the Governance Agreement, signed by the deans of the 4 medical schools in 2004, clearly states: “The Agreement recognizes the present Editor-in-Chief, members of the Editorial Office, Editorial and Advisory Boards, Sponsoring Institutions, and the Publisher.”

The Dean also said that “the changes would bring the journal in line with governance standards recommended by the World Association of Medical Editors.” (18). To open the debate on the changes to the Governance Agreement proposed by the Dean of the Zagreb School of Medicine, we have asked an international expert, not only in journal editing but also in managing disputes between journal editors and owners, to give his opinion on the changes proposed by one of CMJ’s owners (19). We hope this will help our colleagues at all 4 medical schools to reach the decision based on evidence and facts. As we did in our previous editorials, we invite all stakeholders in the present and future of the CMJ to voice their opinion.