Human Embryonic Stem Cell Research, Abortion, and Publication Bias in the New England Journal of Medicine

Abstract

Publication bias in medical journals depends on outside influences and the particular ideological bent of the editorial board. The New England Journal of Medicine (NEJM) is a premier medical scientific publication having among the highest impact rankings of any research journal. The Vioxx question and industry ties it highlighted have led to legitimate questions of whether significant conflicts of interest have arisen within NEJM that compromise the free exchange of scientific information and ideas. Over the past two decades, several socially charged areas have been treated with considerable bias in the editorial policy of NEJM, including the issues of human embryonic stem cell research and abortion. From 2000 to 2017, NEJM published over twenty pieces favorable toward human embryonic stem cell research and over fifty pieces favorable to abortion, with virtually no publication of contrary opinion. An aggressive editorial defense of Planned Parenthood Federation most recently seems particularly striking. A secular journal which is meant to represent the entire spectrum of physician opinion in controversial issues has a practical, if not also an ethical, responsibility to provide an unbiased forum for intelligible discussion for evaluation of the merits of particular issues. To do otherwise is publication bias that suppresses legitimate contrary viewpoints having merit and validity.

Nontechnical Summary:

Publication bias in medical journals is detrimental to the free exchange of ideas regarding controversial issues. From 2000 to 2017, a premier publication, the New England Journal of Medicine (NEJM), has shown considerable bias in only publishing articles and editorials highly favorable toward human embryonic stem cell research and abortion, without permitting valid discussion and publication of contrary opinion. The recent strong editorial defense by NEJM of Planned Parenthood Federation in their sale of aborted fetal body parts seems particularly striking and disproportionate. Publication bias suppresses legitimate contrary viewpoints with merit and validity, suppressing fair debate in controversial issues.

In 2004, I was giving a lecture on the bioethics of human embryonic stem cell research at a time in the United States when the then President Bush had just placed a moratorium on federal funding of the research. In addition, California voters were soon to decide whether to fund human embryonic stem cell research with state tax dollars to bypass the federal restriction. I mentioned to the audience that such research was difficult, ethically problematic, had tumorigenic and immunogenic quandaries, and had to date not yielded a single medical treatment. Conversely, adult and umbilical cord blood stem cells were more promising and already being applied with astonishing results and many clinical successes.

One of the medical students raised his hand and asked why, if adult stem cells are so much better, was there such media hype that human embryonic stem cell research was more promising and would rapidly lead to cures for human disease from leading medical journals. I replied, in all honesty, that I simply didn’t know.

Fourteen years later, there has still not been a single documented, verified, reliable treatment arising from human embryonic stem cell research. My personal suspicion over the real reason for the emotional and aggressive push by the scientific community to fund such research has been supported by several recent articles on conflicts of interest in the practices of leading medical journals (Wilson 2016; Brophy 2016; Natarajan 2016; Schafer 2008; Macklin 2016). Notable were the articles from the Indian Journal of Medical Ethics, among them Wilson’s (2016) piece on the New England Journal of Medicine (NEJM) concerning Vioxx.

The question of publication integrity is paramount in the trustworthiness of scientific-medical journals. Financial and other conflicts of interest resulting in publication bias can be conscious but likely more often unconscious (Macklin 2016). Examining the actions of the NEJM concerning Vioxx serves as important background for possibly understanding their subsequent actions regarding embryonic stem cell research and abortion.

The NEJM published a drug industry–sponsored study comparing rofecoxib (Vioxx) versus naproxen for treating arthritic pain (Bombardier et al. 2000). It reported decreased gastrointestinal side effects in the Vioxx group. But the down side of the trial showed an increase in the incidence of myocardial infarction in the Vioxx group, a difference interpreted by the authors to result from a cardioprotective effect of naproxen, rather than a deleterious effect of Vioxx.

The data, however, presented to the Food and Drug Administration (FDA) in October 2000—prior to the NEJM article—seem to be different than published in the NEJM. Multiple other cardiovascular events in the Vioxx group were presented to the FDA that were not included in the NEJM study. The deleterious effects of Vioxx became ever more evident, and the pharmaceutical company withdrew the drug in 2004. The NEJM published two “expressions of concern” about the original study, in 2005 and 2006. It stated that the study did not accurately represent the safety data available to the authors when the article was being reviewed for publication.

But do NEJM’s expressions of concern completely abdicate the journal of responsibility, as they were published five years after the FDA results were known, a year after Vioxx was withdrawn by its manufacturer, and after litigation had been initiated by patients against the pharmaceutical company, with the NEJM study as evidence in court? Some suggested that the expressions of concern were to divert attention from the failings of NEJM and avoid embarrassment and legal problems upon advice from a public relations specialist (Wilson 2016; Smith 2006; Armstrong 2006). Furthermore, the editor of NEJM, Jeffrey Drazen, was made aware of the cardiovascular risk posted on the FDA website at the latest in August 2001 (Smith 2006; Armstrong 2006). At that time, in a phone-in to a radio show featuring Drazen, a pharmacist informed him of the cardiovascular risk, pleading with him to update the NEJM article with correct information. Drazen dismissed the request stating, “We can’t be in the business of policing every bit of data we put out.” That same pharmacist had submitted a letter on the matter to NEJM for publication several months prior to the call, which had been rejected, citing space issues (Smith 2006; Armstrong 2006). Drazen became editor of the NEJM in 2000.

The NEJM had perhaps the most stringent conflict of interest policy on its publications prior to 2000, having banned altogether any industry ties for authors of editorials, reviews, and opinion pieces. This outright ban was weakened if not entirely eliminated by Drazen two years after taking the helm of NEJM (Drazen and Curfman 2002), and the position reaffirmed in 2015 (Drazen 2015). This was lamented by Marcia Angell (2016), executive editor of NEJM between 1988 and 1999 and editor in chief until 2000, claiming “there is much evidence that financial conflicts of interest are in fact distorting medical research”. She had previously published her concern of industry ties to academia and journal publication in NEJM (Angell 2000). It may be of note that Drazen had strong industry ties and affiliations with at least twenty-one drug firms between 1994 and 2000 (Gottlieb 2000). Drazen additionally was censured in 2000 by the FDA for making “false or misleading” statements about the value of the drug levalbuterol, overstating the safety and efficacy of the drug (Gottlieb 2000).

The editorial and peer review process in the Vioxx debacle was summarized thus by Brophy (2016, 225): “The transgressions included rapid publication to suit the industry’s needs, superficial peer-reviewing that allowed invalidated hypotheses to be circulated as veracities, obfuscation of clinical data, and pervasive conflicts of interest, leading to misleading inferences and conclusions.” Academic physicians with industry ties thus “provided a veneer of respectability to these questionable activities, further misleading the medical readership.”

“Conflict of interest” has a much broader dimension than the narrower but more obvious monetary gains from commercial ties. Publication bias may also be based on the policies and ideologies of the editors, apart from the merit of the article per se. This was described by Macklin (2016) regarding a case of consent ethics in a study published in NEJM. The study compared different oxygen levels given to premature newborns to determine the optimum level (SUPPORT Study Group 2010).

The federal Office for Human Research Protections sanctioned the lead university medical center of the study, citing the medical experimentation consent forms failed to fully disclose the risks of the study posed to the premature infants. The NEJM subsequently published four articles defending the consent forms and the study and accused the federal oversight protection agency of “overreach” in their sanctions of the lead university. Editor Jeffrey Drazen authored one of these articles, chastising the federal research oversight office for their reaction to the consent forms (Drazen, Solomon, and Green 2013). Three top-level NIH officials, including its director, wrote another article, defending the study and consent forms (Hudson, Guttmacher, and Collins 2013). Although it was the National Institute of Health (NIH) Institute of Child Health and Human Development that had sponsored the study, all the NIH officials authoring the article answered “no” to all conflict of interest questions.

Macklin (2016) then submitted a piece to NEJM with forty-five scholarly signatories criticizing the consent forms of the study, which failed to disclose the risks of which parents of the premature babies should have been informed. The subsequent course was detailed by Macklin. Macklin wrote to NEJM editor Drazen: “Your denial of the request for equal space can only be seen as a suppression of viewpoint,” considering that NEJM had published the original study and four subsequent pieces defending the informed consent documents, without any contrary viewpoints.

Several NEJM trends have become evident over the years, with a near-complete domination of the journal in publishing certain viewpoints without presenting contrary perspectives. The official journal of an organization with a specific ideology (as, e.g., the bioethical journal Linacre Quarterly is the official journal of the Catholic Medical Association) will have an overt editorial bent toward publishing papers consistent with that ideology. But NEJM presumably does not adhere officially to a particular ideological framework and is meant to represent ideas in medicine as reflective of all of medicine. This would imply a need to represent in a fair and neutral way ideas in medicine which are controversial or unsettled. The ensuing discussion focuses on two topics for which there appears to be publication bias in NEJM: human embryonic stem cell research and abortion.

Human Embryonic Stem Cell Research and Somatic Cell Nuclear Transfer (SCNT; Cloning)

The introductory paragraph in this article questioned why human embryonic stem cells, as opposed to adult stem cells, were the “holy grail” of medical research, despite the fact that the latter had shown far more clinical and practical promise. In the years 2000–2005, the nearly unopposed secular scientific and popular gestalt was that human embryonic stem cells had the most promise to treat all forms of human disease. As the human embryonic stem cells were pluripotent, they could “morph” into any tissue or organ and had, purportedly, the most promise to cure diseases ranging from Parkinson’s disease to brain and spinal injury to diabetes, and so on.

The ethical dilemma was that the harvesting of the embryonic stem cells from the embryo, of necessity, destroyed the embryo, thus, in essence, destroying early human life. The implications of the immorality of this research were not lost on much of the scientific community, with a moratorium on the “unethical” research called for by fifteen Max Planck scientists (Balling et al. 1988). Jerome Lejeune, discoverer of the chromosomal basis of Down syndrome, described such research as “foolish games” and a “new defamation of science” (Lejeune 1977).

Furthermore, human embryonic stem cell research was dogged by the enormous problems of tumorigenicity and immunogenicity (California Institute of Regenerative Medicine 2017). One perceived solution to the immunogenicity problem was to use “cloning”—taking the nucleus of a patient’s own somatic cell and transferring it into an enucleated ovum (somatic cell nuclear transfer [SCNT]; California Institute of Regenerative Medicine 2017). The resulting clone would divide to form a blastocyst capable of generating a stem cell line. Such cloning, however, compounded the ethical problem as this would be akin, literally, to creating new human life in a laboratory and then destroying it. Proponents of human cloning clouded the issue by claiming that the “therapeutic cloning” they proposed for human disease was morally acceptable and not akin to morally objectionable “reproductive cloning”—the intentional development of a full-term human baby through cloning. Nonetheless, an observer might consider it odd that one could consider the bringing to existence of a cloned human life and then destroying it as morally superior to conceiving a cloned human life and then bringing it to term as a human infant.

A curious phenomenon of the time was the insistence of the scientific community on calling therapeutic cloning as SCNT. The clear purpose was meant to instill in the public psyche a politically correct distance between such research and the generally negative connotation that human “cloning” had. Taking a loud and firm stand that reproductive cloning should be banned and sanctioned gave an effective decoy and veneer of ethical integrity to the whole matter of therapeutic cloning.

Any scientific, practical, and ethical arguments at the time arguing against the ethics of human embryonic stem cell research and cloning were often squelched, largely on emotional rather than factual grounds. Scientific journals and public opinion pundits labeled opponents to the human embryonic stem cell research insensitive and biased, concerned more about the life of an embryo rather than the life of a patient suffering from terrible diseases. Then President Bush’s decision in 2001 to stop federal funding of the research because “a fundamental moral line” would be crossed was met with overwhelming criticism by the academic scientific journals. A hugely successful public relations effort was pushed by the scientific community, the media, and various disease support groups to sway public opinion in favor of human embryonic stem cell research.

The public relations cultural agenda worked well. In 2004, California voters enacted Proposition 71, funding human embryonic stem cell research with taxpayer dollars, thus forming the California Institute for Regenerative Medicine (Ballotpedia 2004; Calif Inst Reg Med-History 2017). And in 2009, then President Obama lifted the federal restrictions on funding human embryonic stem cell research, proposing that his administration would “make scientific decisions based on facts, not ideology” (Stolberg 2009).

NEJM published over twenty articles, including at least three editorials written or coauthored by editor in chief Drazen, overwhelmingly supportive of human embryonic stem cell research (Drazen 2003a, 2003b; Phimister and Drazen 2004; Drazen 2004; Annas 2002a, 2002b; Evers 2002a, 2002b; Sandel 2004a, 2004b; Annas 2010a, 2010b; Annas 2011; Blendon, Kim, and Benson 2011; Cohen and Adashi 2011; Audio Interview 2007; Schwartz 2006; Okie 2006; Daley 2004; Adashi 2008; Iglehart 2007; Okie 2005a, 2005b; Charo 2016a; Yamamoto 2004; Daley 2003; Perry 2005). Although there were several letters to the editor with opposing views (Gerardi 2003; George and Lee 2004; Kay 2004; Pullicino 2004; Anderson 2004; Pellegrino et al. 2002; Meilaender 2002, with rebuttals by the original NEJM authors [Drazen 2003b; Sandel 2004b; Weissman 2002; Evers 2002b; Annas 2002b]), there were no major published pieces of a different opinion. Drazen’s (2003a) editorial “Legislative Myopia on Stem Cells” vilified the banning of human embryonic stem cell research and assured readers “there is no question but that somatic cell nuclear transfer will be used to develop treatments for conditions that are currently uncurable” (p. 300) and that patients afflicted with such diseases “will be offered the prospect of cure.” He suggested that if U.S. researchers were not permitted to perform this type of research, then scientists in other countries would make the discoveries. From the editorial pulpit, he vowed to make this research a priority, stating that the “editors of the Journal will do our part by seeking out highly meritorious manuscripts that describe research using embryonic stem cells,” which appears to be clearly positioning the NEJM to sway the political debate.

Regarding such “highly meritorious manuscripts,” the NEJM published an editorial coauthored by Drazen (Phimister and Drazen 2004) lauding the South Korean research group led by Woo Suk Hwang, which reported the derivation of human embryonic stem cells from a cloned blastocyst (Hwang et al. 2004). The NEJM editorial stated that the work “represents a significant step toward the cure of diseases that involve the loss of a particular cell type—diseases such as type 1 diabetes and Parkinson’s disease.” Another NEJM piece (Perry 2005) continued to heap praise on Hwang for his follow-up publication on the research (Hwang et al. 2005). Both NEJM articles decried the U.S. federal government for their restrictive funding of human embryonic research, claiming it would give the U.S. second-rate medicine. Yet another NEJM piece implied that Hwang and his team “are now the world leaders in SCNT” (Okie 2005b, 2).

But this work that was greeted with such spectacular applause by NEJM editorial proved to be deeply flawed. In 2005, it was reported that the ovum donations procured by the South Korean group had been obtained from graduate students in the lab and the black market (Cyranoski 2004). Furthermore, contrary to the research team’s paper, there was financial payment to some oocyte donors, as noted in a posted 2005 Science Erratum. A retraction of both Hwang’s scientific articles were posted by Science in 2006 after the scientist was found to have engaged in research misconduct, his papers containing fabricated data. He was removed from his university academic position; was indicted on fraud, embezzlement, and breach of bioethics; received a suspended prison sentence; partnered with a biotechnology firm specializing in cloning dead pets; and engaged in talks with Libya to set up a stem cell research center there.

A strong financial conflict of interest and partnership with the biotechnology industry can influence professional journals’ publishing decisions, consciously or unconsciously, and might sway a journal’s editorial policies. NEJM clearly outlines financial and academic perks for human embryonic stem cell research based on publishing and patenting human embryonic stem cell technology (F. Murray 2007). The behind-the-scenes focus “centered on the market for stem cells—the ownership, control, pricing, and availability of stem-cell lines,” with the hope to merge the best of both the academic and commercial worlds with “strong incentives for commercial research investments.” New lines of human embryonic stem cells, including those from SCNT (cloning) technology, were certainly more lucrative than the morally nonproblematic adult and cord stem cells.

In 2000, the journal Science wrote that the embryonic research had “become one of the hottest areas in biotechnology as several companies have jumped in to try to exploit them commercially” (Marshall 2000, 1419). Dr. Jean Peduzzi-Nelson (2004) in his testimony before the U.S. Senate stated:

The main reason for the current emphasis on human embryonic stem cells and cloning is money. The old statement of ‘follow the money’ explains many of the statements made regarding this controversy. It is a superior business plan to have a mass-produced product such as embryonic/fetal/cloned stem cells that can be sold nationwide and have patentable intellectual property. Cloned stem cells derived from embryos with genetic defects represent the possibility of millions in patentable stem cell lines. Adult stem cell therapies are much better for people with diseases or injuries but generate an inferior business plan. In the case of adult stem cells where, in most cases, a person’s own cells can be used, one can only develop a procedure that is generally not patentable.…(Emphasis added)

What practical treatments and cures for human disease have been gleaned from, specifically, human embryonic stem cell research in the fourteen years since California taxpayers have funded human embryonic stem cell research, and in the nine years since the federal government has approved funding the research? Indeed, very few if any; the California Institute of Regenerative Medicine (2017) itself notes no currently accepted embryonic stem cell–based therapy. An embryonic stem cell treatment for macular degeneration was reported in two patients (Schwartz et al. 2012), but the visual acuity results were “unreliable and difficult to scale,” dependent on “subjective observations” and in need of “objective confirmation” (Huang et al. 2012). Another case report of embryonic stem cells—combined with adult marrow stem cells—for tolerance induction in a transplant recipient (Trivedi et al. 2006) was dubious as to what the actual cause of the therapeutic result really was.

Conversely, unlike the nebulous potential of embryonic stem cells, successful clinical treatments and cures using adult stem cells have been tangible and real, affecting thousands of lives (California Institute of Regenerative Medicine 2017). Nonetheless, embryonic stem cell research was financially more attractive to investors, and the efficacy of ethical adult stem cells was downplayed in elite scientific circles, mass media, and pop culture (Fumento 2004).

But, even if there were ultimately effective cures using human embryonic stem cells, the fundamental ethical problem would not simply disappear and has certainly not been addressed by prominent journals, including NEJM, in unbiased forums or reviews. The moral dilemma of creating and destroying cloned human embryos for stem cells is journalistically justified in the name of medical progress to benefit the sick—repeatedly mentioning diabetes and Parkinson’s disease.

Abortion

Abortion and contraceptive promotion are among the topics NEJM treated with the most bias. Aside from the issue of contraceptives, from 2000 to April 2017 NEJM published over fifty pieces¹ sympathetic to and supportive of the practice of abortion by physicians, in the categories of Perspective, Sounding Board, and Editorial. These include four pieces supporting abortion authored or coauthored by NEJM editor Drazen including opposition to banning partial birth abortion (Drazen 2004b, 2007), opposition to mandatory discussions of the biological reality of the developing being within the mother contemplating abortion (Curfman et al. 2008), and support for Planned Parenthood Federation, the largest abortion provider in the United States (Topulos, Greene, and Drazen 2015).

Then presidential candidate Hillary Clinton also published a piece supportive of abortion in the NEJM (Clinton 2016). During this period, as far as could be ascertained, there was not a single piece arguing in favor of abortion restrictions or supporting or acknowledging the right to life of the human fetus. NEJM did allow one letter to the editor to acknowledge that “elective abortion is more strongly associated with subsequent psychiatric hospitalization than is childbirth,” but went no further (Reardon 2004), and a second letter questioned the difference between “watching a 20-to-24-week-old fetus die ex utero” as opposed to in utero (Marchetti 2004).

By pure statistics and numbers alone, the NEJM representation of abortion perspective is clearly not representative of a true cross section of physician sentiments. It is one-sided and has been for some time. As suggested previously by Macklin (2016, 222) in her experience with NEJM, this “raises the question of a reputed journal’s ability to bias its readers by the sheer number of publications on one side of a controversial issue,” falling into an “ethically suspect category: publication bias.”

Within these NEJM publications, a myriad of abortion-related topics was discussed, the editorial position aligning with that of Planned Parenthood: the Mexico City Policy requiring all nongovernmental organizations that receive federal funding to refrain from performing or promoting abortions (Lo and Barry 2017), conscientious objection to abortion (Stahl and Emanuel 2017; Charo 2005), fetal pain during abortion (Charo 2016b), First Amendment right of free speech for sidewalk pro-life counselors (Cohen, Lynch, and Curfman 2014), requiring physicians to provide information on fetal development prior to abortion (Curfman et al. 2008; Mariner and Annas 2015; Oyer 2012; Lazzarini 2008), ultrasound requirements prior to abortion (Weinberger et al. 2012; Charo 2012), requirements for hospital admitting privileges for abortionists and basic abortion clinic safety requirements (Charo 2014), parental notification prior to abortion (Curfman et al. 2008), laws preventing removal of pregnant women from life support (Ecker 2014), partial birth abortion (Drazen 2004b, 2007; Greene and Ecker 2004), and criminal accusations against Planned Parenthood in the sale of aborted fetal tissue (Topulos, Greene, and Drazen 2015; Charo 2017; McDonald-Mosley 2015; Prescott 2016).

These last four pieces, including one coauthored by editor in chief Drazen (Topulos, Greene, and Drazen 2015) and another authored by the chief medical officer of Planned Parenthood (McDonald-Mosley 2015), are particularly noteworthy. They aggressively defended Planned Parenthood in the firestorm which followed the disclosure of secretly recorded videos documenting Planned Parenthood’s alleged sale of aborted fetal body parts in July 2015 (Center for Medical Progress 2017; Wall Street Journal 2015a, 2015b). The videos resulted from an undercover investigation by a pro-life group (Center for Medical Progress) into the alleged sale of aborted fetal organs by Planned Parenthood. It became a public relations disaster for the organization, resulting in accusations of criminal trafficking and profiteering in baby body parts and expanded into congressional hearings and formal investigations in multiple states.

The videos tarnished the image of Planned Parenthood, initially at an individual, then legal and legislative level. The time line and level of defending Planned Parenthood in both NEJM pieces was surprising for a professional medical journal, considering that the facts of the case were still being sorted out, and federal and state investigations were just being organized.

NEJM heaped praise on Planned Parenthood and defended the “duty to use fetal tissue” while criticizing the group whose videos exposed the organization, expressing “outrage” at the “radical” group that “continues to twist the facts” (Topulos, Greene, and Drazen 2015). Conversely, there was hardly a mention of the infamous trial of abortionist Kermit Gosnell (Friedersdorf 2013) for murder in NEJM.

The articles of support were well utilized (Schneider 2015) and boldly quoted in the Planned Parenthood website (2015). Cecile Richards, president of Planned Parenthood, seized the opportunity of glowing endorsements from the editor in chief and associate editor of one of the most prestigious medical journals on earth: “These pieces are further proof of what we already know: Objective media voices, doctors, medical experts…are standing with Planned Parenthood” (Planned Parenthood Action Fund 2016).

Is there a bias on the subject of abortion in NEJM, considering the overwhelmingly supportive views on abortion published in the journal? George Topulos, lead author of one of the articles (Topulos, Greene, and Drazen 2015), served as a member of the medical committees of Planned Parenthood League of Massachusetts and Planned Parenthood Federation of America, as noted in the NEJM disclosure. R. Alta Charo, a frequent contributor to NEJM, served on the National Medical Advisory Committee of the Planned Parenthood Federation as noted on the NEJM disclosure. The chief medical officer of Planned Parenthood wrote another NEJM article (McDonald-Mosley 2015).

Planned Parenthood president Cecile Richards herself then became an author in the NEJM medical journal with her piece promoting expansion of birth control (Richards 2016). In the author disclosure section, it is asked whether the author has a financial relationship “with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what you wrote in the submitted work,” including “interactions with ANY entity that could be considered broadly relevant to the work”, or “other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work.” Richards answered “No” to all questions. Certainly, expansion of birth control financially benefits Planned Parenthood, of which Richards is the head (Bedard 2017) and presents at least an arguable conflict of interest.

The sheer number of publications in NEJM favorable to the social value and necessity of contraceptive expansion—aside from the issue of abortion per se—is breathtaking. Editor in chief Drazen authored or coauthored many editorial pieces (Greene and Drazen 2016; Wood et al. 2012; Wood, Drazen, and Greene 2005a, 2005b; Drazen, Green, and Wood 2004a, 2004b) favorable to the use and availability of emergency contraception. This is the clear position of NEJM, despite the contrary viewpoints representative of many physicians. It prompts the legitimate question: What, if any, is the relationship between the editorial policy of NEJM and Planned Parenthood Federation of America?

With commentary by NEJM on seemingly every nuance of the abortion debate, the journal’s silence on the 2017 death of Norma McCorvey (aka Jane Roe of Roe v. Wade, legalizing abortion in the United States) was deafening, and this silence mirrored most contemporary media sources. McCorvey, in fact, never had an abortion, lied that her pregnancy had been conceived in rape, became a pro-life advocate, converted to Catholicism, and remained vocal in her antiabortion views (Langer 2017; McCorvey 1997). Also, while NEJM has multiple pieces referencing the human rights work of Martin Luther King, Jr. (including Charo 2005), there is no mention of the antiabortion work of his niece, Alveda King, who is the director of the Civil Rights for the Unborn outreach (Priests for Life 2017). King (2010) expressly decried the “lies of Planned Parenthood,” concluding “I too have a dream, it’s in my genes. How can the dream survive if we murder the children?”

What makes all this even more outrageous is that the Hippocratic Oath (Adams 1849) explicitly prohibits physician participation in abortion (and euthanasia), stating: “I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and holiness I will pass my life and practice my Art.” Although the Oath is respected and acknowledged by NEJM and its editor with regard to physician participation in prisoner execution (Gregory et al. 2008), it appears to be a total nonissue relevant to abortion, to the point that even conscientious objectors to abortion provision could not use their own medical Oath as a defense (Stahl and Emanuel 2017; Charo 2005).

Furthermore, it is well worth remembering that Nazi abortion policy was indicted and punished at the Nuremberg Trials as a “crime against humanity,” a “war crime,” and an “activity marking a criminal organization.” The indictments included “providing abortion services,” “encouraging” abortions, and denying “protection of the law…to unborn children” (United States v Greifelt 1950; Tuomala 2011). The international medical declarations that arose directly from the Nuremberg Trials all presumed the Hippocratic protection of the unborn, explicitly or implicitly, including the Geneva Declaration (World Medical Association 1948), War Crimes and Medicine Statement (British Medical Association 1947), and International Code of Medical Ethics (World Medical Association 1949). Fetal “protection of the law” was mandated by the Nuremberg judgments to be codified in the International Bill of Rights (United Nations 1946).

Although the bioethical public policy emphasized in NEJM receives heavy input from the field of law (a field which is not sworn to abide by the Hippocratic Oath), it inadequately acknowledges the Nuremberg Trials and its ensuing medical declarations as part of its medical and legal heritage. The vision spawned over the decades and embraced by NEJM journalism seems to have little tolerance for legitimate discussion to the contrary.

Concluding Statement

Academic institutions, universities, and journals are meant to serve as a discussion board to evaluate with intellectual honesty both sides of controversial topics. Unlike journals specifically and openly subscribing to a particular philosophy, ideology, or faith, a secular medical journal is obligated by its fiduciary responsibility to the field and its readers to fairly and accurately represent differing viewpoints in an unbiased manner. If the current state of affairs in much of academia are any indication, the contrary is true, where with increasing frequency opposing, “politically incorrect” ideas are denied public discussion of their merits and met with rhetorical violence or stonewalling rather than intelligible and rational analysis of the relevant information and honest debate. Evidence suggests that such bias exists at the NEJM.

Biographical Note

Fritz Baumgartner, MD, is a cardiothoracic and vascular surgeon practicing in Southern and Northern California.