Tuesday, November 14, 2006

Beware the Ingelfinger of Doom

So I'm sitting in the front row of a packed seminar room as four speakers describe different parts of an important, but not earthshaking, clinical trial. This seminar, they said, constituted the first public release of data from the trial. A news story for sure, I'm thinking, and since I'm apparently the only reporter in the room, an actual scoop.

The first three speakers describe the trial’s background, details of the experimental treatment, and details of the control treatment. The final speaker, the trial's principal investigator, stands up to reveal the trial's results, and the first thing she says is, "We’ve just submitted a paper on this trial to JAMA [the Journal of the American Medical Association, one of the top three or four medical journals in the world], and if there are any reporters in the audience we request that they not print anything about this trial, because that might jeopardize our publication."

My first thought: “Puh-leese.” My second: “If you wanted this seminar to be off the record, you should have said something at the beginning, before I invested an hour in this room.” My third: “Dream on, sister. You’re describing the results of this trial at an open meeting to which reporters were invited, and there are a hundred other people in the room. If the results were secret before, they sure ain’t secret now. I’m not the only one in the room with a recorder, and I’m not the only one taking digital photos of every PowerPoint slide.” And my fourth thought: “I bet they shake that damn Ingelfinger at me.”

Franz J. Ingelfinger, M.D., (1910-1980) was editor of the prestigious New England Journal of Medicine (NEJM) from 1967-1977. During his tenure he decreed that for an article to be published in his journal it must not previously have appeared elsewhere. The rule prohibited authors from releasing their results to the news media before the date they were published in the journal. A small number of other journals (such as JAMA) developed similar policies, and the net result is that scientists are often afraid to talk to reporters for fear that they’ll lose the opportunity to publish in JAMA or NEJM (or Nature or Cell or Science).

Their fears are misplaced, I explain to one of the clinical trial’s investigators, who worriedly accosts me at the end of the seminar. I promise to send him an e-mail, quoting chapter and verse, and this is what I wrote (with identifying details altered):

Subject: JAMA publication policies

Dr. Smith,

I'm happy to set your mind at ease regarding the effect my article in [my newspaper] will have on your intended publication in JAMA.

It should not hurt your chances of publication if we report on the study as you and your colleagues presented it at the meeting. In general, medical journals follow rules approved by the International Committee of Medical Journal Editors regarding prepublication publicity. (See NEJM 328(17):1283, 1993, and NEJM 324:424-8, 1991). Specifically:

"Policies designed to limit prepublication publicity should not apply to accounts in the media of presentations at scientific meetings or to the abstracts from these meetings (see the section 'Prior Duplicate Publication' in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals). Researchers who present their
work at a scientific meeting should feel free to discuss their presentations with reporters, but they should be discouraged from offering more detail about their study than was presented in their talk."

And in the JAMA instructions to authors at http://jama.ama-assn.org/misc/ifora.dtl#PreviousPresentationorReleaseofInformation it says, "Previous Presentation or Release of Information. A complete report following presentation at a meeting or publication of preliminary findings elsewhere (e.g., an abstract) is eligible for consideration for publication.
Media coverage of presentations at scientific meetings will not jeopardize consideration, but direct release of information through press releases or news media briefings may preclude consideration by JAMA. Rare instances of papers reporting public health emergencies should be discussed with the editor. Authors submitting manuscripts or letters to the editor regarding adverse drug or
medical device reactions, reportable diseases, etc should also report such to the relevant government agency."

I hope this answers your concerns.



This satisfied Dr. Smith and his colleagues, but I would have gone ahead with my article even if it had not.

Whatever motives Dr. Ingelfinger had when he originally promulgated his rule, the current effect is to stifle dissemination of research results to the public that, in most cases, paid for that research, and to increase the influence of a small number of journals at the expense of the public’s right to know.


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