Old AJOB Rut re. Prenatal Dex Picks up New Steam as Undisclosed Double Loyalties and Dependencies of Now Editor Skip Nelson are Suggested

Amended 2014-04-18: see bottom of this post!

I'm sure several readers remember a long series of posts across 2011-12, connected to a series of internal troubles in the management of the American Journal of Bioethics. One of the roots of all that mess was a controversy that eventually led to the resignation of Hilde Lindemann from the AJOB editorial board in protests of its managerial operations, followed by other weighty ones later by, e.g. Udo Schuklenk and John Lantos. Eventually, after much external pressure, following a less than elegantly handled stepping over to private business by then editor-in-chief, Glenn McGee (later to become CEO of the now defunct stem cell banking, cosmetics and therapeutic business RNL Europe), the drop-out of the AJOB operation of both him and his wife Summer Johnson McGee, who had initially been appointed to advance to co-editor with the new EiC appointed to succeed McGee.

The last post with any substance out of this mess was this one, and the entire series is found here.

The affair leading to the resignation of Lindemann connected to a critical scrutiny, and eventual letter to the FDA, signed by a large number of bioethicists, regarding some unresearched, non-evidence based, experimental off-label prenatal drug treatment at the Mount Sinai hospital with regard to congenital adrenal hyperplasia. This led to a long series of complicated controversies involving AJOB, later leading up to the developments summarised above, and one of those concerned the possible conflict of interests of several centrally placed AJOB managerial figures. Among those involved was Robert “Skip” Nelson, now editor-in-chief of the AJOB Empirical Bioethics journal, at the time ethicist linked to the FDA (he still is, as a matter of fact), who sent a letter to the Office for Human Research Protections on the Prenatal Dex case, as it came to be known, clearing the accused doctor of having broken any FDA regulations. Now it is reported that, apparently, Nelson at the same time had close and live ties, to AJOB and the people in the management who were deeply involved in one side of the controversy. That is, it is argued in a recent post by Alice Dreger and Ellen K Feder (who belong clearly to the other side, it must be added), one of the prime expert sources had hidden loyalties and dependencies that remained undisclosed and is now holding a gallant EiC title in the AJOB family of journals.

The whole story and argument is told much better than I ever could by Alice Dreger and Ellen K. Feder themselves at the superb Canadian Impact Ethics blog.

Amendment:
Skip Nelson contacted me personally after posting the first version of this report, and made clear that he finds nothing new in what is described by Dreger and Feder, that no payments to him from AJOB have ever been involved in his service as EiC, that he performs this job as part of his FDA assignment, and that what he claimed in his letter to the OHRP regarding Prenatal Dex remains true (Dreger's and Feder's view on that is set out here). Nelson also told me that he has no plan to respond publicly to Dreger and Feder. This post has been amended in the light of that in a few places above.

The Conflict of Interest Claim Towards New AJOB Editorial Arrangement is not Sexist

The controversy surrounding the new editorial arrangement for the American Journal of Bioethics after Glenn McGee decided to step down in order to work full time as consultant for stem cell company CellTex (covered in former posts here, here and here) continues, now in the landscape of big science, in this news article in Nature.

In the article, new editor in chief, Summer Johnson McGee defends the decision of publisher Taylor & Francis to appoint her editor in chief against the criticism that this cements rather than resolves the conflict of interest created by Glenn McGee's move to industry:

Responding to questions from Nature, Summer Johnson McGee says that the journal has a conflict-of-interest policy that requires editors to withdraw from reviewing a manuscript if they perceive a conflict. She calls allegations that her appointment results from her relationship with her husband “baseless and sexist”.

Now, the firtst line of defense here has already been addressed by the critics, in particular by John Lantos, who resigned from the AJOB editorial board over this matter. And I happen to agree with John about how much of a wife-of-Ceasar-principle has to be applied in the case of defending the credibility of bioethics journals. Simply put: one of the well-known logics of conflicts of interests is that they tend to make you bad at spotting where the conflict is actualised in particular cases. Thus, the report c-o-i based on subjective perception principle is not by itself good enough. A broader margin of safety against suspicion is required to uphold the credibility of a leading ethics journal.

More interesting is Johnson McGee's second line of defense. The claim of "baselessness" is, of course a complete misnomer and question-begger. It is a fact that she and Glenn McGee are married and that, in virtue of that arrangement, vested interests of Glenn McGee are by default also such interests of Summer Johnson McGee. Therefore, I have argued, the conflict of interest is not resolved but rather sustained by switching from one to the other in the leading editorial management role of AJOB.

Now, this way of arguing is, Johnson McGee seems to hold, sexist. Well, Summer, allow me to retort that it is in fact this very line of defense of yours that is a case of sexism. The argument based on default economic relations between spouse holds regardless of the sex or gender of the people involved in this relationship. That is, my argument would have stuck just as much had the roles between you and Glenn been reversed (you being the one leaving the e-i-c position for industry, and Glenn taking up your managerial torch). What you seem to claim is that you should be let off the hook because you happen to be a woman. That, if anything, is a sexist line of argument.

If this is all there to say in defense of the new AJOB editorial arrangements, I would say that the state of things in the management of this journal appear to be even worse than what they appeared to be before. For I cannot convince myself that even Johnson McGee herself seriously believes in what she tries to sell through Nature. This, I would say is not the voice of conviction, but of desperation.

John Lantos resigns from the AJOB editorial board

As a direct result of the affair with regard to the American Journal of Bioethics that I discussed in my former post, John Lantos, Director of the Children's Mercy Bioethics Center and Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine, as well as Fellow of Clinical Medical Ethics at the University of Chicago, to which he belonged for over 20 years, just announced his resignation from the editorial board of AJOB via a post in the closed Facebook group Bioethics International. I've contacted John and he has given me permission to quote this post here, which I will do without further comment:

After thinking about AJOB since the story broke, here's where I stand:

As a long time supporter and admirer of the American Journal of Bioethics, a former member of the Editorial Board, and a friend of both current and former editors, it pains me to see what has happened. AJOB has been a great journal and I have been, until now, proud to be on its Editorial Board. But recent events make it clear that the journal has lost credibility in ways that tarnish not just the names of people associated with it but also the reputation of the entire field of bioethics.

To me, the key issues are not the ones of procedure that have gotten so much attention. Instead, they are issues of substance. They raise questions about the judgment of the editors and, more importantly, about the goals of the publisher. If, as we’ve been told, Taylor and Francis really asked Glenn McGee to stay on as Editor once he’d taken a job at Celltex, and if they really believed that the resulting conflicts-of-interest were manageable, one must wonder about both their judgment and their mission. Imagine that the Editor of the New England Journal took a job as Vice President at Merck, and the Mass Medical Society asked him to stay on as Editor, opining that the conflicts of interest would be manageable. One might rightly wonder, “What are these people smoking?”

An academic journal in any field, and especially in a field as value-laden as bioethics, must earn the trust of readers and writers alike. Authors need to know that reviews will be fair. Readers need to know that suggested revisions are not politically or financially motivated. The current arrangements offer no such assurance. We want to know what is really going on – and what will go on – and who will be making decisions -- when the journal decides what to publish on issues ranging from research ethics, stem cell controversies, conflicts of interest, relationships between industry and academia, innovative therapy, FDA regulation, patient deaths in clinical trials, research standards in other countries, cozy relationships between biotech companies and state governments, and a host of other issues that have direct financial implications for the new editor-in-chief and the ongoing “founding editor.” AJOB’s current policy for dealing with such conflicts is that editors “…will recuse themselves from any involvement in decisions where they have a financial or other conflicting interest.” In other words, “Shut up and trust us.” I am afraid I have lost trust.

I have, sadly, resigned from the AJOB Editorial Board. As long as the current leadership structure is in place, I will no longer submit papers to AJOB. I have withdrawn a paper that was in press and due out in March. I will discourage my colleagues from submitting papers to AJOB. I will not cite papers published in AJOB. In my opinion, the editors have failed to establish the degree of transparency that should be minimally acceptable for any journal and certainly for one charged to host a forum in which ethical evaluations are right at the center.