- Email: [email protected]
Affirmative action needed in The Lancet
Manning’s clinical bias prevents him from realising that my book has many audiences outside medicine. A clinical perspective alone, as Manning seems to advocate, is an analytically anaemic strategy that cannot by itself make sense of cuttingedge medical advances such as fetal surgery. It is essential to present alternative perspectives on a procedure that has important implications for medicine, policy, and women’s health. Monica J Casper Sociology Department, University of California Santa Cruz, Santa Cruz, CA 95064, USA (e-mail: [email protected]) 1
Manning FA. A subjective view of fetal surgery. Lancet 1998; 352: 1073–74.
The sacking of JAMA Sir—The impeachment trial of US President Clinton has had many negative consequences. The provocative sacking of the JAMA editor has seriously eroded the principle of editorial independence, as Richard Horton points out (Jan 23, p 252).1 In an opinion piece in Wall Street Journal, Fumento 2 ventilated on the alleged politicisation of scientific and medical journals and cited the executive vicepresident of American Medical Association (AMA) in support. Fumento also quoted selectively from some medical and scientific journals, and hinted at a left-wing conspiracy at editorial level. It is therefore surprising that Anderson and his colleagues have not been more vociferous in their objection to publications relating to health promotion, disease prevention, and health policy, because they all have resource implications. In their view, science should have nothing to do with human condition, and if it does it should never make a mistake, and yes, it should not affect the politics of AMA. A long time ago a psychotherapy mentor told me that it is futile to enlighten some people, especially if they are holding the light. Only grass roots anger among the AMA membership will change the minds of those who allow people like Anderson to make decisions that affect us all. I have cancelled my membership to AMA but will continue with my JAMA subscription. Raj S Shiw ac h Department of Psychiatry, UT Sout hw est ern Medical Center, Dallas, TX 75235, USA 1 2
Horton R. The sacking of JAMA. Lancet 1999; 353: 252–53. Fumento M. Medical journals give new meaning to “political science”.Wall Street Journal, Jan 21, 1999: A18.
1104
Sir—Six top executives of the AMA were fired after making an inappropriate commercial deal. Now the editor of The Lancet bemoans that the editor of JAMA, the AMA’ s journal, was sacked after publishing an article of limited medical importance at a politically opportune moment.1 The soul indeed needs to rise from the grave to tell us why this article could not have waited 3 months after completion of the US President’s impeachment trial. An explanation is warranted for nonUS readers about the statement that AMA has contributed US$14 million to congressional candidates since 1989, more than twice as much to Republicans as to Democrats. First, this money was given during five elections (congressional elections in the USA are held every 2 years). The contributions are $2·8 million per election, a picayune amount compared with industry or labour unions. For example, the banking industries gave over $15 million to the members of the three committees of the Congress overseeing their industry and more than $42 million to political parties and all candidates for federal offices during the 1997–98 election cycle, according to the Center for Responsive Politics.2 Second, the contributions to political parties by physicians are voluntary. Less than 30% of all members of the California Medical Association belong to its fundraising organisation, which gives about twice as much money to Democrats than to Republicans. Third, contributions to political parties by trade-union members are coerced. In the early 1990s, the US Supreme Court ruled that labour union dues must not be used for political purposes without the individual worker’s permission (Beck decision). Implementation was started by President Bush but cancelled by President Clinton immediately after entering office. In California, for instance, over 40% of teachers who are union members support the Republican Party but 90% of their contributions go to Democrats. Finally, it is surprising that George Lundberg would not appreciate the enormous slack he received from the AMA for 17 years, well knowing that most AMA members are more moderate than he is. Andre Minuth 4770 North Cedar Avenue, Fresno, CA 93626, USA 1 2
Horton R. The sacking of JAMA. Lancet 1999; 353: 252–53. LaBaton S. Debate over banking regulation reopens. New York Times Feb 11, 1999: 4.
Affirmative action needed in The Lancet Sir—As I settled into my favourite easy chair to pursue the latest issue of The Lancet, my wife shot me a quizzical look and asked me why I persisted in reading “that sexist rag”. I replied that The Lancet was not only a leading medical journal, but was progressive as well. My wife proceeded to win the first battle by pointing out that although 57% of the editorial staff listed on the masthead were women, all the letters were addressed to “Sir”. When I protested that at least the editorial staff reflected current demographic trends in medicine, she clinched the bet, with the following rigorous statistical analysis of the data. She proceeded to pull the 51 1998 issues of The Lancet off the shelf and to my dismay began counting the number of women and minorities portrayed in the Lifeline section. Of the 51 medical professionals interviewed, only four (8%) were women, and of the 47 men interviewed only five (11%) were minorities. As I completed the evening’s dishes, my wife, from the comfort of the easy chair, informed me of your editorial about affirmative action. 1 We hope that in the future The Lancet will eliminate the anachronistic habit of addressing letters “Sir”, and will also include more women and minorities in its Lifeline section. Mona Sfeir, *Reuben Granich 2629A Etna, Berkeley, CA 94704, USA (e-mail: [email protected]) 1
Editorial. Affirmative action. Lancet 1999; 353: 1.
DEPARTMENT OF ERROR Abnormal retinal vascularisation in preterm children as a general vascular phenomenon—In this research letter by Ann Hellström and colleagues (Dec 5, p 1827), figure A as published should read normal vascularisation in healthy boy aged 6 years, born at full term and figure B as published should read abnormal retinal vascularisation in boy aged 7 years, born at 27 weeks of gestation. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections—In this article by the MIST Study Group (Dec 12, 1998, p 1877), the first sentence of Findings in the Summary should read “Compared with placebo, zanamivir relieved influenza symptoms a median of 1·5 days earlier in the intention-to-treat (p=0·011) and influenzapositive (p=0·004) populations, and 2 days earlier in patients who were febrile at entry”. Also, the third sentence of the fifth paragraph of the Results section (p 1879) should read “Compared with placebo, zanamivir recipients were able to return to their normal activities 2 days earlier and has less sleep disturbance (table 3). Complication rates and associated use of antibiotics were less in the intention-to-treat population, but not significantly so (table 5)”.
THE LANCET • Vol 353 • March 27, 1999
Manning FA. A subjective view of fetal surgery. Lancet 1998; 352: 1073–74.
The sacking of JAMA Sir—The impeachment trial of US President Clinton has had many negative consequences. The provocative sacking of the JAMA editor has seriously eroded the principle of editorial independence, as Richard Horton points out (Jan 23, p 252).1 In an opinion piece in Wall Street Journal, Fumento 2 ventilated on the alleged politicisation of scientific and medical journals and cited the executive vicepresident of American Medical Association (AMA) in support. Fumento also quoted selectively from some medical and scientific journals, and hinted at a left-wing conspiracy at editorial level. It is therefore surprising that Anderson and his colleagues have not been more vociferous in their objection to publications relating to health promotion, disease prevention, and health policy, because they all have resource implications. In their view, science should have nothing to do with human condition, and if it does it should never make a mistake, and yes, it should not affect the politics of AMA. A long time ago a psychotherapy mentor told me that it is futile to enlighten some people, especially if they are holding the light. Only grass roots anger among the AMA membership will change the minds of those who allow people like Anderson to make decisions that affect us all. I have cancelled my membership to AMA but will continue with my JAMA subscription. Raj S Shiw ac h Department of Psychiatry, UT Sout hw est ern Medical Center, Dallas, TX 75235, USA 1 2
Horton R. The sacking of JAMA. Lancet 1999; 353: 252–53. Fumento M. Medical journals give new meaning to “political science”.Wall Street Journal, Jan 21, 1999: A18.
1104
Sir—Six top executives of the AMA were fired after making an inappropriate commercial deal. Now the editor of The Lancet bemoans that the editor of JAMA, the AMA’ s journal, was sacked after publishing an article of limited medical importance at a politically opportune moment.1 The soul indeed needs to rise from the grave to tell us why this article could not have waited 3 months after completion of the US President’s impeachment trial. An explanation is warranted for nonUS readers about the statement that AMA has contributed US$14 million to congressional candidates since 1989, more than twice as much to Republicans as to Democrats. First, this money was given during five elections (congressional elections in the USA are held every 2 years). The contributions are $2·8 million per election, a picayune amount compared with industry or labour unions. For example, the banking industries gave over $15 million to the members of the three committees of the Congress overseeing their industry and more than $42 million to political parties and all candidates for federal offices during the 1997–98 election cycle, according to the Center for Responsive Politics.2 Second, the contributions to political parties by physicians are voluntary. Less than 30% of all members of the California Medical Association belong to its fundraising organisation, which gives about twice as much money to Democrats than to Republicans. Third, contributions to political parties by trade-union members are coerced. In the early 1990s, the US Supreme Court ruled that labour union dues must not be used for political purposes without the individual worker’s permission (Beck decision). Implementation was started by President Bush but cancelled by President Clinton immediately after entering office. In California, for instance, over 40% of teachers who are union members support the Republican Party but 90% of their contributions go to Democrats. Finally, it is surprising that George Lundberg would not appreciate the enormous slack he received from the AMA for 17 years, well knowing that most AMA members are more moderate than he is. Andre Minuth 4770 North Cedar Avenue, Fresno, CA 93626, USA 1 2
Horton R. The sacking of JAMA. Lancet 1999; 353: 252–53. LaBaton S. Debate over banking regulation reopens. New York Times Feb 11, 1999: 4.
Affirmative action needed in The Lancet Sir—As I settled into my favourite easy chair to pursue the latest issue of The Lancet, my wife shot me a quizzical look and asked me why I persisted in reading “that sexist rag”. I replied that The Lancet was not only a leading medical journal, but was progressive as well. My wife proceeded to win the first battle by pointing out that although 57% of the editorial staff listed on the masthead were women, all the letters were addressed to “Sir”. When I protested that at least the editorial staff reflected current demographic trends in medicine, she clinched the bet, with the following rigorous statistical analysis of the data. She proceeded to pull the 51 1998 issues of The Lancet off the shelf and to my dismay began counting the number of women and minorities portrayed in the Lifeline section. Of the 51 medical professionals interviewed, only four (8%) were women, and of the 47 men interviewed only five (11%) were minorities. As I completed the evening’s dishes, my wife, from the comfort of the easy chair, informed me of your editorial about affirmative action. 1 We hope that in the future The Lancet will eliminate the anachronistic habit of addressing letters “Sir”, and will also include more women and minorities in its Lifeline section. Mona Sfeir, *Reuben Granich 2629A Etna, Berkeley, CA 94704, USA (e-mail: [email protected]) 1
Editorial. Affirmative action. Lancet 1999; 353: 1.
DEPARTMENT OF ERROR Abnormal retinal vascularisation in preterm children as a general vascular phenomenon—In this research letter by Ann Hellström and colleagues (Dec 5, p 1827), figure A as published should read normal vascularisation in healthy boy aged 6 years, born at full term and figure B as published should read abnormal retinal vascularisation in boy aged 7 years, born at 27 weeks of gestation. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections—In this article by the MIST Study Group (Dec 12, 1998, p 1877), the first sentence of Findings in the Summary should read “Compared with placebo, zanamivir relieved influenza symptoms a median of 1·5 days earlier in the intention-to-treat (p=0·011) and influenzapositive (p=0·004) populations, and 2 days earlier in patients who were febrile at entry”. Also, the third sentence of the fifth paragraph of the Results section (p 1879) should read “Compared with placebo, zanamivir recipients were able to return to their normal activities 2 days earlier and has less sleep disturbance (table 3). Complication rates and associated use of antibiotics were less in the intention-to-treat population, but not significantly so (table 5)”.
THE LANCET • Vol 353 • March 27, 1999