Former Medical Journal of Australia editor Professor Stephen Leeder had opposed outsourcing production to Elsevier.
The escalating dispute over the future of the Medical Journal of Australia (MJA) has barely made the headlines, yet it matters to every one of us.
On the face of it, the publisher’s decision to outsource the MJA’s production to the multinational publishing giant, Elsevier, is a familiar cost-cutting measure and the disruption to the journal’s editorial and peer review functions might seem like equally familiar collateral damage. And, given that the journal is published by the medical profession’s peak body, the Australian Medical Association, and that much of opposition to the changes is coming from within the AMA’s ranks, this could all just be an obscure disagreement among doctors. It shouldn’t be mistaken as such.
The MJA matters because the quality and safety of every aspect of the medical and health care we rely on depends on a global knowledge system built on independent, peer reviewed research and fearless, well-informed commentary and criticism. The MJA has long been such a beacon of impartial scrutiny and oversight in Australia.
All day, every day our doctors and health care professionals make critical decisions about approaches, treatments and drugs based on what research journals tell them, directly or via clinical guidelines based on published research. Globally, journals are trusted to scrutinise all the available evidence and to reach the most accurate conclusions possible.
But health care is also very, very big business. Health care spending is approaching 10 per cent of GDP in most advanced economies. In Australia that translates to a total bill of about $150 billion a year. Worldwide about $240 billion a year is spent on medical research to determine what new approaches, treatments and drugs are incorporated into clinical care. The majority of these studies are, in fact, rejected for publication because they don’t meet the exacting standards of the knowledge gatekeepers, the editorial and expert teams of the world’s most reputable academic journals. That’s something that can give us all much more confidence in our care.
By contrast, anything that distorts the information that doctors and health professionals rely on potentially puts patients and communities at risk. Patients with heart conditions will likely remember the 2009 Australian class action against the global pharmaceutical giant, Merck over its recalled drug, Vioxx, that was linked to thousands of stroke and heart attacks. The Journal of the American Medical Association claimed Merck “manipulated” vital safety details about Vioxx, thereby obscuring the associated dangers.
But what does the Vioxx case have to do with cost cutting within the modest Sydney offices of the MJA? It is not, of course, directly linked. However, what was revealed during the Australian court hearings was that Elsevier, the company set to produce the MJA, had published an “academic style” journal that presented positive conclusions about Vioxx and another Merck drug, Fosamax. This so-called “Australasian Journal of Bone and Joint Medicine” was sponsored by Merck. It was later revealed that this was just one of six questionable journals produced by Elsevier and sponsored by pharmaceutical companies.
Elsevier has since shut its sponsored journals and publicly distanced itself from such strategies. Fair enough. But it remains a huge, profit-driven global publisher and, as such, may not have the interests of Australia’s medicos and their patients foremost in its mind. Can we be sure, then, that Elsevier is an adequate replacement for the MJA’s skilled and experienced production team?
For more than 100 years, the MJA has played a unique role in scrutinising and publishing research that matters specifically to Australia and in covering and commenting on national and local issues for the Australian medical profession. The journal, has, for example, played a critical role in revealing the significant health “gap” between Indigenous and non-Indigenous Australians. It has also built a national network of experts who review content, free of charge, and are an integral part of the editing process. And much of the MJA’s content is also available free online. Elsevier on the other hand is one of the world’s most profitable publishers, in large part due to the fees it charges for access to research.
One of the most distressing aspects of the turmoil at the MJA was the recent sacking of the journal’s universally respected editor, Emeritus Professor Stephen Leeder, by the journal’s publisher, the Australasian Medical Publishing Company, a wholly-owned subsidiary of the AMA. Leeder had opposed the outsourcing to Elsevier. That one of Australia’s most esteemed academics, epidemiologists and public health experts was escorted from the MJA building, by people acting for his own profession’s peak body, is truly humiliating, and not just for him. Many researchers felt this slight deeply and personally.
Leeder probably put it best when he compared events at the MJA to the false economy of throwing open the provision of by-pass pumps for cardiac surgical units to cheap, external providers of dubious repute, instead of sticking with the very best, proven devices. The results would, of course, be catastrophic. Where to now for the very best, proven device for the dissemination of Australian research findings I know – the MJA?
Jeffrey Braithwaite is professor and founding director of the Australian Institute of Health Innovation at Macquarie University.