By Steve Levine
A coworker suggested that maybe their workflow got all “JAMA-ed” up. I don’t think so.
It looks like the 145 days it took the Journal of the American Medical Association (JAMA) to publish a 279-word, five-paragraph response to a commentary that ran in August 2017 is exactly the slow and methodical pace the JAMA editors intend.
That kind of approach is well-suited to clinical articles, where the author’s science and reasoning deserve strict scrutiny.
But when you’re dealing with opposing opinions on an important health care policy issue, the dialogue needs to move quite a bit faster.
Here’s what happened.
- On May 29, 2017, the Texas Legislature passed Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway). Strongly backed by TMA, the bill created a new law to protect Texas physicians against mandatory maintenance of certification tyranny.
- Ten weeks after the bill passed, on Aug. 7, 2017, JAMA published a commentary from a former chair of the American Board of Internal Medicine Board of Directors. Dallas internist David H. Johnson, MD, called SB 1148 a "threat to professional self-regulation" by physicians and went on to write that the bill "weakens [physicians'] claim to self-regulation by establishing a precedent for additional governmental intervention into the practice of medicine."
- Three days later, on Aug. 10, TMA President Carlos J. Cardenas, MD, wrote his five-paragraph response to Dr. Johnson’s commentary. He agreed on the importance of self-regulation to the profession.
"It encompasses our responsibility and our authority to establish and enforce standards of education, training, and practice," Dr. Cardenas wrote. "We routinely defend that responsibility and authority in advocating against the intrusion of all third parties — such as government, private insurers, hospital administrators — into the practice of medicine."
But physicians in Texas and across the country, he argued, do not see the certifying boards as "self."
"They are, instead, profit-driven organizations beholden to their own financial interests," Dr. Cardenas wrote. "In fact, they are now one of the outsiders intruding into the practice of medicine."
- If Dr. Cardenas was hoping for a robust conversation on an issue that’s critically important to U.S. physicians, he didn’t count on the JAMA processes, starting with an automatic four-week delay before his response even went to an editor. Then, after about two weeks of editorial review and revision, JAMA informed Dr. Cardenas on Oct. 25 that his rebuttal had been accepted for publication.
- It took another 69 days ― until Jan. 2 of this year ― before his words actually made it into print. All told, 145 days passed from when Dr. Cardenas submitted his response until it was published; that’s five days longer than the entire 2017 session of the Texas Legislature.
As a leading medical journal, JAMA rightly goes beyond purely clinical or scientific studies. In fact, the journal includes this among its critical objectives: “To foster responsible and balanced debate on important issues that affect medicine, health, health care, and health policy.”
But when that debate happens so slowly that it becomes disjointed, when it happens so slowly that even glacial-pace lawmakers already might have decided an issue and gone home, JAMA is missing an important mark. Perhaps the editors need to expend a little more energy on another of their critical objectives: “… to produce a publication that is timely …”
In an age when you can post a response to an online news article immediately, when you can get a letter to the editor published in less than a week, 145 days just won’t cut it.