MEDICAL JOURNALS: More Troubles for NEJM, JAMA?

      A prominent member of the Massachusetts Medical Society -- which owns the New England Journal of Medicine -- has come under fire for a deal that allows an Internet start-up, in which he owns stock, to distribute NEJM articles online. Dr. Barry Manuel, associate dean and professor of surgery at Boston University School of Medicine, was a trustee of the medical society earlier this year when it negotiated a deal that gives HealthGate Data Corp. the exclusive rights to distribute a simplified online version of the NEJM. Manuel owns 1.4 million shares of stock in HealthGate, which the Wall Street Journal reports could be worth $10 million to $13 million after the company's anticipated IPO. HealthGate's stock prospectus prominently features the deal with the Massachusetts Medical Society, characterized as a "coup" for the small Burlington, MA-based company. Several medical society officials said that Manuel disclosed his ownership in the company and that he did nothing to influence the decision to partner with HealthGate. But other MMS officials said that Manuel's ownership was unknown to many and "should have been discussed more openly." A spokesperson said that the medical society chose HealthGate, whose CEO is Manuel's son-in-law, because of its "strong track record" and because it will allow the NEJM to retain content control over the online version.

Seeing Gold
      Behind the debate over the HealthGate deal lies a broader issue: the increasing tendency of not-for-profit groups to engage in for-profit business ventures. Although officials said the chief reason for the HealthGate deal and other ventures is to promote education, the medical society will share in the revenues from the online version of the NEJM. Dr. Jerome Kassirer, the NEJM's recently ousted editor-in- chief, had opposed its involvement in business ventures on grounds its name would be tainted and its brand diluted. Dr. Arnold Relman, who has served for years as the NEJM's editor-in-chief, fears that involvement in such ventures will corrupt its objectivity and status as a "gold standard" in assessing new drugs and treatments. Relman said he plans to bring the issue up for discussion at next month's meeting of the medical society's House of Delegates (Johannes, 10/26).

Medscape Challenges Publishing Establishment
      In the world of the traditional medical journal, articles can take more than six months to be published; article turnaround time in the Journal of the American Medical Association and the NEJM averages seven months. Launched in April and led by former JAMA publishing renegade Dr. George Lundberg, Medscape General Medicine is the first Web site to challenge the leading journals in the "publication of original medical research." Sunday's Baltimore Sun reports that the online journal's opening has sparked a debate over "the importance of speed in medical publishing." Lundberg notes that scientists "rely on other people's work to stimulate ideas -- and if they have to wait months and years, it delays scientific progress." But Public Health Research Group leader Dr. Sidney Wolfe worries that "online journals will compromise peer review in the interest of speed." NEJM top editor Dr. Marcia Angell is "not impressed either," noting, "Accuracy is far more important than speed. And even their greater speed is not that much greater." Lundberg is convinced that he will prove critics wrong, saying, "We have the same number of reviewers and the same quality of reviewers," who are given an abbreviated peer review timeframe -- three days as opposed to the traditional 28. Lundberg concludes, "Until recently, Medical publishing was functioning in Gutenberg time. Now, we're in Internet time" (Bor, 10/24).