It all started when someone sent an unsolicited essay to the Journal of the American
Medical Association last year. It could have happened to any publication. Newspapers,
magazines and scientific and medical journals get manuscripts they haven't commissioned
all the time. The difference in this case was the subject matter of the essay. The essay—500
words or so—was a first-person account of how a groggy gynecology resident in an
unnamed hospital was awakened at 3 a.m. to ease the pain of a suffering, sleepless
20-year-old ovarian cancer patient. The resident ended her pain by giving her what he
believed to be a fatal injection of morphine. The essay ... was a description of a mercy
killing, and, in effect, a confession to a murder. And it had been submitted to JAMA for
publication on one condition-that the author's name be withheld. Editors have many
choices when they get a piece like this. Dr. George Lundberg, a physician and the editor of
JAMA for the past six years, chose a course that landed the AMA in court-and reaped angry
denunciations from physicians, ethicists and many journalists and the editors of other
medical journals.
Lundberg plunked the piece into the essay section of the January 8 edition of JAMA
without listing the author's name, without verifying that the event actually took place, and
without running a preface explaining why he was publishing the essay or that he was
uncertain about the essay's veracity.
Lundberg later explained that he wanted to stir up a debate over a controversial
subject. That he did. But he also stirred up a discussion about his own 'actions, raising
questions of medical and journalistic ethics for which there are no ready answers. And,
through his actions and statements, he illustrated that editors of medical and scientific
journals operate in a culture that is largely foreign to the world of journalists who gather
news for a general audience.
The 105-year-old Journal of the American Medical Association, published in Chicago,
claims to be the most widely circulated medical publication in the world, with 383,000
readers of the English language edition and 250,000 readers of its 10 foreign-language
editions. Published by the most powerful doctors' organization in the country, JAMA also is
one of two top medical publications in the United States. The popular press looks to JAMA
and the New England 10urnal of Medicine each week for the latest medical news.
JAMA's January 8 edition was no exception. Graced with a portrait of a woman by the
19th-century painter Ingres on its cover, JAMA included two items many newspapers picked
up: a study of a syndrome in which people's blood pressure shoots up at the sight of a
doctor's white coat, and an article and editorial saying tighter controls and better
counseling need to accompany Human Immunodeficiency Virus antibody testing,
commonly known as AIDS testing. The issue also included “It's Over, Debbie.”
“Debbie” appeared in a section called “A Piece of My Mind,” which Lundberg portrays
as “an informal courtyard of creativity,” a place where poems, anecdotes and unscientific
matters are published.
Lundberg refuses to reveal many specifics of the editorial process, and he forbids
interviews with his staff. But he does note that JAMA articles are put through a peer-review
process. Lundberg, however, won't disclose the number, names or occupations of the
reviewers who looked at the Debbie piece, or the contents of their reviews. Nor will he talk
about the number of JAMA staffers who opposed publishing the piece.
He also declines to say whether he asked lawyers for the AMA to review the piece.
However, Kirk Johnson, the AMA's general counsel, said Lundberg didn't discuss the essay
with him prior to publication.
Lundberg also refuses to say whether he consulted with medical ethicists in advance of
publication, though AMA attorney Johnson said the essay had been reviewed by an ethicist.
