Altman, Lawrence K. "AIDS Experts Leave Journal After Studies are Criticized," New York

 

Altman, Lawrence K. "AIDS Experts Leave Journal After Studies are Criticized," New York
Times, 15 October 1997, p. A10.

Two internationally recognizes AIDS experts are resigning from The New England Journal of
Medicine's editorial board over the content and handling of articles criticizing the ethics of
Federally financed studies of AIDS treatments in third world countries.

The countries seek a drug regimen less costly than those used in the United States to thwart
transmission of the AIDS virus from mothers to infants. In trials involving more than 12,000
infected pregnant women in Africa, Thailand and the Dominican Republic, some women receive
the drug AZT, which has worked in studies in the United States, while others receive dummy
pills.

The journal's attack on the studies which compares them to the infamous Tuskegee experiment,
has led to wide discussion, including harsh criticism of the journal itself, and focuses attention on
the role of the 25-member board and the two who are resigning in protest, Drs. David Ho and
Catherine M. Wilfert. The two objected to not being consulted before publication of an attack on
research that could save lives, and Dr. Ho worried that the attack itself could jeopardize future
research on experimental AIDS vaccines.

Dr. Jerome P. Kassirer, the journal's chief editor, said that the board's function was to give
advice on broad issues and suggestions of authors for editorials and reviews, but that the board
was not routinely consulted.

Dr. Ho, a virologist at the Aaron Diamond AIDS Research Center in Manhattan, and Dr. Wilfert,
a pediatrician at Duke University in Durham, N.C., are the board's chief advisers on AIDS.

A third board member, Dr. Richard P. Wenzel, chairman of medicine at the Medical College of
Virginia in Richmond, said in an interview that he agreed with much of Dr. Wilfert's criticism
but was withholding a decision about resigning until after the issue was discussed at the board's
annual meeting in December.

Drs. Ho and Wilfert said in separate interviews that they had resigned independently largely
because the journal had not consulted them before publishing an editorial that likened the new
experiments to the Tuskegee experiment, in which poor black men suffering from syphilis were
left untreated.

Dr. Ho, Dr. Wilfert and others have taken issue with the Tuskegee comparison in part because
the subjects in the AZT studies were told that some would get dummy pills. In the Tuskegee
study the men were not told that penicillin had became available while the study was under way,
and so did not know that effective Treatment was being withheld.

A full-time staff of editors produces the weekly journal, but Dr. Ho laid that "the reason you have
an editorial board to help with policy is to get some input when you have major issues like this
one, and that clearly did not take place."
In the editorial process, "it was clear that my role was not crucial," he said.

Dr. Ho said he was deeply concerned about how the critical editorial would affect the future of
studies to evaluate experimental AIDS vaccines in developing countries.

Dr. Wilfert said she was resigning because the journal published the editorial and another critical
article on Sept. 18 without presenting the other side.

Because her name was on the masthead, "it implied that I agreed with it when I didn't," she said.

"It is an error and bad policy" and "a grievous misuse of the journal's power," Dr. Wilfert said.

"Those are not decisions that a few people in the editorial office ought to feel comfortable with,
because no one small group of persons, no matter who they are, can cover the waterfront well
enough" in translating health policy and practice in developed countries to those in developing
countries, Dr. Wilfert said.

Dr. Wilfert said she was resigning effective Dec. 31 in order to "vent my spleen" at the annual
meeting. She said she feared that if she resigned sooner "the issue might not be discussed at the
meeting."

The journal published a rebuttal two weeks after its attack. It was written by Dr. Harold Varmus,
the head of the National Institutes of Health, and Dr. David Satcher, the head of the Centers for
Disease Control and Prevention, and would not have been printed so quickly had not Dr. Varmus
received a leaked copy of the editorial before publication, those involved in the dispute said.

Dr. Marcia Angell, the journal's executive editor, wrote the editorial.

Dr. Wenzel said that if the authors of the critical articles "really knew the facts they would have
done a better job."

Dr. Kassirer said he regretted Dr. Ho's and Dr. Wilfert's decisions to resign and was unaware of
any similar resignations at the journal, which was founded in 1812.

The editorial board members, who have no set term, Dr. Kassirer said, are named by the chief
editor, who can elect not to renew them as members and has done so.

Dr. Kassirer said that Dr. Wilfert "wanted to have prior consultation of the material in the
journal, which is just not acceptable to me because prior consultation is not what the editorial
board is for."

He said the journal intentionally did not strive to present all sides of an issue "because if you did
you would end up with a kind of Talmudic discussion in which readers could end up having no
particular view one way or the other and it would be rather boring."

Dr. Varmus, the National Institutes of Health director, said that "The New England Journal of
Medicine is trying to attract more attention by making political, ethical, philosophical and
economic statements that have traditionally not been in that journal in such an inflammatory
way."

But he also said that "before you inflame the public and attract so much attention, you might
want to ask experts on the editorial board what they think."

The Massachusetts Medical Society owns The New England Journal of Medicine. Dr. Ronald A.
Arky, a Harvard Medical School professor who heads the society's publications committee to
which Dr. Kassirer reports, said he learned of the resignations last Friday.

"The committee will want to hear from the editor about the resignations" at their next meeting in
early November, Dr. Arky said.