Thursday, September 13, 2012

The New England Journal of Medicine: A Look Behind the Curtain

The following article was written by Margaret Dore, who is a lawyer in Seattle Washington. The article explains what happened to her, Senator Greg Hinkle and Bradley Williams, from Montanans Against Assisted Suicide, as they attempt to get the New England Journal of Medicine (NEJM) to make a correction to a false statement.

This is a link to the original article that was published on the Massachusetts Against Assisted Suicide blog.

Margaret Dore
By Margaret Dore Esq - Updated, September 13, 2012

On July 12, 2012, the New England Journal of Medicine (NEJM) published an article by Julian Prokopetz and Lisa Lehmann MD.[1] The article, "Redefining Physicians' Rolein Assisted Dying," has numerous errors.

For example, the article claims: "in Oregon and Washington patients whose doctors don't wish to participate in assisted dying must find another provider to acquire a prescription."[2] This claim is false. Providers have no such obligation.[3] Moreover, this claim is easily verifiable by reading the Oregon and Washington statutes.[4] The article also claims that assisted suicides in Oregon have "stabilized at 30 to 50 per year."[5] This is also false. Assisted suicides in Oregon have been steadily rising with the most recent totals being 65 and 71 deaths per year.[6] This information is also easily verifiable, i.e., by going to Oregon's website.[7] 

The Prokopetz/Lehmann article, as whole, demonstrates a lack of understanding of the Oregon and Washington assisted suicide laws.

The New England Journal of Medicine holds itself out as the "gold standard" of research and claims that it "employs a highly rigorous peer-review and editing process" and that it "is committed to maintaining that reputation and integrity."

I thought, ok, I will let them know. They can do a correction.

I submitted a letter, which identified some of the problems with the article and told them about some of the errors. My letter was rejected. I asked for equal time. I was informed that rebuttals to articles are not allowed. The staff person said:
"Unfortunately, the editors of the Perspective section [of the NEJM] do not accept perspective articles that are rebuttals or responses to published Perspective articles."[8]
I wrote back: 
"Your authors are allowed to say anything, no matter how wrong, with impunity?"[9]
Montana, Senator Greg Hinkle
That led to an apparent change of heart, that they would publish my letter after all. But first, I would have to sign a copyright agreement, which would forbid me from talking about assisted suicide until they published my letter and if they didn't publish my letter, I wouldn't get to talk at all. At least that's how I read it. I asked for a modification or clairification that I would still be allowed to talk about assisted suicide. NEJM refused. I have better things to do than be sued for copyright infringement, especially over a 175 word letter.[10]

Montana State Senator Greg Hinkle, who also sent in a correction, had a similar experience. He wrote back to the NEJM: "Per my reading of your proposed copyright agreement, I would no longer be able to speak or write about the law of Montana regarding assisted suicide except in the narrow circumstances listed in the agreement. As an elected official of the State of Montana, it would be unethical for me to enter such an agreement."[11] He also said:
"I have always held the NEJM in high regard and am now wondering if the Journal is following the trend across the country of the media being unwilling to print both arguments on issues."[12]
NEJM would not agree to a modification.[13] Senator Hinkle's letter was not published.[14] Bradley Williams, Coordinator of Montanans Against Assisted Suicide, also sent in a correcting letter, which was rejected by NEJM.[15]

To view our unpublished letters, see herehere and here.

I then found this article: "NEJM sat on Vioxx article warning for years," about how NEJM allegedly refused to correct another article.[16] As of this writing, the Prokopetz/Lehmann article remains uncorrected. 

This all reminds me of the Wizard of Oz. I have seen behind the curtain.

* * *
[1]  Julian J.Z. Prokopetz, B.A., and Lisa Soleymani Lehmann, MD, PhD, "Redefining Physicians' Role in Assisted Dying," N Engl J Med 2012; 367.97-99| July 12, 2012, available at:
[2]  Id.
[3]  See Washington Act, RCW 70.245.190(1)(d) and Oregon's Act, ORS 127.885 Sec. 4.01(4). The requirement is that if the patient goes to another doctor, the first doctor is to provide the patient's relevant medical records, if requested. That's it.
[4]  Id.
[5]  "Redefining Physicians' Role in Assisted Dying," at note 1.
[6]  See Oregon's annual report for 2011 at:
[7]  Id.
[8]  E-mail dated August 13, 2012.
[9]  E-mail dated August 13, 2012.
[10]  To view my unpublished letter, click here
[11]  E-mail from Senator Hinkle to NEJM, August 29, 2012.
[12]  Id.
[13]  Per Senator Hinkle.
[14]  To view Senator Hinkle's unpublished letter, click here.
[15]  To view Bradley Williams unpublished letter, click here.
[16] "NEJM sat on Vioxx article warning for years: WSJ," May 15, 2006, at  The article states: "Less than a year after publishing an article touting the benefits of Vioxx, editors at the NEJM received warning of possible flaws in the November 2000 piece, including a call-in from a pharmacist to a radio show on which the NEJM’s top editor was featured. During the call-in, the pharmacist told the editor, Jeffrey Drazen, about several extra heart attacks not reported in the article but that had occurred during clinical trials. She also submitted a letter to the NEJM about the missing data. The letter went unpublished, even as the article brought in at least $697,000 in revenue on 900,000 reprints sold—most of them to Merck for use as detail aids. A negative letter would have dampened their impact."  (Emphasis added) 

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