Wendy Chavkin, MD, MPH

On January 15, 1999, E. Ratcliffe Anderson, Jr, MD, the Executive Vice President of the American Medical Association (AMA), abruptly fired George D. Lundberg, MD, the long-term editor of the Journal of the American Medical Association (JAMA). He did this in response to an article in that week's issue about a Kinsey Institute survey of college students' beliefs about sex reporting that 60% did not consider oral sex to constitute "sex." Dr. Anderson justified his action by stating that "publishing this survey this way at this time imposes [sic] JAMA into the highly charged political debate surrounding the impeachment proceedings now underway in the US Senate." There are many perplexing and disturbing facets to Dr. Anderson's decision.

Why does Dr. Anderson believe that science is neutral_ Science has never been and cannot be divorced from the culture and social forces that shape it. The very questions posed by science as well as the methods used to try to answer them reflect the current historical environment and political framework. In fact, this issue comes to our attention when a given scientific query collides with an opposing set of interests. From Galileo's run-in with church authorities who were offended by his suggestion that the earth was not the central point in the galaxy, to the restriction of federal funds for surveying Americans about their sexual practices early in the acquired immune deficiency syndrome epidemic, we see the interaction between science and the political context. The recent definition of tobacco, guns, and domestic violence as public health issues reflects the inseparability of social and scientific concerns.

We can accept that scientific investigation is culturally determined and still want to try to protect it from being buffeted about by opposing political interests. Toward that end, we have established certain procedures meant to safeguard the world of medical publication from direct intrusion of vested interests. The first is the peer-review process, whereby diverse opinions of other scientists are included in determining which work merits publication. Another is the disclosure by investigators of funding sources and potential conflicts of interest. This information is intended to reduce the possibility that commercial considerations might influence the design or results of studies. Another key feature is editorial independence, which is designed to insulate the medical publication process from internal political pressure by the sponsoring institution-in this case, the AMA.

According to The New York Times, Dr. Lundberg followed all of these standard procedures. The act of editorial judgement for which he lost his job was to speed publication so that the article saw the light of day during the Senate impeachment process. To my mind, it is the mark of an intelligent editor to try to present material in a timely way so that it is of utmost relevance to one's readers. Moreover, such editorial discretion is the rule, not the exception. Indeed, it is a peculiar notion that one wouldn't want scientific investigation to address and shed light on the pressing issues of the day. Numerous articles about smoking-related illnesses and behaviors appeared in medical journals as state legislatures and Congress debated tobacco-related policy. Findings from studies about gun violence have been published as states gear up to sue gun manufacturers. Surely, one goal of scientific investigation should be to inform public policy debate.

The President's opponents insist that everyone defines sex in the same one way. The Kinsey data contradict that. While some will dispute the implications of these findings for the impeachment trial, data can shed light on public attitudes toward sexual behavior, which is central to so many current health policy debates.

The issue is probably best understood turned on its head-by removing Dr. Lundberg for this reason, Dr. Anderson has allowed the drama in Washington to intrude on the integrity of the medical publication process far more than Dr. Lundberg did in making his original decision to publish.

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