First Newt Gingrich, then Bob Livingston, now George Lundberg, M.D.
On Jan. 15, Lundberg, editor of the Journal of the American Medical Association, lost his job after approving publication of an article his bosses believed would embroil the association in events surrounding President Clinton's impeachment trial.
The action places Lundberg in the company of former House Speaker Gingrich and his nominated successor Livingston, both of whom resigned amid fallout from Clinton's sex and perjury scandal.
Lundberg's sin, according to AMA Executive Vice President E. Ratcliffe Anderson Jr., M.D., was publishing a paper titled "Would You Say You 'Had Sex' If . . . ?" in the Jan. 20 issue of JAMA. The paper, based on research by the Bloomington, Ind.-based Kinsey Institute for Sex, Gender and Reproduction, detailed how 599 Midwestern college students in 1991 defined sex.
That definition is at the heart of debate over whether the president lied under oath when he said he never had sex with former White House intern Monica Lewinsky. The JAMA issue appeared in the midst of Clinton's impeachment trial. The study found 59% of students said oral sex didn't count, which was Clinton's argument.
Lundberg's predilection for high-profile, timely stories on controversial subjects was too much for the AMA, which recently has redoubled its lobbying and membership efforts to make the shrinking organization more relevant to the nation's doctors.
The AMA especially wants to avoid upsetting Republicans, who are major recipients of AMA campaign contributions, as it tries to get them to support Democrat-backed bills regulating managed care.
"I'm not suggesting he had a political agenda," Anderson said three hours after firing Lundberg, 65, who had spent 17 years editing JAMA. "But he used extremely bad judgment."
Anderson, speaking to reporters in the foyer of the AMA Board of Trustees' meeting room in Chicago, said Lundberg "is injecting us into what's going on in Washington, and that's intolerable." The board backed Anderson's action.
Anderson says he has started a "worldwide search" for Lundberg's successor. He says no one at the association has veto power over any editor and notes that the Kinsey story wasn't pulled from the Jan. 20 issue. "This independence will continue," Anderson says.
The normally outspoken Lundberg, who has never been afraid at House of Delegates meetings to tell the AMA board when it does something he doesn't like, said he would not comment about his termination on the advice of his attorney, William Walsh.
Walsh later said the AMA had "inappropriately intruded into the historically inviolable ground of editorial independence in scientific journalism (in choosing to) sacrifice Dr. Lundberg's distinguished career." Lundberg had not taken action against the AMA as of Modern Physician's deadline.
Lundberg's firing shocked June Machover Reinisch, M.D., who cowrote the sex study, and even Lundberg's rival, Jerome Kassirer, editor-in-chief of the New England Journal of Medicine.
The two split over whether the article belonged in a medical journal; Kassirer rejected Reinisch's piece in December, after she and co-author Stephanie Sanders had withdrawn it and submitted it to JAMA. But despite Anderson's denials, both agree the AMA top executive's action went against all principles of scientific and academic freedom.
"You would hope that the internal politics of the organization would not control what an editor or editorial board does," says Reinisch, director emeritus at Kinsey.
Reinisch says Lundberg never mentioned politics to her, and the paper went through the normal review process before being published. She says a three-page article such as hers running under the "Brief Report" section normally takes little time for review.
Kassirer is one of many who credit Lundberg with turning JAMA from a little-known house organ into one of the world's most respected medical journals.
"George Lundberg has done a superb job in editing JAMA," Kassirer said minutes after learning of his colleague's firing. "He has enjoyed the independence of an editor, and that independence is a critical aspect of running an important journal."
In trying to get a unanimous physician message to politicians and insurers, the last thing the AMA wants is controversy. It came under heavy criticism for its 1997 marketing agreement allowing its logo to be placed on Sunbeam Corp. products. The deal was canceled, but not before it claimed four executives' jobs, including that of Anderson's predecessor. It also cost the AMA $9 million in the form of a settlement payment to Sunbeam.
Anderson has said his goal is to get every one of the nation's 737,000 doctors to join his organization; only 260,000 currently are members. He also recently separated the association's private and public advocacy arms -- or lobbying groups -- so the AMA could devote more attention to such tasks as stepping into disputes between physicians and insurers.
Anderson says the Kinsey article was the final straw in seven months of disillusionment, although he would not say why exactly he had "lost trust and confidence" in Lundberg.
The AMA hired Anderson in May, which means he had been unhappy with Lundberg from the time he walked in the door.
While Anderson didn't say why he soured on Lundberg, one hint may have come when Anderson referred to the Kinsey piece as "sensationalism, not science."
Lundberg and Kassirer have waged a public battle to give their journals the sort of media buzz enjoyed by trendy consumer publications. Lundberg's very explicit wooing of mainstream media, which publicize findings in JAMA articles, was detailed in a June 28, 1998, New York Times Magazine cover story.
Lundberg's supporters say he improved the science behind JAMA articles through such means as a better peer-review process. But the Times magazine story showed Lundberg pushed stories that may not have had much scientific significance, such as a piece linking fish consumption to lower cardiac death rates. An accompanying JAMA editorial disputed the findings, but Lundberg didn't push that message.
"What harm could it do?" Lundberg was quoted as saying.
Lundberg also involved JAMA in policy debates that normally don't appear in clinical journals, such as the plight of the uninsured. He angered some doctors last October when he appeared on the CBS television show 60 Minutes and accused doctors of "burying their mistakes" by not pushing for autopsies, a subject broached in JAMA. Lundberg is a pathologist.
Steven Milloy, a Potomac, Md., biostatistician who runs an Internet site called "Junk Science," is critical of journal editors like Lundberg who he says make publications repositories of specious research and improper politics. Milloy also is an adjunct scholar at the Cato Institute, a libertarian think tank in Washington.
On Jan. 13, Milloy revealed on his site that JAMA would publish the Kinsey survey, a day before the journal issued a news release on the article. "I can't believe that anyone would publish this nonsense," Milloy says. "It's not science; it's not medicine. I don't know what it is."
Reinisch defends the scientific merit of her JAMA article, saying that with sexually transmitted diseases rampant, doctors have to ask more specific questions about their patients' sexual histories. The definition-of-sex questions in the article were part of a larger survey trying to predict high-risk sexual behavior. Reinisch says other colleagues, not Lundberg, pressed her to submit that piece of the survey to journals.
As for criticism that the 8-year-old data are irrelevant, Reinisch says the study's age actually makes its data more reliable. "If you ask now (what defines sex), people are self-conscious about it," she says. "It wasn't affected by what's going on (with Clinton)."
And JAMA editorial board member Uwe Reinhardt, a Princeton University professor, notes that it's common for parts of larger studies to be revived and reinterpreted. Reinhardt says researchers are still plumbing the depths of his 1979 survey of physician practices.