Thursday, June 18, 2015

Latest communication with the JACR editor regarding MOC Establishes clear support of MOC by these editors!

Dear Dr. Kempen -

Thank you for your continued interest in COI as it relates to a May 2015 publication in the journal by Dr. Guiberteau.

As I wrote you earlier today, the journal will soon publish an erratum noting the failure to disclose. However, in your email to me earlier today, I found several misconceptions in the following paragraph, which, for the record, I wish to correct:

"In conclusion, I regret the need to go through the Publisher regarding the COI, but remind you that my clear attempts to point out this intentional deception by the ABR and Dr Guiberteau were unsuccessful via direct communications with you.  The disclosure at the bottom of the publication clearly provides upon very superficial review enough information to demand ABR associations from that author, who gives his Email as at that board-ABR. I am also sure your journal approached these authors directly through the ABR/ABMS to provide a counter point view-just how they would otherwise become involved would otherwise deserve specific mention in your upcoming statement/publication."

1. You said I was non-responsive. However, I answered your initial email almost immediately. Following your second email, a day elapsed, during which I expended some effort researching this issue, before I wrote a response.  If this is being non-responsive, the fault lies more with your expectations than with my actions.
2. I found no justification for your charge that Dr. Guiberteau intentionally tried to deceive readers, nor can I understand why he might want to do so. Do you have some special power that enables you to discern intent?
3. You are incorrect that I approached Dr.s Guiberteau and Becker through the ABR or ABMS. I wished  to publish Dr. Jha's interesting take on the Board and believed readers would benefit from the conventional view. I know both Dr. Guiberteau and Becker, and they seemed the best options to provide the counter-perspective. I recruited their response directly with the authors.
4. There is the implication in what you wrote that Elsevier forced my hand in responding to your email. Incorrect again. The journal is owned by the ACR, not Elsevier. By contract, I have he responsibility for all editorial actions.
5. While I agree with you that it should have been easy for a knowledgeable person to spot Dr. Guiberteau's failure to disclose, I take issue with your implication that we turned a blind eye. It has not been part of the JACR staff routine (nor mine) to review COI disclosures. Perhaps we need to take another look at this issue. In this case, as in most others, it is wrong-headed to attribute to conspiracy what is better explained by simple human error.

Again, I appreciate your interest in JACR and trust that this email concludes the matter.

Bruce J. Hillman, MD
Editor-in-Chief, JACR

In response: 
Dear Dr Hillman:
1) Nowhere in that paragraph do I even see the words "non-responsive".  On The 25th you simply stated "Unfortunately, I found it to filled with unsupported assertions and accusatory language to consider it appropriate for publication. "  
While the message of the letter appeared unwanted by you,  I asked (to absolve any real issues)  what you would like referenced and I would be happy to provide such. I also indicated that the truth is not kind to those who obfuscate and there have been significant problems with these boards. You simply further stated "By no means did I intend to impugn your expertise in this area, which quite clearly is extensive. However, my initial editorial decision stands."
I followed that you had no interest in further pursuit in any information I might add  on the issues propagated upon physicians by the ABMS and ABIM through the other 23 affiliates including Radiology

2) This is not my first Rodeo with the boards, which espouse great amounts of corporate agenda as simple business practice. I am exposing this sort of lack of ethical declaration because it is WIDESPREAD and found only with the ABMS Boards who somehow feel they are magically without conflicts in selling their useless products in an extortive manner and without disclosure.  I did send you this link (  where you could read:
"For example, in two back-to-back articles in the Journal of the American Board of Family Medicine (JABFM), 24,25 one author who contributed to both papers failed to consistently declare conflicts, while another, James C. Puffer, is also executive editor of the journal. Despite the statement, “Conflicts of interest: none declared,”24 Puffer earns more than $600,000 per year as chief editor of JABFP and president and chief executive officer of the ABFM, according to IRS documents. ABMS funds journal supplements promoting its proprietary products, BC and MOC programs,26,27 spending as much as $50,000 per issue. See, for example, the 66-page Fall 2013 supplement to the Journal of Continuing Education in the Health Professions. Recently, the National Quality Forum (NQF), with a long history of American Board of Internal Medicine (ABIM) leadership interactions and personnel exchanges, has been involved in questionable conflicts of interest, leading to congressional investigation and strong allegations of misconduct by an NQF official and inadequate policy to prevent conflicts.28,29"

Dr Puffer is also CEO of the ABFP, Chief editor of the JABFP, senior author of the article espousing the benefits of certification, earns over $600,000 a year and yet has "no COI to declare". Does this amaze you too? See:
24. Schulte BM, Mannino DM, Royal KD, Brown SL, Peterson LE, Puffer JC. Community size and organization of practice predict family physician recertification success. J Am Board Fam Med 2014:27:383-390.  
It is freely available on the web at: because this journal is the property of that ABFP CORPORATION.

3) Normally one might consider Dr Jha's article is quite balanced on it's own. I certainly did. However because of the close link of income from MOC for both the boards and associated national societies which support YOUR journal and so many other close associations, there is apparently a continued need by these societies and their editorial staff to support the corporate structure of these corporations and always find opportunity to pair their viewpoint whenever a contrary view is expressed. These boards have in my opinion outlived any usefulness. 
The fact that  YOU knew both of the authors personally, would seem to support that you knew they were executive board members-which is why YOU asked them to protect the ABR ABMS interests in the face of this balanced, yet corporate embarrassing document from Dr. Jha.  As such, you are your journal's highest representative and ignored the obvious.  Jumping to number 

5) As you Knew these individual and obviously sought them out as representatives of the Corporations they serve, perhaps your choice was "two eyes open" rather than "I take issue with your implication that we turned a blind eye." Certainly you none the less read and approved this statement: "While the opinions offered in this article are the expression of the authors, the document was reviewed and is supported by the Board of Trustees of the American Board of Radiology." As well as recognize this as an ABR corporate email account?

As for Point #4, I refer to the example of Dr Puffer above and clearly recognize that editors and editorial staffs will still have collaboration with the Board Corporate interests. Not all publishers will, like Elsevier, even uphold these important interests regarding the international accepted COI standards. I recognize that would your journal have been directly published without oversight by a professional and acclaimed publisher like Elsevier, we would not be communicating at this point.

In conclusion, I am more than willing to write again an acceptable article or letter for your journal on these important issues, however feel a lack of interest for such on your behalf would require a written request at this time. 
Yes, I do have significant insight I could share with your readership and will be happy to work with you, should you send to me your request.
This is a very important topic of great interest to your readership. 

Thanks again for your time,


Paul Kempen, MD, PhD

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