The New England Journal of Medicine’s Editor-in-Chief: “We Do Not Intend to Correct” Our Mistake.
On Thanksgiving day 2019, I became aware of an editorial falsehood published, as fact, by Dr. Dan Longo - a Deputy Editor at the New England Journal of Medicine (NEJM).
Longo claimed that the 2014 FDA action to limit the use of uterine morcellation in gynecology was “a change that has harmed many thousands of women.” Of course, this statement is not substantiated by ANY data or peer-review publications. It is pure conjecture — in fact, to the contrary, the published data in the Journal of the American Medical Association shows NO rise in complications following the change (see below). The falsehood promoted by NEJM’s Longo comes on the heels of another more extensive false editorial by NEJM correspondent and Brigham and Women’s Hospital physician, Lisa Rosenbaum, in 2016.
Back in 2016, Rosenbaum’s editorial was shocking for its incorrect characterization of the 2014 FDA action, absence of insight, unethical utilitarian thesis, and defamatory content. Rosenbaum actually had the chutzpah to suggest that Dr. Amy Josephine Reed, and I, are “availability entrepreneurs”.
So, the continued mindless editorial carelessness exercised by NEJM’s Longo last week prompted me to write a letter to the editors, again, requesting a correction or retraction. You may read my letter, HERE.
Yesterday, I was pleasantly surprised when my e-mail inbox buzzed with a new message not from Dan Longo, but from Professor Eric J. Rubin — the new Editor-in-Chief of NEJM, himself.
Of course, my enthusiasm was short-lived.
In his email, wreaking of excuses, useless platitudes and condescension in the face of what is an iatrogenic mortality hazard to unsuspecting women’s lives that killed my wife (among others’), Professor Rubin took it upon himself to inform me that NEJM does not “intend to correct or retract” its editor and writer’s unsubstantiated and false statement about a 2014 FDA action to limit the use of uncontained Power Morcellators in Gynecology.
This is shocking behavior on the part of a decorated Harvard academic and NEJM’s Editor-in-Chief!
It would have been better if Professor Rubin had kept his mouth shut, like his colleagues Dan Longo and Lisa Rosenbaum. Though, of course, in an ideal world it would not be a mark of weakness if men like him, at least on occasion, demonstrate the humility and decency to correct harmful errors from their high stations— especially the errors committed by themselves or their own people.
Alas, Rubin forgets himself in his Harvard regalia and newly acquired untouchable power as NEJM’s top dog!
But even more sad, I think, is that Rubin was set up by his colleagues’ cowardice, and his predecessor’s (Professor Jeff Drazen) prejudice on this issue.
To be a bit empathic to the new chief, Rubin is new to NEJM. And I am almost certain he has not taken the time to look at the scale of hazard posed to women by uncontained Power Morcellation in Gynecology. I don’t think he’s really even taken the time to look at the epidemiology, or thought about the ethics of what’s been happening to women whose “missed” uterine cancers were being Power Morcellated for well over 2 decades across the world, and are still.
Of course, if he is in the know and maintains NEJM’s posture, by refusing to “correct”, that would make him an unethical person. Still, I’d like to give him the benefit of the doubt — he’s a newbie in NEJM’s ivory tower.
I think Rubin’s response to me was the knee-jerk response of a man who’s trying to show that he backs up his “rank and file” and was an attempt to impress a few colleagues with his hard potency in response to controversy from “the masses”.
I do wonder if he knows that some of his more senior colleagues and long-standing “deputy editors” at NEJM, probably wanted (and still want) his job. After all, Longo is a Harvard Professor of Medicine too — and he’s been at NEJM for a lot longer than Rubin….Why is it that Rubin is doing Longo’s dirty work for him? Why didn’t professor Longo himself (or Rosenbaum) respond to my critique, instead of their new chief? But, I digress!
I wrote Rubin an email response today (see below).
I’ll let the reader judge my reaction for him- or her-self. Of course, it would be a mistake, if the reader judges me simply as being a “grieving husband with a chip on his shoulder and an axe-to-grind”. I do believe that Professor Rubin is punch drunk with newly acquired power — and that he is naive in his new role as NEJM’s editor-in-chief. He’s forgotten himself and his real charge and purpose as a leading physician and culturally gravid citizen — and of course, Harvard assassins abound all around him….
Professor Rubin, Dr. Longo referred my critique to you for a reason. Please know that characters like Longo and Rosenbaum will bring you nothing but trouble — because they are careless and arrogant with their words. I suggest you bring in some “new blood” to NEJM. Don’t become the latest casualty to “Harvard Hubris”.
Here’s my email of response to Professor Rubin — judge for yourself, reader:
Professor Rubin,
Certainly, it gave me no pleasure to have received your email response — particularly because I know that it is quite a simple matter for you and Dr. Longo to admit that his editorial statement (and Rosenbaum’s) are opinions that are unsubstantiated by data and peer-review publications — in fact to the contrary! The only published data in JAMA show NO rise in peri-operative complications (i.e., harm) following the FDA action.
https://jamanetwork.com/journals/jama/fullarticle/2545671
On the other hand, Professor Rubin, the deadly harm done by the iatrogenic dissemination of “missed” uterine cancers to women (at rates upwards of one in 200 patients) is 100% substantiated by data from many reputable (and diverse) source in 2019 — from Harvard and elsewhere. I urge you to speak with Drs. George Demetri and Suzanne George at Dana Farber about this topic and review the epidemiological literature.
https://www.ncbi.nlm.nih.gov/pubmed/24923260/
https://www.ncbi.nlm.nih.gov/pubmed/30853364
So, any reasonable physician or concerned citizen would see a NEJM editor’s erratum, as follows, to be necessary and appropriate in response to my demand for a correction in the face of undeniable scientific facts: “We previously stated that the FDA action to eliminate the use of morcellation in hysterectomy is ‘a change that has caused harm to many thousands of women’. This statement is the author’s opinion and has not been substantiated by any data. Additionally, it is now evident that one in 200–400 women with symptomatic uterine fibroids carry a sarcoma whose morcellation has been shown to promote loco-regional spread and worsens outcomes — therefore, we want to clarify that the editors do not believe that FDA’s decision was based on a single “anecdote” in 2013.”
Of course, your email convinces me that you are unable to publish such a correction to the words you are archiving for posterity in NEJM.
It is shocking to know that NEJM has such low editorial standards, where scientifically unsubstantiated opinions are comfortably peddled by the Journal’s senior editors, as though they are facts….and when called on your errors, you dig in your heels. and for what, Professor Rubin — ego or loyalty to a few friends and colleagues at Harvard and NEJM? Beware, assassins dressed as friends at Harvard — I’ve seen it with my own eyes.
Perhaps in your capacity as an institutional guardian and Harvard Professor, I should not have expected a different response from you.
BUT, as a morally grounded thinker and a physician for whose educational/cultural heritage and narrative I have a profound grasp and respect, I do indeed expect a higher standard of reasoning and decency: that you would recognize unethical utilitarianism anywhere, but especially in medicine, from miles away — and especially, at the very least, that you would stand at the ready to correct errors and falsehoods in the pages of the Journal you now lead, in the interest of ethics and scientific integrity.
Alas, the hard lessons of ethics and moral judgement do not translate from different domains of human experience and history! Professor Rubin, your response to my call to correct your deputy editor and correspondent’s words is an error. Professor Rubin, you forget your self.
That Dr. Dan Longo himself, and Rosenbaum, do not themselves insist that their words be corrected in response to my valid, evidence-based, critique now, speaks volumes to the nature of their character: intellectually loose, political and full of professional hubris!
It is, indeed, deeply painful to see that an Editor-in-Chief at a Journal of NEJM’s stature seems perfectly at ease with his colleagues peddling unsubstantiated opinion, as though they are scientifically proven facts — opinions that could very well serve to do grave harm to unsuspecting women. More broadly, it is sad and telling of where leadership in American medicine is landing today. Yes, Professor Rubin, even one false statement counts — you underestimate your Journal’s station, sir!
I do not expect you to reverse your “editor-in-chief” decision on my call to correction now — as your type of folks never do, in my experience, no matter what sociocultural and educational narrative they have matured in and no matter the intensity of the facts and potency of the scientific/ethical arguments. Your corporate directive today is: “Don’t rock the boat — defend the institution, irrespective of the facts”.
But I do hope that you will study this issue of “missed” uterine cancer diagnoses in Gynecology objectively, moving forward. Women’s uterine cancers are being “missed” by Gynecologists at an epidemic rate — and real harm has and is being done to unsuspecting patients.
Professor, as a moral physician and culturally gravid citizen, your trust in any utilitarian construct must be constrained by the ethics with which it treats “the forgotten”, “the untouchable”, “the dirty”, “the chosen”, “the unidentifiable”, “the missed”, and “the occult” minority subsets who do not benefit from seemingly advantageous practices and policies marketed to or used by “the mainstream majority”. Medical Utilitarianism without adequate ethical constraint is the recipe for atrocity.
I certainly hope that you lose sleep over your decision not to correct a harmful falsehood in the powerful Journal you now lead — I trust that Dr. Amy Josephine Reed’s (and the others’) spirit(s) and story will visit you.
Dr. Rubin, you have made a significant moral and editorial error in not correcting Longo (and Rosenbaum’s) assertion(s), when given this opportunity.
You forget where you’ve come from yourself and who you are — It’s quite sad!
Sincerely,
Hooman Noorchashm (for Amy and the others).
