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The Canadian Medical Association is facing mounting international criticism over its decision to dismiss the editor-in-chief of the Canadian Medical Association Journal and disband the publication's editorial oversight committee.

The World Association of Medical Editors, former editors-in-chief of the British Medical Journal and New England Journal of Medicine, as well as the now-defunct CMAJ oversight committee say the CMA is interfering with the journal's editorial independence and putting the future of the Canadian Medical Association Journal in jeopardy.

Last week, the CMA fired journal editor-in-chief John Fletcher and disbanded the oversight committee, which was put in place a decade ago in response to a major controversy over editorial interference.

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Under the new structure, the journal's editor-in-chief will deal with the CMA board of directors on editorial issues. NewCo, a subsidiary of the CMA, has been taking on more of the journal's administrative responsibilities.

CMA president Cindy Forbes said the changes were being made to revamp the journal at a time of falling revenue and declining submissions.

On Monday, the remaining editors at the CMAJ published an editorial criticizing the CMA for the moves – and for suggesting the journal's reputation is slumping – and said they remain committed to ensuring editorial independence.

Critics say the changes could do irreparable harm to the journal, which is Canada's top medical publication and read by many health professionals.

Jerome Kassirer, editor-in-chief emeritus of the New England Journal and former member of the CMAJ journal oversight committee, wrote a post on the British Medical Journal website that accuses the CMA of inadequately funding the publication and eroding the editors' ability to maintain editorial independence.

"CMA members should question their allegiance to an organization that fires its journal editor when expedient, treats its professional advisors with disdain, and bends so readily to corporate and financial influences," Dr. Kassirer wrote.

Last week, Dr. Forbes told The Globe and Mail the new governance structure is in line with the recommendations set out by the World Association of Medical Editors, or WAME.

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But WAME says it is deeply concerned about the CMA's actions. Its executive committee wrote an online post that states, "Removing editors for unclear reasons raises concerns about publisher interference that violates the principles of editorial independence advocated by the WAME."

Richard Smith, former editor of the British Medical Journal, said the CMA's actions signify the "death throes" of the CMAJ and similar journals around the world. Fewer researchers will want to submit articles to an organization that is "so cavalier about editorial independence" and that the CMA executives "may be the main architects of the downfall of the CMAJ."

In an open letter to CMA members, the former oversight committee said the CMA ignored its own policies and procedures. The journal is now vulnerable to "the pressures of profitability," they wrote in the letter.

John Wootton, former chair of the oversight committee, said despite the CMA's assurances, the journal's editorial integrity is in peril.

"It's fine for the CMA board to say editorial independence is their first priority. Who's going to raise the alarm if it isn't?" he said.

Dr. Wootton added that he is concerned about the fact that NewCo – which is responsible for the revenue-generating areas of the CMA – is overseeing the journal.

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In an e-mail statement, Dr. Forbes defended the CMA's decisions and said the organization is committed to editorial independence.

"There are some who have publicly disagreed with our approach without the benefit of the facts, but we remain steadfast in our decision and are committed to ensuring a strong future for Canada's pre-eminent medical journal, the CMAJ," she wrote.

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