Among medical journals, the release of articles expected to make national headlines is an art form as carefully choreographed as kabuki. Which is why anyone who does not stay in step may be asked to sit down.
In the case of Dr. Martin B. Leon, a prominent Columbia University cardiologist, the prestigious New England Journal of Medicine has reportedly given him an extended timeout — a five-year ban on reviewing submissions by other researchers or having his own commentary published in the journal.
Dr. Leon’s misstep was to be perceived as breaking the embargo the journal placed recently on an article and accompanying editorial about the results of a major heart study — material that did, indeed, make headlines in national news media, including a March 27 article in The New York Times.
Dr. Leon did not return calls seeking comment, and a spokeswoman for the journal said that its policy was to deal with transgressions privately. But no one disputed the account of his censuring in an online newsletter, heartwire (theheart.org) last week, the details of which heartwire said Dr. Leon had confirmed after an unidentified individual provided them.
The New England Journal article reported a significant medical finding: patients with chronic chest pain who received coronary stents, as well as drugs, were just as likely to die or have heart attacks as those who received only the drugs. Not the best of findings for stent makers, especially industry leader Boston Scientific.
The journal and the American College of Cardiology, a medical society, had planned to disclose the results on Tuesday, March 27, as the highlight of the last day of the college’s annual meeting in New Orleans.
As is standard practice with medical studies, the journal had sent advance copies of the results and its articles to journalists the previous week, to give them a chance to digest the complex material and interview the authors. By agreement, the reporters would honor the journal’s March 27 embargo date.
Dr. Leon displeased the journal’s editors, according to heartwire, with comments he made in New Orleans on Sunday evening, March 25, at a side event to the cardiology meeting — a symposium sponsored by Boston Scientific, one of numerous device companies that Dr. Leon has worked for as a consultant or paid speaker.
In those remarks, reported the next day in The Wall Street Journal, Dr. Leon criticized the design of the medical study and dismissed it as “rigged to fail.”
But while he did not disclose the study’s data, Dr. Leon was seen has having special insight into the findings because, as he told the audience, he had served as one of the medical journal’s peer reviewers of the article. Normally, the names of reviewers are kept secret even after an embargoed study is released. When The Wall Street Journal report appeared, Boston Scientific’s shares tumbled. The New England Journal scrambled to post the online articles immediately and the American College of Cardiology hastily called a press conference to make the results public a day early.
Dr. Sanjay Kaul, a noted Los Angeles cardiologist, praised the New England Journal’s reported punishment of Dr. Leon as an important reminder of the need for confidentiality. Many reviewers — including himself, he said — are not always careful enough to keep their role or the results of the paper they are reviewing completely secret from their colleagues.
But Dr. Kaul said doctors talking about the New Orleans incident were more concerned about whether medical companies or Wall Street analysts had been alerted to the medical study’s results well before Dr. Leon’s reported lapse. “It’s very common,” Dr. Kaul said, “to hear rumors that companies are in the know about trial results.” BARNABY J. FEDER
