The latest flap in our bioethics neck of the woods has to do with the editorship of the American Journal of Bioethics and the doings of the recent editor-in-chief, Glenn McGee, PhD. According to various of my colleagues, Dr. McGee is either a) an unethical bioethicist and should be roundly condemned or b) the victim of scurrilous character assassination.
Here is some of the anti-McGee background:
Briefly, Dr. McGee was originally on the faculty at Art Caplan's prestigious bioethics program at Penn, but left when he failed to get tenure there--not necessarily a black mark as I doubt Aristotle would be granted tenure at Penn. He then became director of the bioethics institute at Albany Medical College, but left there under a cloud--lest I be accused of more character assassination I'll let the Scientific American do it instead:
The above-cited article quotes Dr. McGee as saying, "I am going to be entering a new phase of my career in which I am a dartboard." Dartboard or no, he next landed at the Center for Practical Bioethics in Kansas City where he held the John B. Francis Chair--not a terribly severe demotion, it would seem. All this time he continued to act as editor of AJOB, which he founded, and spun off two new AJOB journals, including one called AJOB Primary Research.
The controversy gets going sometime late in 2011 when Dr. McGee apparently left the Center in Kansas City to take up a position with a firm called Celltex in Sugar Land, outside Houston. Celltex is a very controversial outfit down in these parts, storing and injecting adult stem cells taken from a person's fat cells, a process which has not been FDA approved but endorsed by legislation that Gov. Rick Perry pushed through the Texas Legislature after he reportedly had a dramatic response to these injections for his back pain. Celltex is run by Gov. Perry's physician and a former Perry political ally. Dr. McGee was first listed as President of Strategic Initiatives at Celltex while a more recent news release (http://www.scribd.com/doc/81588050/February-10-2012-Celltex-Press-Release) has him as President of Ethics and Strategic Initiatives.
Now, I have to add a prequel here--a Korean firm, RNL Bio, involved in the stem cell tourism industry, had two patients die after receiving their stem cell infusions. A US group called the International Cellular Medicine Society investigated in November 2010. Dr. McGee was then on the ICMS board of directors and conducted a bioethics inquiry, which, according to Carl Elliott in one of the above posts, "found little fault with RNL Bio; he recommended better informed consent procedures and more ethics training." Now, Celltex has a close relationship with RNL Bio, having paid them a reported $30M to license their stem cell procedure. If I were to issue an "ethics" report that said Firm X was on the up and up, and then shortly after took a job with Firm Y which relies on a relationship with Firm X to be able to market its main product, then you would have reasons to be suspicious of biasin my "ethics" report, it would appear to me.
After complaints surfaced that it was inappropriate for Dr. McGee to remain as editor while working for a for-profit stem cell firm, he stepped down as editor while apparently remaining as head of the "AJOB family of journals" for the publisher, Taylor and Francis. The new co-editors of AJOB are Dr. David Magnus of Stanford, an old colleague of Dr. McGee's from Penn days, and Dr. Summer Johnson McGee, formerly managing editor of the journal, and incidentally, Mrs. Glenn McGee.
The fact that Dr. McGee retains his position as head of all the AJOB journals is significant because the Primary Research journal is now edited by Robert Nelson, a bioethicist and pediatrician. Dr. Nelson works at the FDA and is in the division that would review any application for approval of the adult stem cell treatments that Celltex promotes. So you could say that Dr. McGee is the boss of the guy at the FDA who might end up approving or disapproving his company's product.
That'a the anti-McGee case and critics are calling for the remainder of the editorial board of AJOB to at least meet and demand an acocunting of these measures if not resign en masse in protest.
On the other side, it's been pointed out (mostly on listservs where I don't have permission to copy the entries) that the editorial board is supposed to advise the editor on editorial policy, not advise the publisher on hiring and firing of editors, so it's not the job of the editorial board to decide who should or should not be editor of AJOB. Dr. McGee, it has been said, noted a potential conflict of interest and managed it appropriately by resigning as editor. His wife, as a long-time central figure in the day-to-day running of the journal, is very well qualified to assume a role as co-editor, and it's sexist and patronizing to view her as a mere appendage of her husband for this purpose.
Dr. Leigh Turner of U-Minnesota, in the post cited at the beginning, accuses Dr. McGee of scrubbing the Internet to alter the records of when he was in what position, to obfuscate the fact that he was involved in these conflicts of interest. As I review the instances he cites, the majority of these look more like updating rather than "scrubbing." But the one instance where this charge seems to hold water is with the most recent Celltex news release. That makes it seem that Dr. McGee had left his previous posts before assuming his role with Celltex, whereas it appears that there was at least a few months' overlap. As Dr. Turner alleges, the intent of the news release seems to be to appear to backdate his resignation as editor of the journal.
If anyone is still reading after all this, I will hesitantly offer some opinions.
I am not sure that the charge of conflict of interest can stick at this point with regard to the editorship of AJOB. The argument that there was a conflict, and Dr. McGee resolved same by resigning, seems reasonable. Normally when one transfers ownership of something to one's spouse, it's a transparent mechanism of trying to remain within a conflict while pretending to resolve the conflict; but the argument that Dr. Summer McGee has valid reasons to assume editorship in her own right seems plausible. The charge of COI seems to stick however with regard to Dr. McGee's role in naming Dr. Nelson to be editor of the other journal, and remaining in a position to oversee him as editor, when Dr. Nelson has a role at the FDA that could involve Celltex's interests.
I wonder if my bioethics colleagues, who are ordinarily very good at making fine ethical distinctions, are actually conflating two separate issues:
- Is it a COI for Dr. McGee to edit AJOB?
- Is it seemly for a bioethicist to work for Celltex?
My personal opinion is that it is highly unseemly and embarrassing for the field of bioethics to have one of our own working for this sort of firm, and giving ethical "cover" to their activities. It appears that contrary to the claim that their activities are highly ethical and are fully disclosed as experimental only, Celltex is seeking to make profits by presenting what it does to the public as effective therapy. There seems ton be a conflict of interest within the firm if the news release is to be taken seriously and Dr. McGee is actually charged with creating a true ethics program within the company. If he were to succeed in fully informing all patients that this is an unproven, experimental "treatment," it would seem to seriously cut into any chance of the company recouping the $30M they paid RNL Bio for the stem cell license. So one has reason to doubt that the firm is serious about their "ethicist" and his activities.
I explained in HOOKED that I agree with Ed Erde that the core ethical issue at the heart of conflict of interest is trust in a social role. "Bioethicist" is a social role and all of us have a stake in making the role as trustworthy as possible in the public eye. It seems to me that what Dr. McGee is doing with Celltex is predictably going to diminish trust in our field. (For evidence that this is already happening see http://leiterreports.typepad.com/blog/2012/02/american-journal-of-bioethics-redux-is-this-for-real.html).
So my current advice to my bioethics colleagues, based on what I have learned so far, is: if you think that Dr. McGee is a discredit to bioethics, talk about his role with Celltex. If on the other hand you think he's a fine fellow unfairly besmirched, then defend his role with Celltex. But forget about the side issue of the AJOB editorship which is just a distraction in my view. Now, bioethicists, have at me and send your comments.
NOTE ADDED 2/18/12: Off line, I have been taken to task for my attempted witticism regarding getting tenure at Penn. It was pointed out to me that a number of distinguished people in bioethics were in fact granted tenure there, and I apologize if my ill-timed humor seemed to cast an aspersion on that university.
NOTE ADDED 2/21/12: Nature has now chimed in with news coverage:
NOTE ADDED 2/27/12: Dr. David Magnus, one of the co-editors of AJOB, has asked me to correct misinformation in the main post above: "You suggest that even though Glenn stepped down as EIC of AJOB, he retains his position as "head" of all three journals. This is not the case. Glenn has no role regarding the content of any of the three journals (and in fact never had any such role for AJOB Primary Research). Robert "Skip" Nelson has his own contract with Taylor and Francis and has no reporting line to Summer and me or to Glenn or to anyone other than Taylor and Francis. The relationship between the three journals relates to how they are marketed, sold (they are bundled in institutional subscriptions), and some shared management regarding Manuscript Central and Scholar One. And to be very clear, Glenn's resignation included discontinuing any role at all in the running and management of the AJOB family of journals." My apologies for any erroneous information I may have conveyed.
NOTE ADDED 3/6/12: I had the pleasure of speaking with Dr. Robert “Skip” Nelson, editor of AJOB Primary Research. Dr. Nelson clarified his role at the FDA. He functions as a pediatric ethicist and advises various centers within the FDA about ethical issues in pediatric research. He has no authority to issue any rulings with regard to the approval of any therapy. Again, I apologize for anything I may have said in the original post that gave an incorrect impression. Dr. Nelson also informed me that his role at the journal has been clarified by naming him “editor-in-chief,” to show that the three AJOB journals actually all function independently of each other editorially.