What WAME and ICMJE Can Do: Values Backed By Power

The WAME and ICMJE are excellent bodies for they embody what is right and proper in the world of biomedicine. However, as I see it today (especially in the wake of the CAMJ episode), they lack the teeth to implement their recommendations.

Just look at the others.

1. Medical Associations: Medical Associations have committed office bearers who have to cater to the constituency of their members. They have a finger on their pulse, and will go ahead and do what is in their welfare, oblivious of whether it is right or not. Members of such Associations too are very aware of their rights, and see to it they are well protected by their office bearers.

2. Pharmacists: Pharmacists have equally strong Associations, which will go to any extent to protect their members’ interests. Their economic power, ability to coerce drug manufacturers, and vantage position as medicine dispensers makes them formidable adversaries to have.

3. Manufacturers: Drug manufacturers exercise their considerable clout by the huge drug industry they run and the researches they support, for which most researchers and departments, even Medical Associations, are beholden to them.

4. Patients: Patients now have numerous advocacy bodies and activist groups to support them. With wide information available on the net, and legal advice ready to seize the opportunity, patients appear reasonably well protected today. The number of lawsuits being won by them in recent years should be ample proof of this.

What does this leave out? Only two. Editors and editorial board members, and medical researchers. Let us look at editors here, for WAME represents them.

Editors have at least two bodies which represent them. WAME and ICMJE. But where is the power to implement what they recommend? We may say their power is moral, of the Right, of the stature of their members who toil to lay down guidelines and procedures. But when it comes to the crunch, when it come to implementing what they recommend, what powers do they have to pull up erring parties aside from writing letters and petitions? If someone decides to ignore what they say, what power do they have to implement what they, and we all, know, is right?

I say this not to embarrass our office bearers. I am just voicing my anguish, which must be that of many others too, including, I guess, of the office bearers of WAME and ICMJE.

I think both these organizations have a larger role to play, apart from their role to refine research and offer guidelines for editors and researchers. This role they can decide to ignore, but will do so only at their own peril.

This is the activist role. When we know the forces against which we work are so strong and committed to their welfare, irrespective of what is right, how can we be content with only laying down guidelines and writing petitions?

Values, by themselves, are only words. If not backed by the power to implement them, they come to naught. And will be trampled upon in every crunch situation. As has happened with the present CMAJ episode, and happened earlier with JAMA and NEJM.

So what do we do?

What Can WAME and ICMJE do?

Both these bodies are the conscience of biomedical research. They must give clear-cut calls to their members. When they find their members being shortchanged, they must rise in their favour.

What do we mean by clear-cut calls?

1. First of all, take an unequivocal stand. If injustice is done, it must be clearly spelt out it is so. And ask for revoking wrong decisions. Also helping those who are at the receiving end of brash decisions by appropriate legal counsel and possible placements, ad hoc or permanent.

2. Call upon members to resist this injustice by expressing solidarity with the aggrieved. Members must be exhorted to write editorials and welcome other correspondence which sheds light on such episodes. Both sides need be represented of course, but a goal-directedness in such writing is necessary nevertheless.

3. Insist on members reporting transgressions of editorial independence to these bodies, and helping them resist it in their respective organizations. Otherwise, token espousal of editorial independence is all we will ever get. And its perpetual flouting by the unscrupulous is what we should perennially expect.

4. Adopt method of peaceful noncooperation with the aggressor. Associations fire upright editors when they become inconvenient. Pharmacists pressurize Associations to protect their interests. Manufacturers pressurize researchers and institutions by their money power. Why should not WAME and ICMJE pressurize unscrupulous employers by asking for peaceful noncooperation with their efforts by its members? How? By:

i. Not taking up editorial positions in such journals.
ii. Not reviewing papers for such journals.
iii. Not writing for such journals.
iv. Exhorting those who work for such journals, so to save them in the interim, not to do so. For their intentions are honourable, but misdirected at such times. And likely to blunt the offensive.
v. While we recognize the right of employers to hire or fire, they must recognize our right not to allow biomedical research to be directed by the whim and fancy of highhanded employers.

5. Lay down guidelines for editors and employers. Editors need to be on par with the Association Secretary, or Executive Vice-President, whatever, and report to the Executive Body of the Association, and finally to the Annual General Body, rather than to any individual. They can be impeached, even fired, but only after a statutory body of the Association gives them a full hearing.



Signing off, For Now

The promise such problems offer is tremendous. Provided we are ready to rise to them.

ICMJE and WAME have an excellent opportunity to prove they are not, and never will be, paper tigers.

It is only when they realize that the values they stand for can be backed by the power they have, but is still untapped: the strength of their members, and the clear-cut decisions of their office bearers.

I have great hope in the future of these organizations, and request its office bearers to help actualize this hope and the legitimate wish of its members.

Ajai
17 March 2006

Gandhi, the Movie

Watched the movie Gandhi in Holi Day.

Decided to see it atleast once every six months.

A life such as this is very much after my own heart.

Ajai
16 March 2006

A Poem on Holi Day

Silent and Listen

Did you realise that the two words
Silent
And
Listen
Have the same alphabets?

And aptly so.

For
You
Cannot be truly silent unless you listen.
And
You
Cannot truly listen unless you are silent.

And
If you can combine
Silence with Listening
What happens?

Silences roar,
Listening converses,
Intellect unfolds,
Enlightenment reigns.

Ajai
15 March 2006

CMAJ: A Misty Image Indeed

Some of you may feel this deserves a look:

A Look At CMAJ: A Misty Image Indeed

http://mensanamonographs.tripod.com/id140.html

Ajai
13 March 2006

Reserve Compensated For By Dedication
Mental Health Movement, Not Just Psychiatry

You know what a mental health activist said on reading 'R',or 'Childhood Buddy Hangs Up'(the second post on this Blog)?

She said when they come to know about someone suicidal (or actively sick psychiatrically, but refusing treatment), they just call up, and get talking. And then go and visit the person in a group of two or three. Having herself suffered a psychiatric problem and recovered, she can explain first hand how psychiatry helps. And she has no qualms saying it openly she was a patient and has recovered, though on maintenance therapy.

The person is very reluctant to talk or meet them initially. But if handled tactfully, he/she relents by the end of the meeting, and treatment can get started.

So, the psychiatrist’s professional reserve is compensated for by a mental health activist' s dedication.

Hence, the mental health movement, rather than just psychiatric care.

A sobering, though enlightening thought, perhaps?

Ajai
14 March 2006

Musings
I WONDER, AND I KNOW

I wonder why, knowing so very well that the sacking of the CMAJ Editors was wrong, how come seniors and the influentials are not doing anything about it? I don't even know the sacked editors. I feel like fighting for them. Why not those who know them so well?

And now I probably know why:

1. They all know it should be done.
2. They all know it won't be done.
3. They all wait to be the chosen one.

Sometimes, when we speak less, we speak so much more.

Ajai
11 March 2006

Tiger and Horse
A TOOTHLESS TIGER, A DEAD HORSE?

Two thoughts just struck me with regard to the CMAJ episode, one with regard to Associations without executive powers like WAME and ICMJE, and another with regard to myself:

1. Are they paper tigers?
2. Am I flogging a dead horse?

Ajai
10 March 2006

For Reinstatement of Sacked Editors at CMAJ
AN APPEAL

The Editor-in-Chief and Deputy Editor of a Journal, who brought it to scientific respectability, are summarily fired by a three-paragraph announcement
http://www.cmaj.ca/misc/press/feb20.shtml/

The Editor appointed in his place, along with another Deputy Editor, resigns just a week later on the issue of editorial independence.

Respected journals like the BMJ
http://bmj.bmjjournals.com/cgi/content/full/332/7540/0-f?ehom
and Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140673606682779/fulltext/
write editorials denouncing the ouster.

WAME President
http://www.wame.org/cmajed.htm
and ICMJE
http://www.icmje.org/cmaj.htm
are equally distressed.

16 out of the 19 editorial board members of the Journal risk their positions, and potential careers, by writing a petition asking for the reinstatement of the Sacked Editors:
http://www.chaps.ucalgary.ca/cmaj.htm

Will you not do a simple act of expressing solidarity with these struggling against injustice and highhandedness?

Just go to
http://www.chaps.ucalgary.ca/cmaj.htm
read what’s written there and express your solidarity with them by asking for restoration of the original editorial board by filling up the form at:
http://www.questionpro.com/akira/TakeSurvey?id=370917

One good act. It costs you nothing. But it expresses all the values you always stood for, and admired in others.

Just do it.

I did.


Ajai
9 March 2006

On International Woman's Day
This is what men want to believe:

Woman, without her man, is incomplete.

This is what every woman knows:

Woman, without her, man is incomplete.


Ajai
9 March 2006

Response to three points raised by Fiona Godlee, Editor BMJ, on Sacking of CMAJ Editors
Dear Fiona, and Colleagues,

Thanks indeed for your input. The three points you raise are indeed very important, and must be seriously answered before we proceed further.

Point no 1.
1. Relations between the editors and the CMA seem to have been too far damaged to be retrievable in any way that would lead to a good future working relationship.
Does it mean that when relations are damaged it is the editor who must face the axe? This sanctions highhandedness every time, for the employer will resort to it whenever he feels an editor becomes inconvenient to him beyond a point. Irrespective of whether the editor is right or wrong.
It maybe all right in a private concern or a corporate enterprise, for profit is the main motive there. But here, why can not the employer, who is not a private party but an institution, do a self analysis, and remedy its thinking? Because if this is remedied, the working relationship is automatically remedied. There is no fight then at all.
An editor working against the welfare of a journal need be sacked. True. But where is there any proof this has occurred here? In fact all evidence is to the contrary.

Point no 2.
2. It is not clear to me that the editors themselves want to be reinstated.
They have desisted from speaking probably since they appear to be bound by the confidentiality clause. And canvassing for themselves may not appeal to their sensibility. I think I respect them the more for it.
Although, if they do not want to be reinstated there is no purpose working further. So, some form of confirmation that they are willing to work for CMAJ if the atmosphere is conducive would be in order.

Point no 3.
3. Such a request is unlikely to meet with success.
Such a request has not succeeded in the past. True. Because we have always worked half hearted. In a way, we have accepted the sacked editors fate even as we write that the action of sacking is wrong. And made the proper noises so we all feel self righteous and find an outlet for our moral anger without getting involved in the action to convert it into a movement for the right.

Just tell me a simple thing. If all the editorial board members resign, no new worthy board members take up the work, researchers ask for their papers back and do not send their research work till the editors are reinstated, how can any journal run?
Will not the highhanded employer bend on his knees?
And if questions are asked by members and an agitation started in CMA, and the Canadian parliament too discusses this, what will happen to the smug employer who feels he can ride roughshod by firing anyone by simply making a one-line comment that after ten years there should be change?

I think, Fiona, what you felt earlier when you thought we call for a letter in our individual capacities was right.
Hope you allow the ideal to triumph over the expedient.

We seek your cooperation. And guidance too.

Ajai
7 March 2006
……………………………………………………………………………………………..


Fiona Godlee wrote:

Dear Ajai and all,

I did consider calling for this, but decided against doing so, on three counts

1. Relations between the editors and the CMA seem to have been too far damaged to be retrievable in any way that would lead to a good future working relationship.
2. It is not clear to me that the editors themselves want to be reinstated.
3. Such a request is unlikely to meet with success.

But I would be interested to hear other views, and to invite people to join the debate on this in the rapid responses on bmj.com.

http://bmj.bmjjournals.com/cgi/eletters/332/7540/0-f

All best wishes, Fiona

Dr Fiona Godlee
Editor, BMJ
BMJ Publishing Group
Tavistock Square
London WC1H 9JR
Telephone +44 (0)207 383 6002/+44 (0)1223 327324

Personal Assistant Julia Burrell
jburrell@bmj.com
Telephone +44 207 383 6102
Fax +44 207 383 6418

Posted by psychiatrist400080 at 11:13 PM EST

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Some Submissions
This is the letter I wrote today morning to all the fellow members of WAME:

Dear Colleagues,

Below is the text of the letter WAME president Dr. Michael Callaham has sent to the CMA president Dr Ruth Collins-Nakai, as well as to the Journal Oversight Committee:

--------------------------------------------------

Dr. Ruth Collins-Nakai
President
Canadian Medical Association
Ottawa, Ontario

Dear Dr. Collins-Nakai:

The World Association of Medical Editors (WAME) leadership is concerned by the recent termination of John Hoey and Anne Marie Todkill from their positions with the Canadian Medical Association Journal. These two WAME members are widely respected editors and media reports suggest that their termination was based on their editorial decisions and may have had a political agenda.

WAME's policy on editorial independence (http://www.wame.org/wamestmt.htm#independence) states, "Editors-in-chief should have full authority over the editorial content of the journal, generally referred to as 'editorial independence.' Owners should not interfere in the evaluation, selection, or editing of individual articles, either directly or by creating an environment in which editorial decisions are strongly influenced." Other organizations have similar policies on editorial independence (for example, http://www.icmje.org/#editor).

We believe the principle of editorial independence is critical to the role of the editor "...to inform and educate readers, with attention to the accuracy and importance of journal articles, and to protect and strengthen the integrity and quality of the journal and its processes" (in http://www.wame.org/wamestmt.htm#independence), as well as to the credibility and reputation of a scientific journal.

We are concerned whether this principle has been violated, and therefore request that the Canadian Medical Association address these concerns with respect to this matter publicly, frankly, and promptly.

Yours truly,


Michael Callaham, M.D.
President
World Association of Medical Editors (WAME)
http://www.wame.org/

---------------------------------------------------

My submission:

1. Excellent first letter by the president. I would most respectfully submit that a second letter be sent asking for response as to what has the CMA done to address, 'publicly, frankly, and promptly,' the concerns raised by the WAME president.

I would also urge that in this second letter, the WAME president ask for reinstatement of the sacked editors, unless he feels they are guilty of some gross impropriety, editorial misconduct or dereliction of duty. In which case, there is no purpose continuing this effort. He can also ask whether the CMA president feels, or has proof, such is the case.

As a representative body of editors from all over the world, it is both the duty and an opportunity for WAME to make its point about editorial independence, and journal integrity. It should itself do so 'publicly, frankly and promptly'.

2. I would also urge fellow editors to write edits in their respective journals denouncing the action and asking for reinstatement, as also writing letters to the CMAJ and CMA urging justice be done.

3. Some of you may feel this is not an issue for us to discuss at all. It is only a private matter between an employer and an employee. I beg to differ. This will be the argument of any employer who holds the cards, and would want to regulate the game. For long have we believed that he can.

It is not only a private matter between an employer and an employee. The product of this employer-employee interaction is scientific knowledge and research advancement, which are of great importance to society. Hence, let us realise that it is really speaking a matter of scientific concern, biomedical advance, ethical conduct, and editorial independence. For all of which we toil day in and day out. Our unequivocal stand will have far reaching ramifications if we do not allow our minds to be paralysed by analysis of subsidiary concerns.

I wish to thank many of my colleagues who have boldly appreciated this effort. I do not even personally know the sacked editors. If I could do it, why not you?

Silence, at times, is deafening. Do not be a partner to the quieting of your conscience. You will regret it every time you still that inner voice because of practical considerations, or fear of censure from powerful but unscrupulous sources. Because Silences can Roar!

This is the time to put your shoulder to the wheel, my friends.

I am sorry to make a Sunday morning introspective rather than exhilarating.



Ajai
5 March 2006
……………………………..

CMAJ EDITORS' SACKING
Mood:  energetic
Follow the Five Point Agenda

It is heartening to note that BMJ, Lancet and ICMJE have all categorically condemned the act. With the WAME president's earlier letter, I think that is a sizeable effort in the right direction.

However, one point need be noted. None of them has asked for the sacked editors to be reinstated. None. I would like to be corrected on this, if possible. I find that disconcerting. Does it mean they have accepted the sacking, and are only voicing their opinion on principle? I hope it is not only that.

Ideals and principles are not a substitute for action. In fact they should be a spur for effort. Moral indignation does not necessarily translate into moral courage, or concerted action. This is the time for concerted action that springs from moral indignation.

We must ask for reinstatement of the sacked editors, as well as those who resigned later. Nothing less than that.

Please note that the sacking of earlier editors at JAMA and NEJM met with the usual noises and it all subsided. But sometime, at least sometime, let us girdle our loins and prepare for a showdown. Else editors will shout and rant, and employers will win. And editorial freedom will be voiced but not defended.

The only way highhandedness of employers can be handled is by peaceful noncooperation. This means:

1. The entire editorial board of CMAJ must resign;
2. No one should accept editorial board membership;
3. CMA members should start an agitation for reinstatement;
4. Researchers should ask back for their articles;
5. And the Canadian parliament should be asked questions in.

Once one editor of integrity is reinstated. Only once. No employer, or association president, or commercial interest, will ever dare touch, or manipulate, legitimate editorial freedom.

Every time we only make noises and accept, every time editors will be upturned when they become inconvenient. And nothing substantial will change, except for the filling up of journal and discussion pages with high-sounding principles.

That is the challenge, my friends.


Ajai

4 March 2006

A Poem for Our Times
Mood:  sharp

A Modern Panchatantra Tale


(In the Panchtantra, three princes take their lessons in statecraft and pursuit of knowledge from a preceptor Vishnusharman by studying the behaviour of animals. A modern Panchtantra may or may not get written. But the animals are there all right. And being modern, it cannot do without the character, Man, in whom modernity and animality blend so perfectly.)


‘Yesterday
We diverted a little
talking or reincarnations and myths and
avatars
Narasimha-
Lord Vishnu, half man-half lion
and Prahlad, his bhakta
rescued from the vain father Hiranyakashipu.
That was mythology, prince.
Let’s come to brass-tacks today’.

And the teacher continued,
‘If you wish, prince
to have a lion in your circus
and the ambitious performer must have one-
at least for advertisement’s sake-
you have to learn early
to tolerate his stalk and his ambush
his snarl,
his fierce looks
and his roar.

And you cannot domesticate the king-cat
by feeding it
on milk and bread.
Even the lowly cat cannot give up its snarl
where then is the question of His Lordship?


‘A circus must retain a lion
with his characteristics.
Awe and terror are mass entertainers.

But
the lion has to be trained
to become part
of a well orchestrated performance.

The trainer has to use
meat,
as much as the whip,
coaxing, as much as snubbing.
And tolerate
annoyance of his pets and prot?g?s
as much as shield them from harm.
For, having once tasted blood,
the king-cat will not relent.
He will try to strike again and again.

‘Now, remember, prince,
if you cannot train a lion
or do not have one such in your entourage,
it would be prudent
to do without him right from the beginning.
Image building is all right
but what about the show?
An inept ringmaster with a fierce performer
can upset the circus
and maul the master himself.
And he
will use his paw, and reach,
as much as his teeth and nails.
Loyalty is a quality only in
Domesticated animals.’

‘So, prince’, continued the teacher,
‘beware of ambitions
and ideals
and the lion.
Have a circus without the lion.
You may lose some gate-money initially.
But there are other performers available
better,
and more manageable.
Start with the faithful dog
He will always wag his tail
Eat out of your hand,
and bark at the stranger.
Have the jackal
his slyness
will out manoeuvre the lion
and his antics
can be excellent entertainment.
The monkey is a fine acrobat
Children just love to see him perform.
The elephant is a big draw
he may be clumsy, but he is enormous
and he lays claims
to besting his lord-ship.
And, of course, the noble horse
what a stately trot he has, and so appealing.
Ever-ready to get ridden.
The parrot is so cute
he will imitate your voice
And the myena
will sing sweet tunes to you.

‘Make a troupe out of such as these.

‘So what some children
are displeased there is no lion.
Your other performers will amuse them.
Children today love Mickey and Donald, anyway,
and
my Panchatantra tales are only a comic.

‘Remember, prince,
children are soon placated.
They will forget the lion
The clamour will stop.
Their parents will feed them chocolates and
ice-creams
and lollipops.

‘The show will go on’.


Ajai
3 March 2006
(Written Sometime in 1991. Published in New Quest, 1991.)

On the indignant fellow editors over sacking of CAMJ Editors
Mood:  sharp
Moral Indignation and Moral Courage

They all have justified anger, and moral indignation, but not the moral courage to mount an offensive, sustained and strong enough to upturn a power drunk establishment. Otherwise I see no reason how anyone would have the temerity to sack an upright good editor in the first place.

To change things, it is not enough to be indignant. That is easy. It is more important to be courageous, and go the whole hog. Like Nancy Olivieri did.

Moral indignation does not necessarily translate into moral courage. In fact it can be a convenient substitute for one.

Ajai
2 March 2006

Response to Firing of CMAJ Editors (Posted to WAME)
Mood:  sharp
Topic: Less Heat, More Action
Canadian Medical Association Journal (CMAJ) Editors Fired: What Do We Do?

Permit me, my friends, to express my point of view about the recent firing of our CMAJ colleagues. Please read through the whole piece coolly before you form opinions, or feel like attributing motives to me as the writer.

I think the CMAJ Holdings is well within its rights to hire or fire any employee it decides to employ. Is there any provision in the contract the editors had during appointment that they would be offered an explanation why they were being fired? Is there a provision for the employees concerned to appeal this decision in any forum, statutory or legal? In fact, the right not to go public can be enforced by the employer on the employee, which is why the two editors cannot go public as to the reasons for their removal. What this means is that editors, as employees, have already abrogated their right for so-called editorial independence the moment they sign such employment contracts. They have no solace but to exercise their editorial freedom within the confines of their holding companies’ notion of how much and how far this editorial freedom has to be exercised.

Make no mistake about it. We may want to run, or feel justified in running, biomedical journals for the benefit of patients, research, scientific advancement etc. But for employers all these are only intermediate goals, not the final ones. They are more interested in maintaining a balance between political and economic forces, which have a great say in keeping the financial and other viabilities of their associations, and their own positions, which are executive positions no doubt but with strong political overtones. The reach and prestige of such journals, which are good window dressings for such purposes, and their zealous editors, whose gladiator roles are tolerated, even encouraged, till it serves employer interests, or at least do not threaten to subvert it, only serve to further such interests of ambitious employers occupying executive positions. Or, often such actions have to be muffled simply because the zeal has become too hot to handle, and voices of protest are being raised in influential political/ economically strong circles.

That is why, in spite of all the brouhaha all the editors in WAME and the rest may resort to, the employer concerned is not likely to revert his decision. In fact he has anticipated it, and has decided to remain immune to such concerns. If he had not done so, he would not have taken such a drastic step in the first place. Surely, he is not so na?ve as to believe there will not be a public outcry? If he is, he doesn’t deserve to be an employer (many here may agree to this, but I mean in another context. He will lose his position as an employer.) . Surely, the employer also knows the repercussions of the drastic step he is taking. And yet when he takes it, he knows he has the winning cards in his hands.

Also note, the other members on the editorial board have registered a protest in no uncertain terms. But they have ultimately decided not to quit the board. Do not for a moment feel the employer had not anticipated this. He knew this would happen. He also knows the good work done by the fired editors will be carried forward by the newly appointed, as the dust settles on this episode, as happened with the JAMA and NEJM before. What happened when their illustrious editors had to leave? Did any of those journals close down, or go down in scientific standing? In fact new editors came and carried the journal forward. This, too, the employers know very well. So, we may go ahead and make all the noises. But trust the new editor to first reluctantly, and then with greater zeal, take over from where the earlier editor left, and take the journal to greater heights. This he will do for his own survival, and for leaving his impress ‘on the sands of time’. This too the employer who fires knows very well.

Passionate, emotional responses when a fellow editor is fired are all right, and I guess justified too, as it helps us all let off steam. And it also helps express solidarity with the fired, and our empathy too. And also, (pardon me for saying this, and I do not wish to hurt our sensitivities heightened beyond doubt at present), reflects on our own fears and uncertainties on playing a zealous crusading role as editors, ready to take on establishments’ nefarious activities. But we forget that a shrewd employer holds the cards always. Tell me of any notable example where one editor of note in one prestigious journal has been reinstated because of a public outcry such as this?

No, my friends, the game is not so simple. The letter written by WAME is not to be devalued at all. Neither is the outcry of all you souls hurt and embittered by this episode. But trust me when I say that the show will just go on after the dust has settled. This is not being cynical. This is just being frank and ready to see the writing on the wall.

To change the writing, or to rewrite what’s already put up, requires some other action. I wonder whether editors and other concerned members of such organizations have the will, and nerve, to sustain such agitations. Please do not get this amiss. I do not doubt our sincerity of purpose. I just feel the concerted effort to enter into a protracted, activist battle with the establishment is not the stuff of which we are made. There are not too many Nancy Olivieris around.

I would be very willing to be proved wrong, both in my analysis, and by actions that can remedy such situations.

What Actions Would be Needed?

I think they are basically five:

1. The entire board of present editors should resign in protest against the firing. And not rejoin till they are reinstated. They must be absorbed in other journals if it comes to that, so their positions are secure.
2. The WAME and ICMJE should categorically support the reinstatement of the fired editors. No mincing words, just clear-cut statements of strong protest and expectation of appropriate action. And follow up by supporting the agitating board members, as well as the fired editors, with legal counsel and financial help for the protracted battle to follow.
3. An agitation for reinstatement of the fired editors by members of CMA, lead by members whose credentials are aboveboard and have no political/ personal agenda of their own to fulfill.
4. The research community whose articles have been accepted by CMAJ must ask for withdrawal of the accepted articles, and researchers should decide not to submit their research work to a journal which does not respect editorial independence.
5. Questions must be raised in the Canadian parliament, and the CMA asked to answer on the floor of the house why it took such an action.

Friends and colleagues, a strong arbitrary action by an employer needs an equally strong spirited response from the editors/ researchers. Just as there is a WAME, there is the need to set up a WAMR (World Association of Medical Researchers). This is the right time, and occasion, this is done. And a strong protest by both such organization, and an employer will think ten times before firing an honest, upright editor.

And this is the only language highhanded brash employers will ever understand. If we have the nerve to speak it, that is.

Otherwise, let us feel happy making out loud-muffled noises, and let the show proceed to unfold after a small interval.

I am sorry I have been rather forthright. But how long can one keep the blindfold? Or avoid seeing that which is best seen uncovered?


Ajai
28 Feb 2006

Psychiatry as Behavioral Health
Mood:  bright

The Holy Trinity in Modern Psychiatry

It is behaviour which should be our focus too, and health of course. But along with overt behaviour, we must not neglect both internal thought processes and emotive underpinnings, as also the fact that we have medications which can be powerful tools if used judiciously, for reducing mental distress and ameliorating mental disorders.

I think an eclectic approach which combines emphasis on overt behaviour, with analysis of deeper thought-emotive processes, and judicious drug regimen - this need be the holy trinity of modern psychiatry.


Ajai
11 Feb 2006

Drive Through Life
Mood:  cool
Topic: A short poem

Drive through life

It’s a great idea
To
Come fast
But
Drive
Slow.

For
Guys who
Go very fast
May
Reach very
Late.

One cuts on distance, not time.

And
In any case
The trick is
Not to
Ride roughshod
On rough roads

And skirt
The potholes
And speed breakers
That populate
The highways
And bye lanes
Of your city
And your life.

Not that it’s always possible
But why not
Give it an honest try?

Ajai
28-31 Aug 2005

More Smoke
Mood:  blue

In the hot sultry fiasco of damp
enthusiasms
and silver rays in gloomy
archives,
narcosis and the feeling
of melting ice on frozen palms.

Arborescent shadows of sorrow
in reminiscent silhouettes
the rain soaked evening
of pouring emotions
and grassy long walks on dripping
pavements
Seeking out each other.

Remember, my dear
the sweet faint lavender
in the cleft of your breasts
hidden from the present and
posterity
and the knowledge of transience.

Looking at the grey skies
I think of clear blue water
and simmering passions
although
I’ve heard
you’ve created a smoke screen
from tall chimneys.

Ajai

Published in BLOB, 6 March 1974

Sickness not Reducing in Number, only Changing in Type
Mood:  quizzical
Topic: Medicine
Innovation in medicine is keeping in step with aggressive marketing of health services. The patient consumer has at his disposal a vast array of therapeutic facilities, all attractively packaged, and convincingly portrayed.The physician too has to keep abreast of a sea of fresh information bombarding him from numerous quarters, some genuine, some not so genuine. And he often finds himself at a loss to discriminate between the two.

Health awareness has increased. So has the average life expectancy.Medical science boasts of a vast array of treatment modalities for an equally vast array of diseases. Distress has been ameliorated, disability curtailed,death postponed.

And yet, if the booming medical practice and pharma industry are any indication, the patient population has not reduced. In fact, it has multiplied. Not all of this is because of increased health awareness. While individual distress may have been reduced, individual disability curtailed and individual death postponed due to better treatment facilities, the number of distressed have not reduced. Neither have the number of disabled, nor that of the dead.

What does this signify?

It signifies, if nothing else, that while individual disease treatment is progressing, so also is human pathology. Newer and more ingenious ways of falling ill are seeing the light of day, and the body is finding newer ways of getting out of order.

Sicknesses are not reducing in number. They are changing in type. If infectious diseases and malnutrition took their toll in the earlier centuries(and in certain sections of the world even today), life style diseases, chronic conditions and neoplastic disorders are taking their toll in the present. It is almost like changing fashions in the world of disease.

If we ever do feel we are successful in reducing morbidity and mortality of these conditions, along will come new diseases introduced by use of modern gadgetry. This century will surely witness an upsurge in sicknesses from use of wireless technology, permissive morality and greater commercialization. It will be compounded with deaths not because of infectious epidemics, but mass destruction due to external calamities like earthquakes, floods, tsunamis and hurricanes. As also man-made ones like terrorist attacks using modern technology on inimical civilizations. As though aiming to convert modern technology itself into an inimical civilization.


Ajai

(From Mens Sana Monographs, III,4-5, Nov. 2005-Feb. 2006, p15-16. Reproduced with permission of coauthor and publisher.)

A Poem
Topic: An Indian Village Road

The dust

In dusty drawn windswept
bullock cart roads
and ripe yellow mustard pastures
clinging to slender pathways
tread bold exuberant
rustic giggles.

And I sweep them in an embrace
with every swish of their skirt
and every awkwardness of their run.

Ajai
Sometime in 1974