By Michael Miner

AMA’s Lundberg Crosses the Line

Republicans out to clear Bill Clinton from the territory need to touch up their wanted poster. Too many good folk don’t buy the picture of a duplicitous predator who sneers at their Bible-based values. Shucks, everyone lies about sex–about how well, how often, and with whom. Even the truly virtuous do, even Henry Hyde, who when confronted with a five-year affair that ended when he was 44 years old, promptly dismissed it with the whopper that it had been a “youthful indiscretion.”

Last week the Journal of the American Medical Association published a study that added weight to the counterview of Clinton as the Homer Simpson of the boudoir–a hapless postadolescent clinging to adolescent distinctions between making out and going all the way, groping on the sneak because, like every other horny teen, he lives at home, and getting too terrified and guilt-ridden even to climax. “Would You Say You ‘Had Sex’ If…” was the name of the study, just written by Kinsey Institute researchers on the basis of 1991 interviews with about 600 Indiana University undergrads, “most of whom identified themselves as politically moderate to conservative.”

Among the findings: “Overall, 60% reported that they would not say they ‘had sex’ with someone if the most intimate behavior engaged in was oral-genital contact. Additionally, we found evidence of belief in ‘technical virginity.’…These findings are consistent with other reports indicating that oral sex is not consistently defined as having ‘had sex’ and seem relevant to the issue of ‘technical fidelity’ as well.”

They also seem relevant to the lively issue of technical nonperjury, but the Kinsey researchers declined to wade into those waters. In a nod Washington’s way, they did assert that “recent public discourse regarding whether oral-genital contact constitutes having ‘had sex’ highlights the importance of explicit criteria,” and regret that the “current public debate regarding whether oral sex constitutes having ‘had sex’ or sexual relations has suffered from a lack of empirical data on how Americans as a population define these terms.”

A sensitive reader could sniff a message here: before we crucify the president for lying about sex, let’s take a look at the idiom he lied in. To the AMA’s basset-nosed boss, “Would You Say…” was a rogue editor’s intolerable intrusion into public affairs. Last Friday, four days before the press embargo on the January 20 JAMA was supposed to expire, Dr. E. Ratcliff Anderson Jr. made “Would You Say…” nationally notorious by calling a press conference to announce he’d fired editor Dr. George Lundberg for publishing it.

Anderson, executive vice president and CEO of the AMA, has received precious little praise for canning Lundberg. But let’s give credit where it’s due. Most senior executives who fall out of favor are eased out the door, their pockets lined to purchase their silence, mendacious tribute ringing in their ears. Anderson didn’t play the game. He told the world that Lundberg “through his recent actions, has threatened the historic tradition and integrity of [JAMA] by inappropriately and inexcusably injecting JAMA into a major political debate that has nothing to do with science or medicine. This is unacceptable.”

Anderson apologized to JAMA’s readers and contributors, to President Clinton and Congress, to anyone, he said, who believes “that JAMA has been misused in the midst of the most important congressional debate of this century. JAMA’s hard-earned reputation is based on its editorial independence and integrity, and we intend to keep it that way.”

Jaws dropped across America at the picture of the American Medical Association recoiling in horror from contact with politics. But without seeing the article in question, even Lundberg admirers conceded Anderson had a legitimate point. A serious magazine pays a price when it raises topicality to a supreme value (the New Yorker might be Exhibit A). “The decision to publish an article eight years old is so strange to me,” said a Chicago doctor who has been Lundberg’s ally in past battles and was deeply distressed by his dismissal. Dr. Jerome Kassirer, editor of the New England Journal of Medicine, told me, “It was something we probably wouldn’t have published–it wouldn’t have been important enough.” He added that maybe “you could stretch it” and find medical value in the message that doctors seeking a patient’s sexual history need to be very specific in their questions–but 15 years into the AIDS epidemic most doctors already know that.”

“It strikes me as bizarre,” said Andrew Skolnick, a former JAMA investigative reporter. “I can’t see a public-health issue involved with this.” Skolnick admires Lundberg even though Skolnick made JAMA so many enemies that last November Lundberg fired him–an act perhaps analogous to pitching the plumpest sailor off the lifeboat to appease the sharks. “I have a lot of respect for him,” Skolnick went on. “He’s an amazingly complex man–a man with enormous integrity and an enormous capacity to ignore that integrity. He’s a very ethical person, but it’s based on the situation. He can look the other way when he has to. He killed articles because they would make political enemies. There were battles he didn’t want to fight. An editor with integrity doesn’t do that. However, there’s scarcely any editor in the real world who can have integrity every day of the year.”

Friends of Lundberg agree that the deposed editor operated close to the edge during his 16 years running JAMA, skillfully promoting himself and his magazine, greatly enhancing its professional reputation, infusing it with a keen sense of social engagement, and making enemies right and left. In 1988 he ran an anonymous first-person piece, “It’s Over, Debbie,” which purported to be a gynecology resident’s account of sizing up a 20-year-old cancer patient, deciding on the spot that death would be a blessing, and shooting her up with enough morphine to both deaden her pain and kill her. Though the story had its defenders, important readers excoriated it, and not only because Lundberg admitted he couldn’t be certain how true it was. “I am shocked that the prestigious Journal chose to publish this article without comment,” Cardinal Bernardin wrote in the Tribune. “Such actions must not be given the status of an accepted alternative. And this is what the Journal appears to have done.” The Tribune denounced the AMA for asserting a First Amendment defense against meddling prosecutors. “Ethical journalism does not condone shielding anonymous authors who confess in print to homicide, justifiable or not,” said the editorial page.

In 1990 a Lundberg editorial, “Countdown to Millennium–Balancing the Professionalism and Business of Medicine,” provoked an organized assault on JAMA’s autonomy. “Greed is in fashion,” Lundberg wrote. “Physicians are not immune to the pandemic caused by the greed virus. We have seen that physicians may be impaired by alcohol, other psychoactive drugs, or physical infirmities. Now…we are recognizing that physicians also may be impaired by greed.”

The response to that provocation came from the Illinois State Medical Society, which resolved that JAMA editorials had “provided bases for the public press to denigrate the profession and practice of medicine” and therefore the AMA should establish a board “to review all proposed editorials…with the right of rejection, to assure that editorial comment is compatible with the views and opinions of the publisher, i.e., the AMA.”

The debate took to the airwaves. A panel discussion on WBEZ found Dr. Arnold Relman, then editor of the New England Journal of Medicine, defending Lundberg. “I think it was a very moderate statement,” said Relman, “and to put some sort of censorship device in place to make sure that the editorials in JAMA speak only one line, I think is shortsighted in the extreme.”

“Let me point out,” replied Dr. Harold Jensen, past chairman of the Illinois State Medical Society, “that I see quite a difference between the New England Journal of Medicine, which the physician community sees as primarily a scientific and opinion national publication, as opposed to the JAMA, which, although it presents itself as a scientific journal also is the house organ for the American Medical Association….And when someone picks it up and reads that physicians are impaired by greed it becomes a position of the AMA, and that is what we were objecting to. No one wants to censor or veto or change the scientific editorial work of Dr. Lundberg, which is superb. What we do want to do is find out, when he is shooting from the lip, whether he represents the point of view of the physicians or if he represents merely the point of view of Dr. Lundberg.”

Also on the program was Dr. William Gibbons, former president of the Du Page County Medical Society. Gibbons, who supplied me with the transcript I’m quoting from, was rallying doctors to Lundberg’s side back then. JAMA will “die on the vine” if it loses its editorial freedom, he warned on the radio, and if the state medical society doesn’t back off it “will sort of make a fool of itself.” Sure enough, the resolution went nowhere. But it did make clear what a minefield Lundberg walked in. Every stand he took was open to attack as “shooting from the lip.”

Last year a Lundberg editorial argued for more frequent autopsies; too often, he believed, doctors were ignorantly burying their mistakes. “It is not a conspiracy of silence or necessarily a massive cover-up,” he wrote, “but it is a movement with millions of players, all in complicity for widely varying reasons with the final result of ‘do not bother me with the truth’ on the sickest patients–the ones who die.” Lundberg infuriated the AMA brass by taking his case to 60 Minutes. “Anderson was furious with him,” Andrew Skolnick told me. “The scuttlebutt was ‘Lundberg survived that one.’ That’s how close it was.”

“Would You Say…” was one crisis too many.

Lundberg’s ouster made front-page news across the country as both another bizarre turn in the Monica Lewinsky saga and another chapter in the AMA’s recent history of incomprehensible blunders. If you thought the endorsement deal with Sunbeam was gamy, how about this–trashing your journal’s reputation for intellectual freedom in order to suck up to Republican pals in Washington, the ones who got two-thirds of the $14 million your PAC has thrown Congress’s way since 1989? (Those are Tim Jones’s numbers in the Tribune.) Ridicule rained down in the media–even from bystanders who considered “Would You Say…” a mistake to run.

Some decided it wasn’t a mistake, once they’d read it. “A damn good study,” said Skolnick after finishing the piece. “The key question in taking a sexual history is the number of sexual partners, but we may not be getting accurate answers because we’re not asking the right questions.”

Tom Delbanco, a Harvard medical-school professor who contributes to JAMA, told the Boston Globe that Lundberg had saved the AMA from humiliation. “What would have happened to the AMA if this article had been published two months after the impeachment trial?” Delbanco wondered. “There would have been outrage over what would have in effect been suppression of important evidence affecting public policy.”

This week protest stirred within various groups–including medical librarians, antismoking forces, and Quackwatch Web site activists. The E-mail from librarians that I got to read revealed a lively debate, with opinion ranging from “Take away the scientific-looking data, and the report reads like something out of a cheap newsstand magazine” to “The JAMA article is perfectly timed. Let’s hope the senators read it.”

One librarian passed along an item from the Philadelphia Inquirer. Last autumn, it seems, the AMA stepped into a tight local congressional race, spending $450,000 on “last-minute” advertising that touted Republican incumbent Jon Fox. “The AMA likes to make a safe bet,” a local political scientist told the Inquirer. “They throw their money around, but not away. It certainly suggests they smell victory.” But Fox lost, though he did get to vote for impeachment on his way out the door.

“A LOT of doctors in our district supported our friend [the winning candidate] for Congress and have distanced themselves from the AMA. It’s a real shame, I think,” wrote the librarian. “BTW, I too am no fan of Clinton’s behavior.”

Once an Enemy…

The enemies of your enemy are your friends. On this principle Hollinger International’s Sun-Times and Daily Southtown got together with the Daily Herald and agreed that all of them were in competition with the Tribune, not each other. So why not work together?

Peter Neill, editor in chief of the Daily Southtown, spelled out the details the other day in a memo to his anxious staff. “Let me quell some rumors,” his note began. “The Daily Southtown and the Daily Herald entered into an agreement to share ‘second tier sports coverage’ on Sept. 28, 1998. It’s a simple arrangement: We send them the Fire, Cheetah, WNBA Condors (now out of business) and local auto racing in exchange the Herald sends us Wolves, Fire off-day/player features and occasional horse racing coverage.

“I have spoken with Herald news execs on at least three occasions in an effort to open up some form of news sharing which I think would benefit both papers. However, as I write, nothing has been agreed.

“The Herald and the Sun-Times entered into an agreement on Jan. 14, which is exclusive to both of those properties. At no time in any of my meetings with the Herald and Sun-Times news execs has the subject of the Southtown and Sun-Times sharing ever been discussed. The Sun-Times recognizes the Daily Southtown as a competitor in the marketplace and has never attempted to undermine the editorial integrity of our product by attempting to establish a sharing agreement.

“The bottom line is: We have our arrangement, minimal as it is at the moment, and the Sun-Times has their agreement.”

What the Sun-Times and Daily Herald will be sharing, according to Daily Herald editor John Lampinen, are local news stories that can run at length in the paper where they originate and as briefs in the other. The Daily Herald wants to carry more news out of Chicago, while the Sun-Times will do anything to expand its coverage of the suburbs except pay more reporters to work there.

The three papers have been quiet about their arrangement, which has raised union concerns, questions about compensating freelancers for shared copy, and rank-and-file apprehensions about the future. When the interests of two newspapers dovetail so comfortably that they begin pooling resources, perhaps they’re fated to become one paper. Which is what those rumors ultimately were about that Neill attempted to “quell.”

The Daily Southtown staff aren’t eager to help Big Brother, much less disappear into it. They’re no fonder of the Sun-Times than the old Daily News staff down the hallway used to be. And everyone remembers what happened to them.

News Bite

When the event is ghastly and little is known, newspapers will throw almost anything into a story to give it heft. On Tuesday the Tribune reported that an elderly Lake Forest woman, Gunvati Kapoor, and her nurse, Raveica Luca, both died of carbon monoxide poisoning in the home of the woman’s son in an expensive neighborhood. The son, Kamal Kapoor, was hospitalized near death.

Scrambling for details, reporters located “a woman who lives two doors west” who didn’t give her name. She allowed that the neighborhood wasn’t tight-knit and that the Kapoors were particularly remote. However, she was able to tell the Tribune that “the Kapoors entertained extended family at the home and a steady stream of relatives ‘came and went.'” On this note of revelation the story ended. Whether it was there to illuminate the Kapoors or the neighbors, who knows? But in either case it was gratuitous.