Two years ago, the American Medical Association fired the celebrated editor of its flagship journal, The Journal of the American Medical Association. AMA leaders said George Lundberg, M.D., JAMA’s editor of 17 years, "went a step too far" when he published findings from a survey on what physical acts college students said qualified as having "had sex."

While the subject may or may not have major medical implications, the AMA brass thought it more than coincidental that the article appeared during the Clinton impeachment hearings. They intimated that the JAMA editor had, in this instance, used the journal to make a political statement.

Dr. Lundberg, they said, "through his recent actions, has threatened the historic tradition and integrity of The Journal of the American Medical Association by inappropriately and inexcusably interjecting [JAMA] into a major political debate that has nothing to do with science or medicine."

Dr. Lundberg’s dismissal provoked many of his fellow editors to pen strong letters of protest, alleging that the AMA had violated JAMA’s editorial independence. Dr. Lundberg himself claimed AMA leaders had "inappropriately intruded into the historically inviolable ground of editorial independence in scientific journalism."

If you’ve been keeping up with the news lately, you may know that I will step down at the end of this year after 10 years as JADA editor. I’ve always enjoyed strong support from the ADA leadership. Mine is an amicable departure. I am the one who decided it is time to go, no one else.

The search for my successor has been in progress now for several months. Indeed, the deadline for candidates to submit their credentials is March 31.

It seems appropriate then, during this transitional period, to explore the issues and challenges that all editors face—to take stock of what we really think and really believe about such matters as editorial independence, scientific integrity and an editor’s responsibility to the organization. And vice versa.

Candidates seeking the JADA editorship and those charged to make that selection should consider the issues raised in the Lundberg debacle. And so, JADA reader, should you. You have a stake in this as well. It is, after all, your professional journal we’re talking about.

As I see it, the first order of business is to define what actually constitutes "editorial independence." This raises a number of questions. For instance, is it inconsistent with editorial independence if a journal solely represents the views of its constituency—the organization and its members? Is editorial independence violated or altogether lost if a manuscript is rejected because it is considered politically unfit? And if this ever happens, will readers be able to accept with confidence that what is published represents the best knowledge available, served up without institutional bias?

Obviously, as a scientific journal, JADA’s publication goals should not be confused with those of the public press. JADA is dedicated and funded to serve the needs of the members of the American Dental Association. The Association’s dual mission—to serve the interests of both the public and the profession—challenges its editor to determine the proper balance between editorial integrity and professional responsibility.

When you are not the editor, it may be easy, even comforting, to imagine that you would always make the right call and fight the good fight. But that assumes that you could invariably discern clear-cut distinctions between right and wrong, good and evil, black and white. In publishing, I submit, the predominant color is gray, and it comes in an ever-widening variety of shades.

Let us now play a game. Call it "What’s My Choice?" Described below are a number of situations that require an editor’s judgment. These are fictitious, of course, though they represent the kinds of decisions the editor of a major scientific journal is called on to make everyday. You are that editor. You make the call.

1. You have published a peer-reviewed article on the instrument sterilization practices of the dentists in a particular state. Findings from this study, which involved more than 400 dental offices, show that 80 percent of the offices in the state were doing a poor job of sterilizing their instruments. However, the study also showed that once staff were instructed in how to "pack" instruments properly, the sterilization failure rate was reduced to 2 percent.

Shortly after the study is published, you get a call from the president of the state’s dental association, who says he’s swamped with complaints from his membership. He says his member dentists are concerned that the article could invite unwanted attention from investigative journalists from programs like "20/20" and "60 Minutes" who might use the article to characterize the dental office as an unsafe place.

How do you respond to these concerns?

2. You have received a well-crafted report on the dental profession’s participation in Medicaid from a dentist who is universally disliked by his peers. This dentist often is insulting and dismissive of his colleagues, and is well-known for criticizing dentists who are reluctant to treat Medicaid patients. Still, the paper is well researched and presents a number of solid suggestions on how to increase dental participation in Medicaid. You know you won’t win any popularity contests by publishing his material. In fact, it’s conceivable you might lose your editorship if the dental community challenges your judgment.

Do you publish the article?

3. A research manuscript on the safety of an infection control product has passed through the peer-review process with flying colors. Without exception, the reviewers recommend that the paper be published. The study explores the efficacy of a well-known product used in dental offices across the country. The study concludes that this product is not particularly effective; it even identifies other products that clearly work much better. But the maker of this apparently ineffective product is your major advertiser. Most likely, if the article is published, the manufacturer will cancel his ads. Your journal is expected to turn a profit, and you depend on that revenue.

Do you follow your reviewer’s suggestions and publish the research?

4. Your dental association’s executive committee has decided it will seek approval of a dues increase at its next annual meeting. You have been an outspoken critic of such an increase, arguing that it would harm membership among younger dentists—encouraging them to quit or not to join in the first place. The association’s officers predict that the loss of membership resulting from the dues increase would be minimal, and they think you’re something of an alarmist. But your own research shows that, in fact, the membership loss would be substantial, and you’re thinking about writing an editorial to that effect. This, of course, would pit you directly against the association’s hierarchy.

Do you write the editorial?

As an ADA member and JADA reader, you are a stakeholder in a for-profit enterprise that is driven, as its mission states, to deliver high-quality, accurate and relevant information on matters related to dental care and dental practice. That information should reach you in a timely fashion, and it should be presented without external and internal influence. The ability of the editor to function in a censorship-free environment is critical to fulfilling The Journal’s mission.

All of us accept it as a basic tenet of our profession that dentists should have the right to treat their patients as their knowledge and experience dictates, within the limits of accepted dental practice. Is the profession willing to apply that same principle to the work of the editor of its flagship journal? Will the ADA bestow on the editor the right to make difficult, sometimes unpopular choices?

I urge those seeking the JADA editorship to pose such questions to their interviewers.