Is Obama's JAMA paper OK?

Question

As some of you may have heard, Barack Obama recently published a paper in JAMA describing the US health care reforms (link). First of all, I am not trying to start a discussion on the validity of the content of the paper.

Maybe I am overreacting, but as an academic, that specific publication raises a number of concerns. Within scientific research and publishing we have a number of ethical principles that should always be adhered to (e.g., authorship, conflicts of interest, plagiarism, ...). When I look at that publication, I can't help but wonder about a number of things, such as:

1. Authorship: Obama is listed as sole author on the manuscript. I personally highly doubt that he has done all of the research and writing himself. That constitutes a problem in publication ethics, as is often discussed at length on this site. He does name a couple of people in the acknowledgements, but in my opinion these people should have been authors while Obama should've been in the acknowledgements. Quoting the acknowledgements:

   I thank Matthew Fiedler, PhD, and Jeanne Lambrew, PhD, who assisted with planning, writing, and data analysis. I also thank Kristie Canegallo, MA; Katie Hill, BA; Cody Keenan, MPP; Jesse Lee, BA; and Shailagh Murray, MS, who assisted with editing the manuscript. All of the individuals who assisted with the preparation of the manuscript are employed by the Executive Office of the President.

2. Conflicts of interest: the paper essentially "finds" that the reforms done by the Obama administration are a good thing. Of course Obama will say his reforms are good, yet this was not explicitly disclosed in the conflict of interest statement.

3. Political papers: the article is published as a special communications, which requires prior inquiry before submission. I feel that this type of paper does not fit into a scientific journal. It's fine to do politics, but I feel it should be done elsewhere.

I am genuinely left wondering whether papers like this one are good or not. While I applaud the idea of scientific papers coming from policymakers, the above mentioned issues (and others) are significant.

My question: are such papers in scientific venues OK or not?

Answer 1

• Authorship: This one is messy. The JAMA instructions say Authorship credit should be based only on (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; and (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published based on the acknowledgements, I think there is a case that Matthew Fiedler, PhD, and Jeanne Lambrew, PhD could be authors for their contributions to planning, writing, and data analysis while those who only edited the manuscript fail the test.

  The difficulty is that the JAMA requires written permission from everyone named in the acknowledgements. For whatever reason, the contributors did not feel they deserved authorship. It is possible that they were bullied out of authorship. Universities, and I am hoping the White House, have systems in place to handle this type of bullying. In the absence of any evidence wrongdoing, I think we need to assume that credit was fairly given.

• Political papers: This is also a little messy. I think good scholarly journals should include non-research papers (as long as they are clearly mark something like special communications) that likely have broad appeal to the readership. I think journals should strive to keep readers up to date on important issues in the field, even if it is not original research. I also think journals should actively engage in activities that will bring wider attention to their respective field. I think the specific paper falls well within the scope of JAMA which includes all subjects that relate to the practice of medicine and the betterment of public health worldwide. What makes things messy is that in addition to Special Communications JAMA also publishes Controversies in a point-counterpoint and Health Law and Ethics, both of which may have been better fits. Given the partisanship surrounding obmacare a Controversies may have been a fairer way to present the issues.

• Conflicts of interest: The JAMA instructions say A conflict of interest may exist when an author (or the author's institution or employer) has financial or personal relationships that could inappropriately influence (or bias) the author's decisions, work, or manuscript. and I don't think that being the originator of an idea counts as a personal relationship that would qualify as a conflict of interest.

Answer 2

My thoughts:

• Authorship: This is probably the most problematic one, as it seems unlikely that this was entirely written by the President, especially given the acknowledgements. But it's also possible that the framework was written by the President, and what's being acknowledged is editorial assistance, talking over the idea with experts, etc. Especially for a position piece, I don't think that's overly troubling - the piece is clearly "President Obama's perspective on things".
• Conflict of Interest: This one I think is a non-issue. "Cares a lot about something" isn't a conflict of interest. Even "considers this the major accomplishment of his career" isn't a conflict of interest.
• Political papers: "the article is published as a special communications, which requires prior inquiry before submission." What makes you think it wasn't? I doubt the White House just sent off a paper to JAMA on a lark. If your objection is that JAMA said yes...well, I don't think there's anything inherently wrong with that. JAMA is the journal of an academic society - one that takes political stances. Public health and medicine are inherently political fields - an editorial calling for more preparedness for Zika is political, as an example. This is part of a series examining one of the largest changes to the American medical system...what venue is more appropriate than the Journal of the American Medical Association?

Answer 3

I've been working on several research project these years, and it looks like a normal position paper[1] to my eye. A very well written one, given the standards. Regarding your specific concerns:

1. Authorship This one is the more intriguing, as the norm usually is quite the opposite[2] and you'll expect to find one author from each strong University/Research Centre involved to be listed. But talking about strength, Who's at the level of the POTUS individually and the White House as an organization? Being all of them part of the same "Research Centre" just confirms the rule of listing one (THE one in this case)
2. Conflicts of interest This is very normal. Position papers are written by the people that are funded to research about the topic.
3. Political papers I wouldn't surprise if I found position papers on every journal, not only in JAMA. At least I found some examples in CS conferences (I know, proceedings are not journals) where the "next grant research project" are presented.

[1] "A position paper presents an arguable opinion about an issue. The goal of a position paper is to convince the audience that your opinion is valid and worth listening to. Ideas that you are considering need to be carefully examined in choosing a topic, developing your argument, and organizing your paper." https://web.archive.org/web/20070316023144/homepages.uhwo.hawaii.edu/~writing/position.htm

[2] mandatory joke: http://researchinprogress.tumblr.com/post/73499257618/authors-popping-up-to-be-listed-for-a-project

Answer 4

The authorship and conflict of interest problems are very troubling to me.

I see authorship questions as a matter of academic honesty. To not include an author or add an unearned authorship is an implicit lie about how the research was conducted. "Who actually did this?" is a critical question in any study, as only those people can actually say the methods or valid or that the study was done at all. From the perspective of scientific witnessing, only the person who actually did the work can say what was done, or if it was done at all. To have an author who didn't actually do the work saying what was done reduces the paper to heresay, it's just someone saying what they heard was done.

So to have a single author on this paper implies that Obama personally did the majority of the work in this paper, which seems likely to be untrue and thus, academically dishonest.

Also, Obama lists himself as the corresponding author on this paper. Which means it seems that he will be personally handling requests for materials. I somehow suspect that it might be difficult to get a timely response to requests for materials and data.

The conflict of interest issues are also important, but others have already addressed these better. He clearly has a vested interest in the outcomes of this work, and they don't even bother to mention it.

What makes me a bit angry about this is that it reduces something serious that scientists work hard to do right to something which is just PR. Authorship comes with responsibilities, and I have doubts about how seriously that's being taken.

Let's all hope this doesn't become a trend.