How the ABMS MOC Program Threatens Major Medical Journal Integrity

They are two of the most prestigious academic journal's in the United States: the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA). Both have published extensively on the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program. Both have clear rules requiring full disclosure of conflicts of interest: the NEJM has its Integrity Safeguards and JAMA, like the NEJM, follow the conflict of interest disclosure recommendations (pdf) of the International Committee of Medical Journal Editors.

But what happens when authors who are widely published in these journals fail to disclose financial relationships that are more than de minimus? Are articles retracted? Are authors sanctioned? Or are conflicts that also benefit the bottom line of one of these medical journals just ignored?

Take, for instance, this article that was recently published in the NEJM: "Maintenance of Certification 2.0 — Strong Start, Continued Evolution" written by Mira B. Irons, MD and Lois M. Nora, MD. The disclosures of the authors reveal that "Dr. Irons reports being employed by the American Board of Medical Specialties" and "Dr. Nora reports being an employee of the American Board of Medical Specialties, and being a coauthor on work describing the American Board of Medical Specialties Maintenance of Certification program." In another correspondence, Drs Norris and Nora, both of the ABMS, disclosed "Dr. Norris reports being on the board and Dr. Nora reports being the president and chief executive officer of the ABMS. No other potential conflict of interest relevant to this letter was reported." In JAMA in August 2015 entitled "American Board of Internal Medicine and Maintenance of Certification Standards," a similar disclosure only lists Dr. Nora's affiliation with the American Board of Medical Specialties.

What was never publicly disclosed by either of these major medical journals was the authors' significant financial relationship with the Georgia-registered Foreign Limited Liability Corporation, ABMS Solutions, LLC (Control number 11096304), whose office address exactly matches that of the American Board of Medical Specialties in Chicago, IL. Furthermore, Dr. Nora, as President and CEO of the ABMS, never mentions the congressional lobbying the ABMS conducted with members of the Congressional Energy and Commerce Committee to solidify their MOC program as a "quality" standard for "800,000 licensed US physicians," to assure virtually unlimited funding of their organization through the sale of primary source verification of physician certification status to third parties via ABMS Solutions, LLC.

It is no secret that the New England Journal of Medicine also earns money for the sale of educational products for the ABMS Maintenance of Certification program through their 'NEJM Knowledge+' educational product. This relationship makes the NEJM's response more economically difficult for them. But if the NEJM and JAMA fail to actively address the failure of ABMS authors to publicly disclose their multiple significant financial conflicts with the ABMS MOC program at the time they submitted their manuscripts,  they risk compromising their own integrity with the entire international medical community.

-Wes

P.S.: I contacted the New England Journal of Medicine letter editor to make them aware of these conflicts. They are currently evaluating the situation.

11:05 CST 9/6/2016 - Link to the Georgia corporate registration fixed.

Addendum: For follow-up of the letters I sent to JAMA and New England of Journal Medicine regarding the perceived ABMS conflicts, click here.