The AMA point of view

 

President’s Report 28 May 2015 : Agenda Item 2.1 Federal Council

2.1:22 Medical Journal of Australia

The AMA’s fully owned subsidiary AMPCo, the entity that publishes the MJA and the Medical

Directory of Australia, has been under significant financial pressure for some time. The

business is essentially a publishing and database business. Across the board businesses in these

areas have been under pressure and even existential threat.

 

In late 2013, it became apparent that the financial situation of AMPCo was perilous. As a result

of some serious work by Steve Hambleton during his Presidency, Elizabeth Feeney who was

Treasurer of Federal AMA at that time and our Secretary General Anne Trimmer the situation

was significantly improved. Those who were on Federal Council at the time will recall the

concern that was recognised in formal motions at Federal Council.

 

While the dire situation improved, this would be a temporary improvement without real

changes in the business. Following discussions within Federal Council, the AMPCo Board was

subsequently restructured, introducing two new independent directors (replacing two longserving

independent directors) who had considerable experience in publishing – Mr Richard

Allely (as Chair) and Mr Rowan Dean. Dr Elizabeth Feeney and Dr Steve Hambleton

continued as directors of AMPCo, representing the AMA.

 

Along with a host of other internal changes such as the appointment of a General Manager and

alignment of AMPCo business infrastructure and procedures between AMA and AMPCo to

drive efficiencies, the cost of production of the MJA also deserved scrutiny. The AMA

subsidises the production of the MJA each year through member subscriptions – last year $2.35

million was provided from AMA to AMPCo solely related to MJA production. The MJA

continues to operate at a loss.

 

AMPCo exists as a separate entity in order to allow the business to be run at ‘arm’s length’

from the AMA. As part of the aligned strategic plans of the AMA and AMPCo, there is an aim

for AMPCo to be able to run as a business on its own merits rather than as a subsidised

business. This does not mean that AMPCo should be providing the MJA at no cost but rather

where production of the MJA is not so dependent on AMA contributions.

 

In order to achieve these aims AMPCo has examined a number of options targeted towards

savings. These included the outsourcing of production, largely focused on sub-editing and

related administration. There is no intention, nor has there been any intention, to outsource the

editorial functions or to challenge the editorial independence. On the contrary, I asked for a

policy on editorial independence of the MJA to be established, for the first time, earlier this

year. This was approved by the AMA board, Editor-in-Chief and AMPCo Board at the time.

During the process a group of three people at AMPCo, independent of the AMPCo Board, were

tasked with developing proposals for outsourcing of MJA production. The team recommended

the Elsevier proposal. The Board and the team were aware of the concerns that have been held

by some people in relation to Elsevier over controversial events and/or publications. These

issues were considered by the AMPCo Board and discussed with representatives from Elsevier.

The proposals were discussed with Professor Stephen Leeder as early as December 2014. He

had been invited to submit alternative proposals. However, despite multiple attempts to resolve

the issues, it became clear that the Board could not reach agreement with Professor Leeder in

relation to securing the future of the MJA. As such his contract was terminated. The Chair of

the AMPCo Board informed me that this was a possible outcome.

 

Subsequent to the decision, there have been a number of media reports, public comments and

campaigns that have either been factually incorrect or have been designed to harm the AMA

and the MJA.

 

The AMPCo Board is the entity that is responsible for the conduct of the AMPCo business and

the production of the MJA. It is not possible for the directors of AMPCo to fulfil their duty as

directors unless the Editor-in-Chief co-operates with the decisions of the AMPCo Board. The

Editor-in-Chief reports directly to the Chair of AMPCo.

 

I support the decisions of the AMPCo Board including the decision to terminate the contract of

the Editor-in-Chief.

 

I respect Professor Stephen Leeder as a member of the medical profession. At no time have I or

members of the AMA or AMPCo Board suggested otherwise.

 

However, the reports that Professor Leeder was marched from the building are untrue. He was

accompanied to his office where several staff later packed his personal belongings so that they

could be couriered to his home. He then attended drinks with his staff at a local hotel, paid for

by AMPCo.

 

Numerous members of the Editorial Advisory Committee, many of whom were appointed by

Professor Leeder, have also resigned. While there have been several reasons for their

resignations, it is mostly in personal support of Professor Leeder. Three members of the

Committee have not resigned and have elected to continue.

 

Some former members of the Editorial Advisory Committee have written to me directly as

President of the AMA and I have also received correspondence collectively.

 

The reasons for the resignations from the EAC and opposition to the decisions of AMPCo are

several. As mentioned there are some that feel that the treatment of Professor Leeder was not

appropriate for an esteemed member of the medical profession.

 

The decision to outsource the production of the MJA at all has been raised. Clearly some

people feel that the MJA should continue in its current state and that any change, particularly

related to outsourcing per se, is wrong. That is not a rational or viable argument.

There are some that have argued that the decision to outsource will inevitably include an

editorial component and compromise editorial independence. There is nothing to suggest that

this is the case. We have emphasised the fact that editorial direction and content was not going

to be outsourced. The look and feel of the MJA would be unchanged and the position of Editor

in Chief along with the Deputy Medical Editors would be unchanged.

Finally, there has been an argument that Elsevier is a disreputable company that has been

unethical. There have been a number of controversial issues that have been addressed by the

company to the complete satisfaction of the AMPCo Board during the conduct of its due

diligence.

 

Soon after the Editor-in-Chief was terminated and we began to receive correspondence on this

issue I wrote to Federal Council to clarify the issues and the decisions that had been taken. I

have also written to the AMA membership through individual emails along with making some

limited comments in the media. I have also remained in close contact with the AMPCo Board

during this period.

 

While we have had some correspondence on this issue, the contents of the comments have been

mixed. There has of course been some correspondence critical of the decisions, some of which

is from AMA members and but much of it is not. There has also been some correspondence, all

from members, supportive of the decision. I am aware that there have been a total of 3

resignations directly related to this issue.

 

There is a campaign that is being run by a number of academics, mainly from the public health

area, some of whom were on the Editorial Advisory Committee. The group is petitioning me as

President to reinstate Professor Leeder, to sack the AMPCo Board and conduct an independent

review. Apart from not being in my powers to act as a dictator, I have no intention of

withdrawing my support for the AMPCo Board or its decisions.

 

The campaign that is being run is harmful to the MJA and its supporters. Those members of the

Editorial Advisory Committee who have not resigned have been personally abused for

continuing their contribution. Many of the people involved in these groups of critics are not

members, nor have they been members, of the AMA. This includes Professor Leeder. I am

more interested in ensuring that AMA members’ funds are used soundly and that their interests

are foremost.

 

The decisions that have been taken are in the best interests for the future of both the AMA and

the MJA. The AMA remains committed to the production of the MJA and its editorial

independence. The decisions have been difficult ones, and it would have been preferable if

Professor Leeder had decided to continue his contribution in a constructive manner. However,

the AMA and AMPCo will continue with those that are committed to the future of the MJA as

a well-respected academic publication that is financially sustainable to be produced.

 

Statements from the AMA President and the Chairman of AMPCo, and an FAQ document issued the AMA

3 May 2015

OPEN LETTER TO THE MEDICAL COMMUNITY (From AMPCo Chair)

Recent media coverage about the outsourcing of a number of Medical Journal of Australia production functions contain numerous inaccuracies and we are deeply concerned that the medical community is receiving misinformation about the rationale and nature of the AMPCo Board’s decision.

We are writing to you to explain the process behind this decision and why it is essential to maintain the quality and future sustainability of the MJA.

This project is the culmination of an 18–‐month review of the AMPCo business where it was identified that the process for producing the MJA in–‐house was extremely costly and inefficient and could be substantially improved. Indeed the future viability of the Journal was at risk, hence it was deemed absolutely necessary to seek operational efficiencies to put the Journal on a sound financial footing.

The Board consulted with the Editor In Chief –‐ Professor Stephen Leeder from late December 2014 to April 2015. We sought Professor Leeder’s feedback on the outsourcing proposal and explored alternative plans with him and his editorial team. All concerns raised by the editorial team were acknowledged and seriously considered by the Board.

After proper due diligence, the Board decided to outsource the production process only to an external provider (Elsevier) with editorial direction, content development and IP remaining wholly within the Journal as a separate function. Elsevier will only facilitate the operational production of the MJA under the direction of AMPCo.

The MJA will achieve significant benefits from outsourcing, including efficiencies ofscale, improved production workflow using more up to date technology, whilst drawing on Elsevier’s workflow for Journals such as The Lancet.

This is a model that is widely utilised throughout scholarly society publishing and has served those societies well as it will ours. Elsevier, like many publishers is a member of COPE, and adheres to the Publishers Code of Conduct, which states that publishers should foster editorial independence.

As esteemed academics, I am sure you are aware many other journals in Australia work successfully with outsourced suppliers/publishers who support the editorial independence with sub–‐editing and production functions.

We worked closely with Professor Leeder to reach an agreement on the direction that the AMPCo Board had decided. Unfortunately no agreement could be reached and the Board was left with the only option of concluding Professor Leeder’s employment contract. This was a great disappointment to the Board.

We refute the media commentary about his treatment on termination, which is totally inaccurate.

There is no doubt about Professor Leeder’s eminence and standing in the medical community –‐ particularly in the field of public health. We wish him well with his ongoing career and have appreciated his service with the MJA during the past two years.

The Board has been criticised for its decision to choose Elsevier for the production of the MJA.

Prior to engagement the Board discussed all issues raised by the editorial team with Elsevier and is satisfied that the issues were fully addressed. It must also be noted that any criticism of Elsevier was related to editorial content and the company will have no editorial role with the MJA.

The Board has also received criticism for not consulting with the wider medical community on this decision. While we greatly appreciate your concern and support of the Journal, unfortunately it is not logistically possible to consult with all the members of our community and we ask that you trust us to deliver the best outcome for the MJA.

Change is always a difficult time in any organisation and can be very challenging. However I cannot stress enough that the future viability of the MJA and the continuation of its success is dependent on ensuring its sustainability and improving the efficiencies of its publication.

We are fully committed to ensuring the Medical Journal of Australia remains the leading provider of Australian clinical research, evidence–‐based reviews and debate on the important issues affecting Australian health care.

Yours Sincerely,

Richard Allely,

Chairman, AMPCo Board

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Briefing sent to members of the AMA Federal Council by the President of the AMA, A/Prof Brian Owler on the weekend of May 2/3

Dear Federal Councillors

Federal Councillors may have seen recent media coverage of changes to some aspects of the production of the Medical Journal of Australia (MJA). The MJA is Australia’s flagship medical journal. It was established by the AMA to promote world class medical writing and it has fulfilled that critical role.

I would like to provide AMA Federal Council with a briefing on events of the past week in relation to AMPCo and the termination of the employment of Professor Stephen Leeder as Editor–‐in–‐Chief.

Those of you who have been on Federal Council for some time will know that AMPCo, a wholly owned subsidiary of the AMA, amongst other activities publishes the MJA. About 18 months ago, the financial position of AMPCo could only be described as perilous.

Through intense efforts by many people at AMA and AMPCo, the position of the business has significantly improved. A new Board was appointed in mid 2014 with the AMA represented by Dr Stephen Hambleton (former AMA President) and Dr Elizabeth Feeney (Chair of AMA Board and former AMA Treasurer). In addition two independent directors were appointed, both with significant publishing experience -Mr Richard Allely (Chair) and Mr Rowan Dean.

The role of the Board was to ensure the future success of AMPCo including the MJA. As part of that role, it was clear that the process for producing the MJA was not efficient and could be substantially improved.It should be noted that AMPCo receives significant financial support from the AMA ($2.355 million last financial year), over 20% of Federal AMA’s member subscription income, purely for the publication of the MJA. In accordance with the strategic plans of both AMA and AMPCo, it is intended that the MJA become less dependent on the AMA for financial support.

A range of options was canvassed in order to produce the MJA more efficiently. The AMPCo Board, after due diligence that included a tender process, decided to proceed on a path to outsource the production of the MJA. The AMPCo Board considered it essential that the outsourcing be for production only and have no influence over the editorial content of the MJA. Editorial content was to remain within

AMPCo under the Editor–‐in–‐Chief.

Since January of this year, the Board has worked with the Editor–‐in–‐Chief on this decision. Unfortunately despite significant effort, the Board and Editor–‐in–‐Chief could not come to an agreement on the best way to ensure the future of the MJA. As a result the Chair of the AMPCo Board terminated the contract of the Editor–‐ in–‐Chief of the MJA Professor Stephen Leeder.

This is of great disappointment to both AMA and AMPCo. Both Boards readily acknowledge ProfessorLeeder’s credentials in public health and as a leader in the medical community. We were proud to have him as Editor–‐in–‐Chief of the MJA. However, the role of the AMPCo Board is to ensure that AMPCo is sustainable as a business, that AMA members’ subscriptions are utilised appropriately and that the MJA will continue to be published. All of these would be compromised without significant change and these changes have included difficult decisions.

The AMA Board was informed of the decision of the AMPCo Board at its meeting on Thursday. The AMA supports the decision of the AMPCo Board and its Chair.

While there have been a number of media stories surrounding this issue, the narrative is not reflective of the rationale and nature of the AMPCo Board’s decision. It also disappointing that several of the Editorial Advisory Committee have decided to resign as a result.

As part of the reporting, the decision to enter into a commercial relationship with Elsevier to produce the MJA, has also come under criticism. Elsevier has been involved with a number of controversial issues. The AMPCo Board has been aware of these issues and, after discussion with Elsevier, has been satisfied that the issues have been addressed and that it is appropriate to enter into such a commercial relationship.

Elsevier publishes the Lancet. Some have raised concerns about editorial issues at the Lancet as a reason for not engaging in a commercial relationship with Elsevier. However, as I noted above, Elsevier will have no editorial role with the MJA. The scope of the outsourcing is limited.

It is regrettable that a path to ensure the future of the MJA could not be agreed with Professor Leeder. I would like to acknowledge and thank him for his contribution to the MJA as Editor–‐in–‐Chief during the past 2 years.

I am reassured that the AMPCo Board is working with senior staff to ensure that the MJA continues to produce a high quality medical journal for the benefit of our members and the broader medical community.

Sincerely

Brian Owler

President

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Memo from the CEO of the AMA CEO as a list of Frequently asked questions (FAQs) for AMA Federal Council members, sent 5 May 2015

memo

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Letter from Dr Brian Owler to Dr Peter Arnold 3 May 2015

On 3 May 2015, at 12:56 pm, Australian Medical Association <president@ama.com.au> wrote:

Dear Dr Peter Arnold,

The AMA, through its subsidiary Australasian Medical Publishing Company Pty Limited (AMPCo),

is proud to publish Australia’s leading medical journal – the Medical Journal of Australia (MJA). It is

an integral function of the AMA and we intend that this remain so.

We value your membership and recognise that in order for the AMA to be effective in the

development of health policy and successful in representing your interests through advocacy and

political lobbying, you contribute a significant membership fee. Included in this fee is your

subscription to the MJA. 

As is well known the field of publishing has had difficult times across the board. AMPCo is no

different. Although it continues to evolve and adapt in the new digital era, it has also faced financial

challenges. In recent years the financial position of AMPCo could only be described as perilous.

However, through significant work by people at the AMA and AMPCo, the situation has significantly

improved.

Both the AMA Board and the AMPCo Board have strategic plans which recognise the importance

of making our publishing company less dependent on the AMA and your membership fees for

financial support.

Last year, approximately 16% of the Federal AMA’s total revenue was spent on publishing the

MJA through AMPCo. This was a total of $2.355 million or about 20% of Federal AMA’s income

from membership subscriptions.

The AMA Board believes that we need to ensure that your membership fees are spent prudently.

While we absolutely value the MJA and are committed to its success, there was an appreciation

that AMPCo needed to address these issues.

As a consequence, the AMPCo Board has considered a number of opportunities to ensure that

production of the MJA is cost efficient, just as many other journals and publications have done.

After due diligence, the AMPCo Board decided to outsource some of the production elements of

the MJA.

I want to emphasise that at no time has it been suggested that the editorial component of MJA 

production would be outsourced.

We have been fortunate to have had the services of Professor Stephen Leeder as Editor-in-Chief

during the past two years and are grateful to him for his service to the MJA. He is a highly

respected and distinguished member of the medical profession.

Since January, the AMPCo Board had been working with Professor Leeder to secure the future

of the MJA through the outsourcing arrangementsUnfortunately an agreement was not able to

be reached regarding the future of the business and production of the MJA. As a result the

AMPCo Chair terminated Professor Leeder’s tenure as Editor-in-Chief of the MJA. 

There have been a number of comments in the press, particularly the medical press, about

the circumstances of Professor Leeder’s termination. Unfortunately many are inaccurate.

A significant number of the Editorial Advisory Committee, some of whom are AMA members,

have also resigned. I have thanked them for their service and asked them to reconsider. I hope

that they do so.

Some of the publicly expressed concern relates to the choice of Elsevier, an international

company that produces many journals including The Lancet, as the company to which AMPCo

will outsource some of its production. This decision was made after a competitive process

during which the AMPCo Board interrogated Elsevier management to satisfy itself about the

company and its reputation.

While it is regrettable that the AMPCo Board’s decisions to secure the future of the MJA have

not been accepted by some, I want to ensure that the AMA continues to publish a successful

medical journal in a tough environment. I also want to ensure that you receive the best possible

value for your membership fee.

I thank you for your continued support of the AMA and hope that this message provides you with

reassurance that the AMA and AMPCo continue to act in the best interests of AMA members.

Yours sincerely,

signature

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On 5 May 2015, at 10:20 am, President’s Inbox <president@ama.com.au> wrote:

Ref: D15/3524 & D15/3461

Dear Peter

Thank you for your emails about the Medical Journal of Australia and Prof Stephen Leeder. You have raised specific questions which reflect a particular view of what has transpired at AMPCo which is not accurate.

In answer to your questions:

  1.  1. Prof Leeder has been invited to attend Board meetings to present on the editorial activities of the MJAsince the new board was put in place in mid 2014. He attended periodically, at times for the MJA report and at other times for the entire meeting. In 2015 the Board meeting dates were changed to accommodate Prof Leeder so that he could attend the entire meeting
  2.   2. The losses incurred by the MJAare well-known to Prof Leeder, having been discussed with him as part of the budget process within AMPCo. Prof Leeder was also provided with each monthly P&L so that he was fully aware of the financial position of the MJA.
  3.   3. The Board undertook a competitive process to identify a preferred provider of production activities. The General Manager is a former employee of Elsevier at its regional office in Singapore. This is not unusual in a small pool of experienced publishing personnel. Ms Redden played no part in the AMPCo Board’s decision-making and is not a member of the AMPCo Board. There was no conflict of interest.
  4.   4. I am sure the AMPCo Board has the view that reviewers and others have loyalty to the Journal and that most will continue to support it.
  5.   5. Elsevier plays no part in determining the editorial content of the Journal. Whatever may be the criticism of past action by Elsevier, this matter was explored by the AMPCo Board which was assured that Elsevier changed its processes many years back to ensure that there is no recurrence of the event that has given rise to criticism. Prof Leeder sits on an Elsevier advisory board as does at least one member of the Journal’s editorial advisory committee.

You ask what AMA President does not take account of the views of his members? Of the members who have contacted me the overwhelming majority have supported the actions of the AMPCo Board in the decisions which it has taken. Any negative comment has come primarily from non-members who are associates of Prof Leeder.

Yours sincerely

Brian Owler

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And Elsevier’s point of view

From http://elseviermedcomms.com.au/important-announcement

Elsevier Medical Communications and the Australasian Medical Publishing Company are pleased to announce a collaborative agreement on medical advertising sales effective from April 1, 2015.

Under the agreement AMPCo will be responsible for advertising sales in a range of medical journals and newspapers published by Elsevier including:

Specialist Newspapers
(click here for rate cards)
Journals and associated websites
(click here for rate cards)
Cardiology NewsClinical Endocrinology NewsHaematology & Oncology NewsRheumatology News Heart, Lung and CirculationAustralasian Emergency Nursing JournalAustralian Critical CareCollegianJournal of Science and Medicine in Sport

Elsevier is a world-leading provider of information solutions and publishes nearly 2,200 journals, including The Lancet and Cell, and journals managed on behalf of leading medical societies and colleges.

AMPCo is the publisher of the MJA and the leading medical database provider in Australia. AMPCo has enjoyed considerable success in managing print and online advertising across a range of medical disciplines.

“This collaboration combines the editorial leadership of Elsevier with AMPCo’s expertise in delivering targeted medical advertising solutions,” said Sally Stone, Director – Clinical Solutions & Journals, Elsevier Australia.

According to David Kelly, AMPCo’s Sales and Marketing Manager, “this agreement enables AMPCo to offer marketers the widest possible medical audiences together with the effectiveness of targeting advertising campaigns to specific audiences”.

For all your 2015 advertising bookings, information on rates and pricing, please contact Brendan Frewbfrew@ampco.com.au; M 0414 388 973.

For all other Elsevier Medical Communications sales queries, please contact Stephen Yue: s.yue@elsevier.com; M 0448 008 159.

Thank you for your advertising support  and we hope you can continue to grow with us as we embark on a new era for 2015.

If you have any questions regarding this, please do not hesitate to contact us, below.

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2 Comments

  1. the losses sustained by AmpCo are unsustainable
    How do you see the move to Elsivier as being a disaster?

    • Response from FoMJA:
      Yes, efficiency gains could be achieved with good management, but outsourcing is not the best option. These issues are discussed in some depth in the document entitled Submission to the AMPCo Board from the Editor in Chief and the Editorial staff. This can be found by going to the menu item “The opposing points of view”.

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