Is Obama's JAMA paper OK?

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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?

Marc Claesen

Posted 2016-07-12T12:46:21.850

Reputation: 6 928

61"While historians will draw their own conclusions about the broader implications of the ACA, I have my own." This statement alone reflects that this is not a scientific article. I think the difference is that this article is classified as a "special communication" vs. "original investigation" and therefore isn't purposed to be 'scientific'. – Hobbes – 2016-07-12T13:21:58.480

4Has JAMA previously invited contributions from other non-scientists? What about other top journals, like Nature? – GEdgar – 2016-07-12T13:43:49.040

22While this is certainly a worthy question to debate, it seems better suited to a blog or other discussion-based platform, and not a great fit for a Q&A site. – Nate Eldredge – 2016-07-12T15:02:36.983

14This should be troubling to the academic world. We all know Presidents don't write their own speeches or their own jokes, but this is probably crossing a line. – None – 2016-07-12T14:32:39.480

13@GEdgar: every issue of Nature has "popular" articles written by staff and freelance journalists. As does Science. JAMA in a similar model also includes view points and editorials, as well as other infographics presentations many of which are not prepared by "scientists". – Willie Wong – 2016-07-12T16:02:20.540

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Of interest: the JAMA editor-in-chief's published discussion about this.

– Willie Wong – 2016-07-12T16:15:27.710

3One might imagine that none of the parties involved cares much about the highly artifactual rules about authorship, etc. Nor "impact factors", citations, or anything else connected to academic games and status. Arguably, they transcend those rules in purpose and in their own professional situations. – paul garrett – 2016-07-12T20:18:16.217

9What is "OK" supposed to mean? – Najib Idrissi – 2016-07-13T07:26:31.547

6Indeed I too wonder what is exactly meant by "Is it OK?" OK to whom exactly? Obviously, it's OK to the journal. The question doesn't invite any true question about actual rules and goes off with vague accusations: I cite "I personally highly doubt that he has done all of the research and writing himself." and "I feel that this type of paper does not fit into a scientific journal." ... – Tomáš Zato – 2016-07-13T11:10:19.510

7Whilst its a really interesting subject, I can't find a question here. The OP list things they "wonder" about, and then asks if it's "OK". Lets be honest, the only reason we're discussing this paper is that the author is Obama, and the OP is implying unfair treatment due to the author's reputation. You can literally taste the irony. I don't have an opinion on Obama, but I know criticism without evidence leads nowhere. – Wetlab Walter – 2016-07-13T13:20:50.940

7"I personally highly doubt that he has done all of the research and writing himself." Based on what? I would a assume an Ivy-league educated former law professor was capable of composing a peer-reviewed article. We have no idea how long he has been working on it. – alvaro.muir – 2016-07-13T04:22:31.453

2@TomášZato questions about ethics are always going to be a discussion as no black and white answer exists. Publication ethics are explicitly on topic for this website. Given the amount of votes for both the question and its answers, I would hardly dismiss it as irrelevant. To answer your question: I was referring to "OK" for the scientific community. The answers and many comments indicate that the publication does raise eyebrows and (clearly) conflicting opinions. – Marc Claesen – 2016-07-13T16:32:53.323

3@WillieWong hits the nail on the head. A 3-word quote from the editor sums this up: "Three other editorials" (my emphasis) - i.e. this is to be treated more like editorial content than research content – Chris H – 2016-07-14T09:58:36.110

4The JAMA editor said it's an editorial, and even if he hadn't, it's clear enough Obama's connected to Obamacare and not the scientist behind a new study. Academics having a two-way interaction with policymakers is a good thing; without it they lose an opportunity to help craft better policies. Given JAMA decided to support that sort of interaction, the rest follows: they made clear it's a special case, followed norms of political writing re: authors etc. Also note the editor extended an invitation to other similarly situated folks who may disagree (future presidents, the candidates). – twotwotwo – 2016-07-14T18:45:47.470

Surely the President of the US can always just do whatever he wants? /joke – Anko – 2016-07-15T03:58:24.407

As a side note, I would suspect that there's few people who have reviewed more information regarding the ACA than Obama (and those that have likely work for him). As such, it would be very foolish to ban him from sharing his findings with the research community, even with his very obvious bias. – Cliff AB – 2016-07-15T16:04:01.437

Answers

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  • 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.

StrongBad

Posted 2016-07-12T12:46:21.850

Reputation: 74 063

9I might be completely wrong but he has done more than beeing the originator of the idea. Thus he has a personal relationship with it. – Llopis – 2016-07-12T16:32:13.133

42@Llopis All researchers have personal relationships with the theories/projects they develop. I think conflict of interest here would mean something like the author or a close personal relation has stakes in a business which would profit from the ACA. – Kimball – 2016-07-12T16:46:29.577

77For better or worse, most journals effectively have the view that any conflicts of interest that arise from your primary affiliation are "obvious" and don't need to be explicitly stated. (e.g. not reporting that tenure is contingent on publishing). Only non-obvious conflicts (e.g. an academic's side business) need to be reported. Given Obama's affiliation as President, the policy and legacy "conflicts" should be obvious. It falls under the same "of course an academic thinks their new methodology is great" and "of course an industry person thinks their drug is great" bin. – R.M. – 2016-07-12T17:38:57.613

You seem to think that the others wanted their name on the paper. I'm inclined to believe they explicitly didn't want their name attached to the paper and were probably not at all amused that they were given credit in the paper anyways. – Dunk – 2016-07-12T22:08:37.150

@Dunk: We've had a question related to the ethics of that.

– Nate Eldredge – 2016-07-13T04:58:48.633

14@Dunk That's a stretch. What would make you think so? – xLeitix – 2016-07-13T11:12:17.890

@xLeitix Dunk is probably not a fan of the PPACA. – TylerH – 2016-07-13T13:57:50.443

10@Dunk In JAMA, you must expressly get permission to name people in the acknowledgements section. Beyond that, "Worked at the White House" is going to be way more prominent in someone's career than "Was acknowledged in Obama's JAMA paper." If they didn't want to be associated with the administration, that ship sailed long ago. – Fomite – 2016-07-14T03:12:25.813

1@Fromite - Working at the White House looks good no matter who the president is. Having your name attached to a document that plays games with the truth is another matter. Of course, what are the people supposed to say if the president wants to include their name on a document? – Dunk – 2016-07-14T13:50:43.080

2The fact that he's term-limited seems like it has bearing on the conflict of interest part. He actually doesn't have much of anything to gain, other than "legacy" type things, which is true of anyone doing research on an idea they played a role in originating. – Jeff – 2016-07-14T14:07:31.077

3@Dunk In what way does this "play games with the truth"? They say that they don't want to be named, that's that. – Benjamin – 2016-07-14T15:57:53.933

1@Benjamin - Tell your boss that you don't want your name attached to the work they assigned to you and let me know how that goes for you over the long term. – Dunk – 2016-07-14T20:48:17.490

1@Dunk In this instance, I see no reason for Obama to object. – Benjamin – 2016-07-14T20:56:22.840

The link to the JAMA policies appears to be broken; presumably it's moved here. Alternatively, a Wayback Machine version is here.

– E.P. – 2017-03-10T15:41:45.130

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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?

Fomite

Posted 2016-07-12T12:46:21.850

Reputation: 43 740

I ignored it in my answer because I agree with you, but I don't see anything in the author instructions that say special communications require a pre submission inquiry.

– StrongBad – 2016-07-12T20:25:03.200

4@StrongBad Indeed, it's expressly not in the heading for that, even though commonly for medical journals I might expect a pre-submission inquiry. But there's no way this isn't a coordinated effort. – Fomite – 2016-07-12T20:27:15.883

16In fact, I would suggest that the 'prior inquiry' was JAMA asking Obama, not the other way around. – Jon Custer – 2016-07-12T23:11:36.813

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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

malarres

Posted 2016-07-12T12:46:21.850

Reputation: 463

1

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.

ccoffman

Posted 2016-07-12T12:46:21.850

Reputation: 433

8Given that it's a single-author paper, how could anyone else possibly be the corresponding author? – aeismail – 2016-07-13T18:11:41.543

@aeismail: The fact that there can't be other corresponding authors does not mean that the single author actually will be the corresponding author. – einpoklum – 2016-07-13T19:27:11.570

Also, perhaps you should emphasize you're not suggesting Obama did not do the "health care reform work", but rather the work of authoring this report. – einpoklum – 2016-07-13T19:32:25.627

4"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." - but writing articles in journals is exactly PR of your work. I write how great and important my results are in every paper and so does everyone else. – sashkello – 2016-07-14T02:26:28.197

4"seems that he will be personally handling requests for materials" -- is it the convention that an academic who has a personal assistant who helps with correspondence, would list the assistant rather than themselves as the corresponding author? A President has a lot of people who help with their correspondence, and I suspect Obama will continue to do so once out of office, and those people will change over time. So listing one of his current secretaries would seem... counterproductive. His address is the correct one to contact, albeit he doesn't read all his own mail. – Steve Jessop – 2016-07-16T10:35:06.020

I don't know many academics who have assistants who can handle detailed scientific questions about their studies, but I suppose some may exist.

Obama though is taking personal responsibility for the timely and accurate sharing of materials and questions though. Do you think he will fit it in? If these requests are handled entirely by another person, with no input from him, then well, he's not the corresponding author. Also, if a mistake is made in this process, he'd be responsible for it.

I just don't buy that he's the single-author here. – ccoffman – 2016-07-25T23:09:24.877

2@ccoffman: I've been working in institutes where the convention was to usually list (one of) the most senior authors as they are far easier to track down years later than the PhD student who is first author - implicitly assuming that they can forward questions to the right quarter. So the idea with that is that corresponding author addresses are not necessarily the email of the student deepest into the details, but an address that makes sure communication is possible/can be started. – cbeleites – 2016-11-21T18:02:25.567

2@SteveJessop No. The corresponding author is the author to whom correspondence should be sent. The correspondence may well be dealt with by the author's staff, rather than personally by the author, but the correspondence should be sent to them. – David Richerby – 2016-12-03T12:24:42.430

1@DavidRicherby: indeed, I think ccoffman has unrealistic expectations of the corresponding author. – Steve Jessop – 2016-12-03T15:15:55.973