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House Organ Failure; Plane Truths

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By Michael Miner

If something dire happens to American Medical News, after 40 years dedicated to edifying the nation's doctors, a debate is sure to rage over whether austerity pure and simple did it in or austerity plus old enemies seizing a chance to settle scores.

"The AMA is on hard times," says Dr. George Lundberg, "and when an overall organization can't meet its budget, it looks to slice--or chop--and it looks wherever it feels it can politically get by with it at that moment."

And that would be the AM News, Lundberg believes, with its reservoir of ill will. "There are people high in the AMA," he says, "who have been very unhappy that it didn't always speak the party line and that it tried hard to tell the truth."

In the publishing trade, a good piece of the conventional wisdom about the AM News is that each week gallant journalists put out a magazine so scrupulous that AMA executives despised it. AM News reporters have not been known to discourage this vision of their labors, and I've heard enough testimony over the years to suppose that it's largely true. Lundberg speaks on the subject with imposing authority but no semblance of disinterest. He edited the sister publication, the Journal of the American Medical Association, until he was fired early last year after publishing a survey on sexual attitudes just as President Clinton was being impeached. During his last four years at JAMA, Lundberg also had ultimate editorial responsibility for AM News. He was often at war with his bosses.

"During this time AM News thrived," he says. "The newspaper was not jerked around by the politicians in any way that hurt it, although there was pressure all the time. Readership was strong, and revenue was strong. At one time in the early 1990s to mid-90s it was turning a very hefty profit.

"After I left, the AMA reorganized its publications area so that AM News would no longer report to an editor in chief, and thus it reverted to reporting to a nonphysician," Lundberg continues. "I have heard that it has had hard times since then, and I've heard that many of its employees have left."

In late February the trade magazine Physician's Weekly ran a long-awaited article reporting that AM News lost $2 million last year--"almost a fifth of the AMA's $10.1 million deficit at the close of 1999"--and now faces an overhaul "in a last-ditch effort to save the paper."

Said Physician's Weekly, "Gone will be all political and policy news. In its place will be more on practice management and clinical medicine." Such a change presumably would delight the folks Lundberg calls "the politicians," the ones who'd prefer an AM News that's a docile house organ. As Physician's Weekly put it: "Resisting pressure to serve as an AMA propaganda tool, the paper evenhandedly reported the debacle that followed the AMA's product-endorsement deal with Sunbeam and other controversies."

Lundberg applauds this heritage. "It's generally believed in the United States that people like to be able to trust what they read. Many readers of AM News want to hear about AMA actions and the AMA positions on things, but it reports those very well, clearly labeled."

The Physician's Weekly article was written by freelancer Peggy Peck. She sent the AMA her first draft a month ago and asked for comment. "They ignored me for like 24 hours," she says. "They called back and said, 'Our current position is we have no one to comment.' So I said, 'Is your position no comment?' They said, 'No, it isn't no comment. It's that we have no one to comment.' I said, this is stupid."

But the AMA did comment--sending Physician's Weekly a six-line response "attributable to" though not written by Robert Musacchio, senior vice president for publishing and business services. While challenging none of Peck's facts and acknowledging that an "evaluation" was under way, the AMA asserted cheerily that the newspaper "is now attractively positioned among this nation's 'top ten' medical publications, and the staff is at work to move this vital and successful publication up into the 'top five' list."

Though they didn't bother to rebut Peck's story when they had the chance, Musacchio and editor Kathryn Trombatore now insist she got it wrong. Musacchio says that AM News is a "flagship" publication whose future was never in doubt, that some of the $2 million loss reflects onetime costs of redesigning the paper, and that more changes are coming but "political and policy news" will not be eliminated.

Trombatore, whom Lundberg hired and continues to extol, is emphatic about that. "You cannot write about medical things without writing about the AMA," she says. "That said, we do have to be guided by what our readers want. There's a group of physicians who are extremely involved in organized medicine and like a lot of inside-baseball stuff. But there's a much larger group of physicians who are not as intrigued by all of that."

Though it appears she'll soon be producing a magazine fewer doctors love to hate, she expects the potshots to go on forever. "I believe that bullet will be fired over and over and over. Because the medical world is full of controversy, to write about it accurately and helpfully requires that you write about the controversy. And it's never been possible in my experience to write about controversial topics without drawing some of the heat to the publication."

AMA membership is about 270,000 and stagnant. AM News is mailed free to each member, and because four-fifths of the subscribers are members, advertising pays the freight. Advertising dipped, says Musacchio, because readership dipped: "We got a little out of touch with what readers wanted." The pharmaceutical companies that are the big advertisers covet faithful readers who prescribe a lot of drugs. That's why some specialists, such as internists and cardiologists, get AM News subscriptions even though they don't belong to the AMA. It's why the drug manufacturers don't care much about reaching pathologists, Washington policy makers, and other readers who don't write prescriptions.

As you may have noticed, drug companies are peddling their merchandise in new ways. On the principle that managed care has demystified doctors and turned them into used-car salesmen with stethoscopes, the manufacturers are pitching their wares directly to consumers, who are encouraged to demand the neat pill they heard about last night on television. Times are changing. The complete text of every issue of AM News is now available free on-line, but the AMA is thinking of changing the site so that only subscribers can enter it. Letters will soon go out to 100,000 subscribers--as I hear it, ones that advertisers aren't interested in--inviting them to read the paper on-line and discontinue their print subscriptions.

In the long run, boiled-down on-line journalism might become the only kind acceptable to American doctors, who are busy people. As Musacchio says, "Basically, our buzzword is 'news they can use.' Insider baseball or esoteric political issues, they're not interested in."

George Lundberg has gone over; he's now editor in chief of the Web site Medscape. "The world of the Internet is the world of the future," he says. "Physicians with access to the Internet are now 85 percent of all doctors. We get three new members a minute at Medscape. We passed the two million mark last week, from 230 countries, and we were about a million a year ago. We had 70 employees a year ago. Now we'll have a thousand, through mergers and expansion."

In this bright new age, readership surveys suggest that the editorial independence long asserted by AM News is more important to its staff than to its readers. As one staffer told me, you can't respect the work you do unless you're willing to bite the hand that feeds you. That's the "Greek classical dilemma...the aching urge to write about the parent entity. That means you're real."

Plane Truths

The national airline of Zimbabwe has stewed in its juices for nine months, trying to decide whether to sue the Chicago Tribune. Grounds for the suit are as plain as the morning sun, and thanks to the Internet they'll probably live forever. Last June the Tribune published a travel article by freelancer Gaby Plattner about--to quote the headline--"a white-knuckle flight on Air Zimbabwe." The story was presented as Plattner's account of her astonishing plane ride from Kariba to Hwange: first the copilot missed the flight entirely; then the pilot locked himself out of the cockpit while answering the call of nature and had to break down the door with an ax.

Soon after publication, Plattner came clean. She explained that she hadn't actually witnessed these misadventures but had been told about them by the very credible sounding passenger in the next seat as she flew to Hwange. She'd simply punched up her material by putting it in the first person. In the end, no part of the story turned out to be true; Plattner had been suckered by a tall tale so common you can find it anthologized in a book of urban legends.

Plattner and the Tribune promptly apologized to Air Zimbabwe, and the Tribune published a small retraction. But the story had spread far and wide on the Web, and there was no way to recall it. Earlier this year I searched online for "Gaby Plattner" and came across nine references to her story. One site, "Urban Legends References Pages," tore it apart. But seven of the sites retold it as God's truth. Air Zimbabwe spokesman David Mwenga tells me the story has cost the airline between half a million and a million dollars in business.

Zimbabwean newspapers began reporting last summer that legal action was being considered. "We do not keep axes on our aircraft. For what purpose?" Mwenga protested to the Zimbabwe Standard. "We never fly aircraft without the full complement of cockpit or cabin crew." He went on to say that the distance between Kariba and Hwange is so short that the automatic pilot is never employed--the implication being that even the most distressed airman can hold it until he lands.

At stake here wasn't simply an airline's reputation but a third-world nation's sense of dignity. People were willing to believe anything about Zimbabwe, even that it was a place where axes were put in airplane cabins where hijackers could grab them because its pilots couldn't break the habit of locking themselves out of their cockpits. In October the sense of insult was compounded by a Cable News Network story that allegedly called Air Zimbabwe the second most dangerous carrier in the world. Furious airline officials responded that this ranking was meaningless, being based on two Air Rhodesia Viscounts that had been shot down by missiles in the late 70s during the Rhodesian civil war. Everyone aboard those planes either died in the crash or was executed by guerrillas, but according to Air Zimbabwe not a single passenger has died in a plane crash since.

On December 31 the Zimbabwe Independent announced that the airline "has instigated legal proceedings" against the Tribune and CNN. Its American lawyers "are finalising their lawsuit."

Apparently they still are. "The weather changes every day," says Surjit Soni, the carrier's Los Angeles-based lawyer, when asked if the airline will sue. "This is obviously an act of great stupidity on the part of the Tribune." But he's moving so slowly to do something about it that as of this week he still hadn't contacted the Tribune--or, for that matter, Gaby Plattner. "It's unusual we don't hear in advance," says the Tribune's senior counsel, Dale Cohen.

Cohen says the only reason he knows what's in the works is that weeks ago a freelancer from Africa offered the Tribune a story reporting that Air Zimbabwe was preparing a suit. The Tribune turned down the story.

News Bites

A lot of nostalgic prose has just shown up in the press about that glorious night in Lake Placid 20 years ago when the doughty American Olympic hockey team toppled the mighty Soviets. It was the height of the cold war, the Soviets ruled the hockey world, and no one gave the Americans a chance.

But was that really the height of the cold war, or by then did it exist more vividly in John Le Carre novels than in Americans' daily lives? Wasn't the world a lot chillier in 1960, just seven years after Stalin died, three years after Sputnik, the year Gary Powers's U-2 was shot down and JFK ran for president by denouncing a missile gap, and a year before the Berlin Wall was raised? The Soviets dominated international hockey then too. But in Squaw Valley that year the Americans beat the Soviets and won the Olympic gold medal. Astonished as this country was then, it acted less giddy than it would 20 years later, perhaps because mass communications weren't so enveloping and perhaps because the cold war seemed so much more weighty in 1960 that sporting events didn't measure up as a surrogate.

Nothing's wrong with journalism that indulges memories the public already holds. But any story gets better if you dig, even if you're only digging up history. Though nobody I read mentioned it, what happened at the 1980 Olympics happened for the second time.

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