Not a member of the club

May 15, 2006

A Wall Street Journal article discusses the role of the New England Journal of Medicine in the Vioxx affair (1). An aspect of the article that caught my attention was the attempt by a pharmacist, Dr. Jennifer Hrachovec, to make known the dangers of Vioxx.

She first tried to do this during a radio call in show which had as one of its guests, Jeffrey Drazen, the editor of the New England Journal of Medicine. He blew off her comments.

She next submitted a Letter to the editor to the New England Journal of Medicine. It was rejected.

Finally, she was able to get a Letter published in JAMA, the Journal of the American Medical Association.

I can relate to this sequence of events and suggest that part of the problem is that however relevant and correct a person is on an issue, the person’s issue may not be taken seriously if that person is not “a member of the club”. Journals such as the New England Journal of Medicine have so many submissions that they are always looking for ways to reject papers. I suspect that one criteria used is simply the status of the person submitting the paper. Fortunately, Dr. Hrachovec persisted. For me, when someone blows off my comments, it is a source of motivation, and I have had my share of rejected Letters.


  1. Bitter Pill How the New England Journal Missed Warning Signs on Vioxx. David Armstrong Wall Street Journal, May 15, 2006, page A1.


Beware of the filter

May 14, 2006

Facilitators play an important role in quality activities. For example, they often lead training and brainstorming sessions. Brainstorming is a key part of FMEA (Failure Mode Effects Analysis) and fault trees. Whereas this blog entry is not meant to be a summary of what makes a good facilitator, I was recently reminded of a problem with some facilitators; namely that of the filter.

Filters are people who while serving as facilitators, feel compelled to have all information go through them. The filter then re-releases the information but in a changed form. That is, whatever was originally submitted to the filter becomes changed into a form that the facilitator understands (which may or may not be the same as the person who had the original idea). In some cases the facilitator changes the way the information is presented by rewriting it or restating it (e.g., out loud). The latter must be familiar as one often hears, “now let me make sure I understand what you’ve said, you mean that, …., “.

There is nothing wrong with the concept of a filter, since in principle, a filter could make ideas more clear and if nothing else ensures that an idea is understood as intended. Whereas this is often useful – sometimes essential – between two people, the danger is when the filter is used in a group setting and the filter makes ideas less clear, changes ideas, or omits ideas.

I recall a CLSI (formerly NCCLS) strategy session a few years ago. I had prepared a list of issues which the facilitator rewrote. My list had already been read by the head of the organization with a few minor changes so this rewrite by the facilitator seemed completely unnecessary and more importantly, it failed to capture the issues as clearly as I had and at the same time dropped some issues. So the strategy session took place without the right list of issues and during the strategy session, all material went through the facilitator, as in “now let me make sure I understand what you’ve said, you mean that, …., “. The facilitator of course also wrote up the results of the meeting. In all, this was a lost opportunity, largely driven by a filter.

So a better way is for the facilitator to assemble all ideas through a consensus process. The final product may have some editing for readability but without the effects of a filter.