MEDICAL JOURNAL EDITOR OUSTED IN BATTLE FOR PUBLICATION'S IMAGE

The ouster of the New England Journal of Medicine's longtime editor was the
culmination of a yearlong battle over whether to use the journal's venerable
brand name to sell new products and reach a wider audience.

Jerome P. Kassirer, whose departure was announced late Sunday night, had
fought to keep the magazine out of a number of money-making ventures. Dr.
Kassirer, the magazine's editor since 1991, recently helped rebuff a
revenue-sharing deal with an Internet bookseller and opposed the journal
branching out into a mainstream medical magazine, arguing that it would
tarnish the journal's reputation as one of the world's leading medical
magazines.

The Massachusetts Medical Society, which has owned the journal for eight
decades, hasn't yet appointed a successor. But Dr. Kassirer's departure
suggests that a new editor of the journal will now move aggressively to
expand the organization's activities, particularly on the Internet.

Web Priority

On Monday, the medical society said one of its first priorities is
bolstering the journal's Web site. Dr. Kassirer first launched that site
several years ago, but it is mainly a vehicle to deliver the content of the
journal electronically.

Jack T. Evjy, president of the medical society, says the journal has to
expand to fend off competition from Internet-based medical upstarts,
including E-biomed, a proposed project of the National Institutes of Health.
"We want to make sure we're here 50 years from now," says Dr. Evjy. He
argues that the journal, which boasts a circulation of about 250,000, is
uniquely positioned to benefit from a huge demand for credible medical
information on the Internet.

Allies of Dr. Kassirer at the 17,500 member medical society say he has been
a staunch defender of scholarly values. "What the Massachusetts Medical
Society wants to do will diminish the luster of the New England Journal of
Medicine," says John T. Harrington, dean of the Tufts University School of
Medicine, Boston. Dr. Harrington, a longtime colleague of Dr. Kassirer,
resigned from the medical society's publications committee to protest his
ouster.

The medical society bought the struggling medical journal in 1921 for $1 and
built it into the world's most respected scholarly publication for doctors.
The journal has been flush in recent years, and its profits recently
financed plush new headquarters for the medical society in Waltham, Mass.

The medical society derived almost $49 million in revenue from publishing
last year, according to federal tax filings. Most of that revenue is
believed to come from the New England Journal of Medicine.

The expansionist desires of the medical society have been a steady source of
conflict with Dr. Kassirer for years. But the tension came to a head about a
year ago, when the society formed three committees and hired consultants to
consider future moves, ranging from new ventures to organizational
restructuring, according to people familiar with the matter.

This winter, Dr. Kassirer's opposition killed a proposed co-marketing deal
with online bookseller barnesandnoble.com Inc., say people familiar with the
matter. The joint venture called for linking the bookseller's Web site to
the medical journal's electronically posted book reviews, so that readers
could click a button to order the book. The plan called for the journal to
get a cut of each purchase.

At the time, Dr. Kassirer felt it was inappropriate to mix editorial content
with advertising, say people close to the dispute.

Opposing Hippocrates Purchase

When the medical society formed a committee to come up with new Internet
ventures for the journal, Dr. Kassirer wasn't asked to be a member. This
spring, Dr. Kassirer opposed the society's purchase of Hippocrates, a
journal for primary-care physicians that is significantly less technical
than New England Journal.

In April, Dr. Kassirer's bosses at the medical society told Dr. Kassirer
they wanted to renegotiate his three-year contract, which was set to expire
in March 2000, say the people familiar with the situation. Specifically,
they say, the society wanted to eliminate his ability to veto new uses of
the journal's name.

Matters deteriorated over the past few months. Dr. Kassirer asked to begin
renegotiating his contract to leave enough time to discuss key issues. He
was asked to resign and sign a nondisclosure agreement. When he declined,
the medical society told him it wouldn't renew his contract, people familiar
with the situation say; he will continue as editor until Sept. 1, then go on
a seven-month paid sabbatical until his contract expires.

Dr. Evjy declined to comment on the contract talks.

"I love the job and I'm sad to be leaving it," says Dr. Kassirer.

The society, which sponsors a wide range of educational programs for
physicians, owns six publications, including HealthNews and Heart Watch,
which it markets by direct mail to lay readers. Almost all the publications
are marketed as being from the "publishers of the New England Journal of
Medicine."

Under Dr. Kassirer, the weekly journal took bold editorial stands on a
variety of issues. It raised a red flag about the dangers of diet drugs. It
aggressively explored issues such as financial incentives given to doctors
to limit services under managed care. And an editorial published under Dr.
Kassirer's name endorsed the use of marijuana for medicinal purposes.

"I'm sorry the Massachusetts Medical Society took this course," says
executive editor Marcia Angell. "It will be a great loss."

- -- Carol Gentry contributed to this article.