Why the most powerful club for journal editors must change

The International Committee of Medical Journal Editors (ICMJE), a club formerly known as the Vancouver Group, is an important and historic organization in the world of medical journals. Journal editors used to work in almost complete isolation, many still do. But the ICMJE was founded to allow editors of major journals to meet, discuss, develop and share best practice. Without a doubt the ICMJE helped raise standards in medical journals. Yet Richard Smith, former editor of the BMJ, once described the ICMJE as ‘a self-appointed group of busybodies’. And the organization faces a major challenge over finding a new purpose for itself, now that journal editors are less isolated. The ICMJE has had a major effect on unifying standards across medical journals. Its authorship guidelines, for example, are the ones that most medical journals recommend. In addition, the ICMJE has been influential in clarifying issues over publication bias and sponsorship of studies. One of its major triumphs was accelerating best practice in registration of clinical trials. This was followed by advice on reporting of trial results. Nonetheless, while some members of the ICMJE would heartily congratulate themselves for these achievements, other observers would be less generous. The authorship guidelines, for example, cause as many problems as they solve. Many journal editors and authors consider them to be unworkable, resulting in the introduction of contributorship statements by some more adventurous journals, including the JRSM. The ICMJE’s original stance on trial registration was problematic for European journals and authors, although a subsequent revision was better received. The latest stance on pre-publication of trial results in international databases has been criticized in this journal. Why does this matter, I hear you say? Well, the ICMJE is an influential organization. It comprises the world’s five largest medical journals, the BMJ, The Lancet, JAMA, NEJM and Annals of Internal Medicine, plus several others from Europe and the Antipodes. Its statements and policies are widely adopted, affecting the practice of journal editors, authors, and sometimes the delivery of patient care and the introduction of legislation. Some members might like to think that their deliberations and statements are for internal purposes only, but that is impossible when their words and advice are published in their own influential medical journals, and their wisdom followed almost blindly by the many thousands of other journal editors and authors. There are, of course, other clubs for journal editors. The World Association of Medical Editors is the largest such organization but the ICMJE keeps a distance. The ICMJE, in my view, is small, self-obsessed and uncertain about its purpose. It is dominated by North American and Western European countries, and has an English-language bias. It is undemocratic and closed to new members unless invited in on the basis of a ‘needed perspective’. It is a major concern that the ICMJE has the feel of an old boys’ club instead of a dynamic, leadership organization, harnessing the revolution in information technology. I put these points to the members of the ICMJE last month at the 30th anniversary of the ‘Vancouver Group.’ Many of them agreed that the time is ripe to question the purpose of the organization and make a better connection with the rest of the world of medical journals. A hardened core disagreed. I must have a troubled childhood, said one. I can’t be a doctor, said another. I was too young to remember the great work of the ICMJE, was another reply. I may be accused of bitterness; the JRSM is not part of this club but it doesn’t seek to be. I do believe it is time for change to raise the standard of service that medical journals deliver. Authors and readers will benefit. The technological revolution has bust the power of self-appointed busybodies, the great unwashed are able to create movements of relevance and immediacy. Look at elections in both the USA and Iran. Look at the creation of organizations to challenge the established supremacy of the BMA. The world, publishing, clinicians and patients have changed, and the ICMJE must change with them. The first question to answer is does this organization, at the summit of medical publishing, have any purpose?

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