Ethical issues in publishing

The publication of a medical journal raises a surprising and often challenging array of ethical issues. A paramount ethical issue for many journals is editorial freedom. Not the freedom to self-indulge,1 but the freedom to speak one's mind without political interference. Many medical journals are sponsored by colleges or associations with their own agenda. In some notable cases, the society and the journal editor have not seen eye to eye over issues of advocacy and policy. In 1999, the editor of the Journal of the American Medical Association (JAMA) was sacked by the AMA because he published a survey that showed that 59% of medical students agreed with Bill Clinton's claim regarding Monica Lewinsky that having oral sex was not ‘having sex’.2 At least the AMA gave a reason for the sacking. The Canadian Medical Association did not give a reason for sacking the editor of its Journal in 2006, nor did the Australian Medical Association when Dr Annette Katelaris was summarily dismissed from the position of MJA editor in 2013. In both cases there was intense speculation that the editor had not toed the party line to the association's satisfaction, although the facts remain obscure. The Journal of Paediatrics & Child Health (JPCH) is the official journal of the Paediatrics & Child Health Division of the Royal Australasian College of Physicians (RACP), and the relationship has fortunately always been collaborative and constructive. As an example, paediatricians have recently been discussing (again) the merits of seceding from the RACP and forming a separate College, as has happened in the UK. When two opinion papers were submitted to the JPCH, the Editor approached the RACP to ask if there would be a problem and the College agreed readily that airing the debate was healthy.3, 4 Medical colleges and associations can be important instruments for child advocacy and so can medical journals. Advocacy for child health may have political implications, such as challenging Government policy, as in the recent and current Australian approach to asylum seekers5 and to climate change.6 The RACP and the JPCH are equally critical of recent Australian Government policy on both. Advertising is an important source of revenue for journals. The Editor of the JPCH vets all advertisements prior to publication. If he is uncertain of the veracity of claims, he seeks expert advice. Most advertising claims are reasonably scientifically accurate. On one occasion, however, he rejected an advertisement that made unjustifiable claims about efficacy. The company immediately submitted a new advertisement with less extravagant claims, so quickly that they must have prepared both advertisements originally and were just ‘trying it on’. The journal editor needs to be constantly vigilant for conflicts of interest, his or her own as well as those of contributors, publishers, advertisers and pharmaceutical companies. Journals often behave as if what I shall call a ‘conflict confessional’ exists: an author merely needs to state their myriad links with pharmaceutical companies, and this absolves the author and the journal of consideration of the ethical implications. The argument is that making the potential conflicts explicit allows readers to make up their own minds. However, there is a counter argument that Editors should make the hard decision and deem some authors too conflicted to be able to express an unbiased opinion. This is particularly relevant to Guidelines and opinion pieces, which are particularly susceptible to conflicts of interest. Furthermore, such conflicts are not always stated.7 The content of published articles is determined by what is submitted and what is commissioned, although a disappointingly small proportion of writers who agree to write a commissioned article deliver on their promise. Readers' opinion should guide content, but readers are not always good about communicating their likes and dislikes. Editors tend to commission articles from people they know can write well and it often helps if the Editor sees them in the corridor to embarrass them about undelivered manuscripts. This may engender complaints of nepotism, a word deriving from the Latin nepos for nephew and referring to the tendency for Catholic popes and bishops, childless due to their vows of chastity, to treat their nephews preferentially. One response to those who voice complaints is to invite them to submit a review article; one such invitation by the Editor was accepted with the comment, ‘I suppose I should put my money where my mouth is’. The article was excellent. Most medical journals and almost all medical schools use software packages to check submitted papers and essays for plagiarism. The software informs what proportion of a paper has been published online previously. The software will recognise previously cited references, so the ‘Similarity Index’ is almost always over 20%. Obviously if the Index is 100% the entire paper has already been published, either by the same authors (dual publication) or by others (plagiarism). Fortunately, such fraudulent behaviour has only happened once in the 3 years since we introduced the software. Currently, as the Editor of the JPCH, I review all papers with a Similarity Index 40% or greater. Most have been written by authors for whom English is not their first language and have copied and pasted for clarity of language. I turn a blind eye when it is done from many different publications, but I am less lenient if there is extensive borrowing from one paper, particularly if it includes the Discussion section. Discussion should be original thought. Sometimes authors re-use some of their own work (self-plagiarism), including the Editor himself on one infamous occasion. When there is clear cause for concern, we follow the invaluable flowcharts published by the Committee on Publication Ethics (http://publicationethics.org/resources/flowcharts). Newspapers are frequently criticised for their ethical standards. Medical journalism also raises tricky ethical issues that challenge our professional integrity and deserve thought and discussion.

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