Ethics of Publishing: Balancing the routine and revolutionary

1
Ethics of Publishing Balancing the routine and
revolutionary

• Peter A. Singer, MD, MPH
• University of Toronto
• peter.singer_at_utoronto.ca

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What is the greatest ethical challenge in medical
publishing?

• A) Publishing information from patient-doctor
  relationship
• B) Editors duty to warn of unethical clinical
  or research practice
• C) Conflict of interest
• D) Open access
• E) Global health equity

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My point in this talk

• The greatest ethical challenge in medical
  publishing is global health equity
• Develop action plan that goes beyond open access
  to bi-directional information flow (turning
  Southern readers into authors)
• The routine stuff should be thought of in terms
  of ethics processes in journals using framework
  of accountability for reasonableness

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Routine publication ethics

• Publishing information from patient-doctor
  relationship, duty to warn, COI, etc
• How shall we think about these?
• Knee-jerk reaction is write guidelines
• Risk of this approach overlong, overpompous, a
  bit of a crusade

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A focus on process

• Think about this as how to institutionalize
  ethics processes into journal
• This is in fact what BMJ has done empirically
  with its ethics committee, first journal to do so
  and fine model to study
• Of course this may also result in guidelines but
  they will be more case-based
• Ethical framework Accountability for
  reasonableness

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Accountability for ReasonablenessDaniels BMJ 2000

• Relevance priority setting decisions based on
  reasons upon which fair minded people can agree
  in the circumstances
• Publicity reasons publicly accessible
• Appeals mechanism for challenge and dispute
  resolution
• Enforcement voluntary or public regulation to
  ensure 3 conditions met

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Implications for BMJ

• Leadership in routine publication ethics, but
  lessons must be captured and used for
  improvements within BMJ and sharing lessons with
  other journals
• Create a learning platform under process
  describe (case study), evaluate (a4r), improve
  (action research)
• Example developing country membership

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Open access
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Open access Ethical arguments

• Ownership of research
• Scientific progress
• Public accountability
• Global public goods for health
• Global health equity

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Peers
Readers

• Peer review including new open forms
• Citation analysis including new contextual forms
• Secondary reviews such as ACP Journal Club and
  Evidence Based Medicine

• Web hits
• Scoring article
• Letters
• Rapid responses

Quality
Authors

• BMJs What this paper adds
• Most important papers list with explanation

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From open access to global health equity, from
Southern readers to authors
Health InterNetwork Access to Research Initiative
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Global Information FlowGodlee, Horton, Smith
2000

• The ecology of information will change
  dramatically in the next 20 years in ways that we
  cannot fully understand. There seems, however,
  every chance that information exchange among
  those interested in health should improve
  dramatically, leading ultimately to an
  improvement in health itself.

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Bridging the North-South GapWhat can editors do?

• Broaden geographical reach of editorial boards,
  reviewer panels
• Seek out primary research for publication through
  these networks
• Raise priority of research submitted from LDCs
• Commission work from authors in LDCs
• Review more papers from LDCs

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Bridging the North-South GapWhat can editors do?
(2)

• Write editorials to raise awareness about these
  issues
• Invest in manuscript editors to assist
  non-English speakers
• Establish pre-print servers for international
  health
• Create writing fellowships for Southern
  investigators
• Invite a "Letter of intention"

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Bridging the North-South GapWhat can editorial
bodies do?

• Prepare and distribute information describing
  range of primary research journals, including
  instructions to authors
• Hold publication workshops to train prospective
  researchers
• Twin journals in North and South to promote
  editorial training and to support journal
  development.

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Bridging the North-South GapWhat can editorial
bodies do? (2)

• Create a core group of journal-editor mentors who
  might assist colleagues thinking of either
  writing papers or starting journals
• Include representatives from less-developed
  countries in governance of editorial organisations

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Further suggestions Authorship

• Look for the missing co-author on Southern
  research papers
• Look for the superfluous Northern author ...
  are Southern authors authentic?
• Give precedence to Southern author's article on
  Southern topics (even if less perfect ms,
  especially if submitted earlier)

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Further suggestions Incentives

• Pay attention to the lack of incentive to publish
  in many developing country settings
• Offer research grants for good writers

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Further suggestions 10 solutions

• Devote 10 of journal to research relevant to 90
  of the world
• Create regional editions of journals (e.g., BMJ
  Asia or Lancet Africa) that devote 10 of space
  to regional research

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Further suggestions Mindset

• Make serious attempt to view article through eyes
  of writer and not UK reader, and be receptive to
  things you dont want to hear since they make you
  uncomfortable

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Closing comment

• Editors have to first accept that what they
  publish is mostly irrelevant to the 90 of the
  world. What is the point of having free access to
  a journal, when they don't publish what is
  relevant to the developing world? They have to
  come out of their cocoon and cross this barrier
  of relevanceand the notion of serving a limited
  section of the world. Once they start looking
  beyond what is relevant to them, they would
  automatically startlooking at research from the
  south ...

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Closing comment (contd)

• They can make a humble beginning by only allowing
  a small space in their journals. It is possible
  that their regular readers may not read those
  articles but I can assure you that if all
  journals started with this effort it would make a
  world of difference to the diseases and suffering
  in the developing world.Unfortunately their
  current agenda is too narrowly focused. If there
  is a policy change it would be dictated by the
  will of the people who matter atthe helm of
  affairs.

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Questions for discussion

• Routine group Top three ideas for improvement
  in BMJ ethics committee in light of
  accountability for reasonableness framework?
• Revolutionary group Top three action steps to
  push beyond open access towards global health
  information equity?

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Acknowledgements

• I am grateful to the following colleagues whose
  suggestions I paraphrase or quote on slides 17-22
  of this presentation Solomon Benatar (South
  Africa), Abdallah Daar (Oman and Canada), John
  Gyapong (Ghana), Nandini Kumar (India), Richard
  Muga (Kenya), Jens Mielke (Zimbabwe), Joseph
  Ochieng (Uganda), and Asad Raja (Pakistan).