Ethics Publishing

8/3/2019 Ethics Publishing

1/24

Ethics of Publishing: Balancing

the routine and revolutionary

Peter A. Singer, MD, MPH

University of [email protected]


2/24

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


3/24

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 interms of ethics processes in journals using

framework of accountability for

reasonableness


4/24

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


5/24

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 guidelinesbut they will be more case-based

Ethical framework: Accountability for

reasonableness


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Accountability for Reasonableness

Daniels BMJ 2000 Relevance: priority setting decisions based

on reasons upon whichfair minded people

can agree in the circumstances

Publicity: reasonspublicly 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 sharinglessons 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


10/24

Web hits

Scoring article

Letters

Rapid responses

Peer review

including new open

forms

Citation analysisincluding new

contextual forms

Secondary

reviews such as

ACP Journal Cluband Evidence Based

Medicine 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 Flow

Godlee, Horton, Smith 2000The ecology of information will change

dramatically in the next 20 years in ways

that we cannot fully understand. Thereseems,however, every chance that

information exchange among those

interested

in health should improvedramatically, leading ultimately to an

improvement in healthitself.


13/24

Horton R. Lancet 2000; 355: 2231-6

Bridging the North-South Gap

What can editors do? Broaden geographical reach of editorial boards,

reviewer panels

Seek out primary research for publication throughthese networks

Raise priority of research submitted from LDCs

Commission work from authors in LDCs

Review more papers from LDCs


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Horton R. Lancet 2000; 355: 2231-6

Bridging the North-South Gap

What can editors do? (2) Write editorials to raise awareness about these

issues

Invest in manuscript editors to assist non-Englishspeakers

Establish pre-print servers for international health

Create writing fellowships for Southern

investigators

Invite a "Letter of intention"


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Horton R. Lancet 2000; 355: 2231-6

Bridging the North-South Gap:

What 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.


16/24

Horton R. Lancet 2000; 355: 2231-6

Bridging the North-South Gap:

What 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: Mindset

Make serious attempt to view article

through eyes of writer and not UK reader,

and be receptive to things you dont want tohear 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 relevance

and the notion of serving a limited section of theworld. Once they start looking beyond what is

relevant to them, they would automatically start

looking 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 articlesbut 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 narrowlyfocused. If there is a policy change it would be

dictated by the will of the people who matter at

the 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 reasonablenessframework?

Revolutionary group: Top three action steps

to push beyond open access towards globalhealth 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: SolomonBenatar (South Africa), Abdallah Daar

(Oman and Canada), John Gyapong

(Ghana), Nandini Kumar (India), RichardMuga (Kenya), Jens Mielke (Zimbabwe),

Joseph Ochieng (Uganda), and Asad Raja

(Pakistan).

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