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Journal of Postgraduate Medicine, Vol. 48, Issue 4, 2002 pp. 292-296 The Role of the Ombudsman in Biomedical Journals Satyanarayana K Indian Council of Medical Research, Ansari Nagar, New Delhi - 110029, India.
Code Number: jp02099 Recently, a researcher from a Delhi-based medical college faced a serious ethical problem in the publication, based on one of his research projects. Part of this work was presented at a national meeting with names of all the co-workers listed. The complete version was subsequently published in a well-known journal, but his name was left out. On appeal, the corresponding author agreed to make amends. The aggrieved author wrote a letter to the editor explaining that his name has been left out and that the other authors were agreeable for a correction in the authorship. The corresponding author also wrote to the editor admitting the error. The editor while publishing both the letters in his journal pleaded inability to change the authorship of a published paper as the Vancouver (International Committee of Medical Journal Editors, ICMJE) Guidelines do not permit change of authorship after publication. There are three points in this episode that merit attention. Firstly, the awareness and realisation that issues as this could be discussed outside the formal editorial system and authors can express grievances against a journal, and possibly seek justice. This is a very welcome and encouraging sign in the Indian scholarly communication system. Second and most importantly, he is among the new group of more conscious authors who believe that such issues hitherto confined to the editorial offices need to be discussed more openly. Finally, has the editor in question been justified in turning down their requests? Editorial offices by and large have been conservative and excessively secretive about the way they function. Peer review in learned journals, which aims at critical appraisal of authors' work, continues to be called a `black box'. Editorial peer review, as a recent study reiterates, although universally used, is largely untested and its effects are uncertain.1 Editorial offices and editors have been neither keen nor very helpful in opening channels of communication with authors on the way they work. Even in the West, until recently, the communication between editors and authors has been less than transparent. In recent times, a few journals have tried to bridge this gap with such innovative steps as `open peer review' with varying degrees of success. Very few journals have established the trust and confidence with their authors on what has essentially been an impersonal relationship. Even today, only some journals clearly outline their publication polices - basic information so elementary and yest so vital to authors - information on how they handle manuscripts, how they get their papers evaluated, the time-frame of the editorial process and what they expect from the authors. Finally and more importantly, hardly any journal talks about its responsibility and obligation towards their authors. There is hardly any author with some publications in learned journals who sometime or other has not got `rejects' from editors. Most authors learn to put up with avoidable delays (most of the time), rudeness (often), misbehaviour (occasionally) and getting cheated (rarely). Most people within and outside the scholarly communication system are aware that editors and reviewers are as much fallible as anybody else and may not always deal honestly and honourably with authors. There are also allegations of editors riding roughshod over complaints of authors. Although rare, there is clear evidence that serious editorial misconduct does occur,2 all over the world. Authors complain, mostly privately, as there is no appellate body outside the editorial office. Few authors willingly take on editors (usually powerful and influential people) and choose the softer and more practical option of joining the silent majority of sufferers. Editorial lapses and misbehaviour rarely get publicised essentially because of the way in which editorial offices function. Significantly, there is no forum or formal channel through which such instances could be made widely known. Few pursue such cases vigorously as authors fear that in the absence of a formal system of investigation and redressal, their relationship with editors could deteriorate further. At worst, the editor can even become vindictive. That few editors acknowledge their mistakes publicly is hardly comforting for potential whistle- blowers. Inadequate information about the way editors function has led to this serious communication gap and avoidable mistrust in the minds of authors. Thus, every time a paper gets turned down, on any reason from scope to quality considerations, more often than not authors feel that they have not been given a fair chance. Often, there is difference of opinion between the author and the editor but once the author questions the editorial decision, hostility of editorial office is the usual response. What is more, most often editors choose to dismiss authors' appeal citing the obligatory confidentiality or editorial prerogative or both. Very few journals publish letters of protesting authors and many journals do not even have columns that entertain such criticism. Finally, journals do not encourage outside intervention of any kind. There are several types of grievances authors can have against the editors - from deliberate delay in processing the manuscripts to getting it rejected outright through a pliable referee. Manipulation of priority while handling similar papers from competing groups, poor quality and indifferent peer review could be other issues. While some of these can occur due to poor editorial-management practices, occasional bias cannot be ruled out. Bad handling of manuscripts is quite common in India as many biomedical journals are run with limited budgets and untrained editorial staff. Part-time honorary editors who cannot give enough attention add to the authors' woes. In some journals even referee's confidentiality is not maintained and such lax editorial management leads to development of lack of trust by both the referees and the authors. In journals run by learned societies the editor and the editorial office change at specified intervals between one and five years. There are several instances where a new editor chooses not to process papers submitted under the previous regime. Even accepted papers are either returned or just kept in abeyance until their term of editorial control is over. Group rivalry is quite common in these journals as the editor is often `elected' or nominated by the office bearers. There are innumerable reported instances that editors are `known' to have committed unethical practices and have got away. One of the most celebrated cases involves Sir Cyril Burt. Burt is supposed to have used his position as editor to publish many of his own research papers. Some of these articles allegedly contained fictitious data and nonexistent co-authors.3 What is more, he also allegedly altered the text of other authors' manuscripts without their agreement and published letters to the editor that he had written himself under false names to attack a rival. It appears that the surge of cases of editorial misconduct closely coincides with the flood of unethical practices in science reported during the 1980s, especially from the West. Such an increase was attributed to the tremendous pressure among scientists to `perform' due to fierce competition for both funding and publication. This led to the so-called `publish and perish' syndrome - scientists desperate to publish to beef up biodata to hold faculty positions and get competitive grants. Even editors seem to be under similar pressure now, if the increasing number of controversies on published papers is any indication. Not surprisingly, journal editors eagerly await the release of their annual performance indicators listed in the Journal Citation Reports published by the Institute of Scientific Information, Philadelphia that catalogues citation-based indices for learned journals. To remain high in the pecking order of Impact Factor (IF) listing is the dream of virtually every journal editor. Especially since most authors now routinely check the Impact Factor before submission and flock those journals with high IF. With the dependence on the impact factor getting stronger with every passing day, it is not surprising, that editors are keen to publish that potentially highly citable paper to keep the IF of their journals high.4 Interestingly, the need for some systematic effort to keep track of the functioning of editorial offices was suggested as early as 1989 by a British pharmacologist Andrew Herxheimer.5 He argued forcefully that there are far too many authors who have been unfairly treated by editors of scientific journals and many unhelpful editors generally continue to make things difficult for authors, who remain helpless. "Editors are well defended by their position, by their editorial boards, and publishers. An author who has been treated badly stands alone."5 He proposed that journals should take up an exercise of some kind of yearly audit on their editorial and peer review processes and publish such information. He pleaded for a mechanism for formally taking up cases of editorial misconduct outside the editorial offices. He proposed an International Press Council similar to bodies that exist in many countries (including India) that essentially respond to public grievances over the conduct of the media.5 I had suggested peer review audit in Indian medical journals as early as 1993,6 but there were no takers. Stephen Lock, in his seminal work on peer review,7 is credited to have first proposed that an editor should function as ombudsman essentially to protect the author from the unfairness by referees. It sounds quite logical as editors are expected to publish quality science and it is essential that in this process they be protected from biased, ignorant and self-opinionated referees. Oxford dictionary defines ombudsman as an official appointed by a Government to investigate and report on complaints made by citizens against public authorities. This issue of editorial accountability was discussed at the International Congress on Peer Review in 1994. Doug Altman and colleagues2 suggested that the ICMJE should consider means as to how this body can help address the complaints of authors against editors as there is an increasing concern of the abuse of editorial office. They proposed investigation of editorial misconduct and possible procedures for allowing authors' grievances to be heard. The creation of International Scientific Press Council, which could produce a code of conduct for editors and come out with definitions of inappropriate editorial behaviour was mooted. With the creation of independent Press Council, they proposed, scientific journals would sign an agreement to abide by a set investigation procedure. Journals could announce their participation in this new system of editorial oversight which could be the first step towards editorial transparency. It was hoped that such a system also could lead to some accountability of editors. What is surely among the first steps towards addressing the issue of editorial accountability, The Lancet established the position of ombudsman in 1996 "to record and, where necessary, to investigate episodes of alleged editorial maladministration when a complainant remains dissatisfied with the journal's first response to criticism."8 The journal drew up clear criteria for the functioning of the ombudsman, modelled on the UK Parliamentary Commissioner for Administration. The Lancet's ombudsman had wide-ranging powers. He, for example, could investigate delays in handling manuscripts and letters; editorial discourtesy; failure to follow stated editorial procedures; failure to take reasonable account of representations by authors and readers; and challenges to the publishing ethics of the journal. Significantly, complaints about the substance of editorial decisions were kept out of his ambit. The ombudsman in UK Parliament on which this position was modelled has certain attributed duties. He could investigate complaints about government departments; he is independent; his investigations are confidential; he provides his services free; and he recommends redress or relief if he finds a complaint justified. His concerns are "maladministration [that] has led to injustice." Maladministration is defined as avoidable delay, bias or unfairness, failure to give appropriate advice when asked, discourtesy or harassment, failure to follow proper procedures, failure to take account of representations, and mistakes in the handling of claims.7 Complaints to the Lancet's ombudsman could be made directly by writing to him without having to go through the editors. While investigating a complaint, he could seek correspondence and all other details relating to the paper. When necessary, he could talk to the editorial and other staff members concerned. His final judgment would be delivered to the editorial staff, to the editor and to the complainant. In July 1996, The Lancet appointed Professor Thomas Sherwood, retiring dean of the medical school at the University of Cambridge and a former member of the journal's international advisory board as its first ombudsman. The journal guaranteed that his reports would be published annually, which it has been doing for the past six years. To develop mechanisms to handle these inquiries and understand how the editorial office functions, he visited the journal's office regularly to study the editorial processes. Sherwood also interviewed editors and other staff, attended all meetings, and went through relevant records. In the first year (July 1996-June 1997) there were 11 complaints.9 The numbers did not significantly increase during the subsequent years. Between July 2001 and June 2002 the Lancet's ombudsman examined just four complaints. Appeals against editorial decisions about publication were made, despite clear instructions ruling out these complaints. Those were rejected. Occasionally, the standard of peer review of the Journal was questioned. In one instance after further peer review, editors admitted that their earlier decision to reject a letter had been incorrect. According to Horton, the overall impact of the ombudsman on his journal has been positive.8 His presence reportedly helped the editorial staff devote more attention to the editorial process. He admits, as editors elsewhere, that editors tend to be preoccupied with a broader picture in terms of attracting better papers, try out new ideas often at the expense of equally important house-keeping job of a journal which involves the sensitive author-editor relationship. Thus, the journal could initiate setting time-limits for handling all manuscripts, introduce a fast-track publication procedure for articles and research letters, and appointed an editor with specific responsibility for the rather mundane but important aspect of editorial process. Most importantly, the presence of an experienced and independent ombudsman who rules on matters of editorial and commercial dispute added credibility to certain decisions taken by the journal. There are several contentious issues and Horton tried to bring more clarity on this proposal of ombudsman.8 For instance, what happens if the Council upholds complaint against an editor? What kind of action should be taken and how does one enforce punishment? Other possibilities include the wider publication of the Council's ruling, perhaps in a publication such as the bulletins of the European Association of Science Editors or the Council of Biology Editors or in a leading scientific journal or both. When the journal is run by or for a professional society, the editor has a clear additional responsibility to that society. Therefore, another route for complaints to be aired is via the publication or journal committee of the society. Few scholarly societies, however, have a specific mechanism for dealing with such cases. Nearly all journals have editorial boards. Members of the society may not be too keen on maintaining their contacts with an editor who has been acting unethically. Finally, according to Horton,8 such a Council would not do a policing job but would rather act as an appellate organisation existing to set appropriate standards and determine if these standards had been breached. There is however a thin line between what constitutes editorial decision and editorial indiscretion as a recent example from The Lancet on genetically modified (GM) food10 illustrates.There was panic and confusion as when an influential journal like The Lancet publishes a paper claiming the GM food is possibly harmful to human health, the world sits up and notices. In an unusual move and in view of the sensitivity and public outrage, the Royal Society came out with a strong denial of the claims made in the paper and said that the data were flawed. Several inconsistencies in the paper were pointed out including the way the experiments were designed making interpretation of results difficult. Horton gave a spirited defense claiming that five of the six referees recommended publication of the paper. Sir Aron Klug, President of Royal Society even questioned the motive of Lancet to publish the paper. Klug also contested Horton's claim that the paper would encourage sensible debate on GM food. In a rare moment of introspection, even Nature did an uncharacteristic pontification on the merits of peer review.11 Horton claims the ombudsman who was made aware of the controversy ruled that as it concerns editorial decision making, it is outside his purview. The question to be asked is: Should the ombudsman examine the role of editors in the publication of papers with data not unequivocally accepted by the scientific community? Interestingly, Richard Carter, the current ombudsman of The Lancet, admits that what constitutes matters of editorial process and procedure and editorial decision can be hazy.12 For details of this and such controversies see Balaram.13 In one of the e-mail debates on the World Association of Medical Editors (WAME) (accessed during March 2002), Richard Smith, editor of the British Medical Journal (BMJ) confessed that he rejected several accepted papers because his journal is already publishing too many papers. While admitting that it was a mistake, Smith makes some important points. Editors of academic journals may be bothered about authors but not readers. Editorial discretion is used to choose papers. He argues that the BMJ has no legal obligation to publish and that what he has done is not unethical. Many editors participating in the debate did not think so. Smith claims that he is accountable only to his employers, the British Medical Association. He suggests that a section on `how to complain about the editors' be included in the guidelines to authors/contributors. The issue is whether Smith's claim that as editor of BMJ he is answerable only to his employers is tenable. To whom is the editor accountable? Employers, subscribers, readers, authors or the scientific community. This issue needs to be debated. The concept of ombudsman in biomedical or any scientific journal in India or elsewhere is yet to take root although the Indian Journal of Pharmacology (IJP) was perhaps the first journal to do so. As its ombudsman for about three years I have hardly been busy. I had to address just one complaint. I had to examine whether a member of editorial committee of IJP can question the contents of a published article. The issue was whether publication of papers in a journal is a collective decision or the responsibility of the editor. I had opined that members of editorial committee do not forego their academic freedom and are free to discuss and comment on the contents of published papers. One major reason why journal editors are not enthusiatic may be because of the apprehension of the idea of some outsider asking inconvenient questions and looking at records hitherto inaccessible to any outsider. They have been resisting any attempt that will intrude into or dilute their authority.4 There are editors who firmly believe that no purpose is served by corresponding with those authors whose papers have been turned down. This is especially true for well-known and high impact journals like the NEJM, Nature or Science where the rejection rate hovers around the high eighties or more. The emeritus editor of NEJM nearly ridiculed the concept of ombudsman saying that it is just not worth it.14 It is unlikely that other high impact journals will accept any change in editorial autonomy and freedom they enjoy. This singular lack of enthusiasm is in stark contrast with the zeal shown by editors to take on unethical authors or bossy publishers.4 Some unethical practices came to light during the 1980s, thousands of column inches were devoted to pontificate on the need to keep the scholarly communication free from scandals. The issue of who qualifies to be an author, in what form those who have actually done the work and wrote-up the paper should share the credit and a host of similar new declarations were made and ruthlessly imposed by editors. In fact, the ICMJE promptly came up with appropriate guidelines on unethical authorship practices, editor-owner relationship, etc. Ironically, despite the debate on ombudsman for about a decade, it has yet to come out with appropriate policies to address the issue of editorial misconduct. Interestingly, another US-based editors association, the Council of Science Editors (formerly called Council of Biology Editors) has come out with policy guidelines in respect of the role of editor in a journal, especially responsibilities of the editor towards authors, readers and reviewers. In addition, the CSE clearly outlines what are the editor's rights.15 However, despite the ombudsman being in existence for over six years, there are still several gray areas that should be addressed before the concept takes firm root. For example, in the GM food controversy, did the Lancet editor err in accepting and publishing a paper with known deficiencies to promote a debate on GM foods? It is also well known that most medical journals have and continue to publish papers from authors with close relationship with the drug and pharma industry. Until recently, even the conflict of interest declaration was not sought from the authors. Many do not seek any such guarantee even now Whether such a declaration is needed from a reviewer, whether they honestly declare such a conflict of interest and how many journals seriously enforce such a policy is still not known. There are several allegations of editors and reviewers accused of such a bias. Yet, there is no system to bring them to book. There are some practical problems as well in introducing ombudsman in all scientific journals. There are not enough people around who are conversant with publication ethics and who could take up such an assignment. This position also envisages sparing considerable time looking at complaints of authors and seeking details from an essentially non-cooperative editorial staff. Ideally, therefore, the ombudsman should be located in the same town or at least very close to the journal's editorial office. Thus, there may not be enough people who could take up such a responsibility. In my opinion, the situation will certainly change in the near future. There are distinct pointers. The entire issue of publication rights (copyrights) hitherto enjoyed by the editors and their owners are coming under severe criticism. The advent of PubMed Central is a significant step in that direction. Authors are becoming more vocal of their rights. Soon, authors would demand fair treatment from editorial offices. The situation is somewhat similar to the scenario in the 1980s when many unethical practices in science surfaced in the US and elsewhere. Instead of trying to clean up the science of its ills, many scientists and science (medical) editors pontificated that the rate of fraud in science is too low to be of serious concern and in any case science is self-corrective. They essentially argued that there is no need to take any concrete steps to stem the rot. What is more, they strongly resisted any `outside' intervention as at least one public spirited US legislator John Dingle was keen to intervene. Eventually, despite the stiff resistance from the scientific community, Congressman Dingle cleaned up the system. He could do it only because of the clout he enjoyed through the largest funding agency of the world - the extramural grant system of the National Institutes of Health, Bethesda. With a budget of about $20 billion to be funded to thousands of investigators in the US and elsewhere, the NIH could set and enforce rigorous policies for ethical conduct of science for its grantees. Most of the systematic guidelines including setting of the Office of Research Integrity at the US PHS owe their existence to this tenacious and public-spirited politician. In my opinion, the sooner editors make their functioning transparent and author-friendly the better. This long pending move could help everybody and serve the primary objective of editors to publish high quality science and encourage scientists to do high quality work.
References
This article is also available in full-text from http://www.jpgmonline.com/ © Copyright 2002 - Journal of Postgraduate Medicine |
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