Australian Academics' Confused Responses to Sacking of Medical Journal of Australia Editor

The Board of the Australian Medical Association (AMA) fired yet another Editor in Chief of its flagship publication, the Medical Journal of Australia.  Australian public health icon Stephen Leeder is the latest victim of the AMA's shenanigans. The MJA, like the Canadian Medical Association Journal, is by and large an also-run kind of academic publication. Doctors in those countries get a free copy by virtue of their membership in the association, it's doubtful that they do much more than check job ads and perhaps read the odd editorial during a break. Nobody would seriously expect cutting edge medical research findings of international significance published in these sorts of publication. However, they do serve an important role as regional medical publications.

Often these journals are run in manners that can best be described as unprofessional, by the associations that own them. There are plenty of examples of interference with the editorial independence of editors by these associations, the half-life of editors appointed by them is typically low, too.

For some reason good people continue to apply for these positions, only to be shafted at the next unexpected opportunity. What happened this time around? Apparently the AMA, behind Leeder's back, decided to outsource the production of the journal to international publishing behemoth Elsevier. Elsevier is publisher of illustrious publications among medical journals that you will have actually heard of before, such as for instance The Lancet. Like most international publishing houses Elsevier has a dreadful reputation among academics, mostly for its price gauging (ask your librarian in case you have doubts about this claim), but also for a range of deeply unethical activities such as creating fake medical journals to promote particular drugs for pharmaceutical companies.

It is not at all unreasonable for Leeder to not want to be involved with Elsevier and leave (or get fired by the AMA if he refuses to leave). The same is true for the members of the journal's Editorial Advisory Committee who also resigned bar one (someone looking for an Editor-in-Chief job by any chance?). And yes, Leeder had good reason to question  the decision and should have resigned in a huff over the shenanigans that happened mostly behind his back. Folks are also correct to be upset about the AMA's decision to go to bed with Elsevier, of all commercial publishers that would have been willing to take over the production of the journal. Fair enough criticism.

For some reason in Down Under this is also debated as a threat to editorial independence. Reports the Sydney Morning Herald, 'one of the signatories, Professor Gary Wittert, the head of medicine at Adelaide University, said AMPCo's track record in sacking editors, including Dr Annette Katelaris in 2012, and its commercial arrangements with Elsevier "does not inspire confidence in editorial independence".' This charge clearly doesn't stick. As of today there is no evidence that Elsevier interferes with the editorial independence (ie the published content) of its editors. It is as simple as that.

A bunch of Australian academics that wrote to the AMA Board to criticise the decision also lamented that The Lancet has published a controversial piece about goings-on in Gaza as well as a controversial paper on vaccines and autism that it failed to retract for about a decade. That is about as bizarre a complaint as it gets. Here the publisher is in effect held accountable for non-interference with its journal editor's editorial independence, and that is also held against it by these academics. Medical journal editors in days gone by were crusaders for particular causes (in the current Lancet editor's case it's global health), and they were expected to write and publish sharply worded editorials with a view to changing the world of health. In this instance Australian academics think that's another reason why the AMA called it wrongly, they don't want to see their journal being produced by a publisher that respects its editors doing precisely that. In any case, it is worth repeating that Elsevier wouldn't even have that sort of oversight in the case of the MJA, because it's not that the journal is being sold to the company, only its production is outsourced to it.

The owners of journals are well within their rights to change the production modi of their journals. They can even outsource the production to international publishing houses (eg in bioethics the Hastings Center's Hastings Center Report is these days produced to some extent by Wiley, with zero impact on the publication's editorial independence). Editors are well within their rights to protest such decisions and to resign (or face the chop) if they ultimately do not wish to go along with such commercial decisions. A threat to editorial independence such decisions are not.

One would expect senior academics to appreciate these differences.

Wow! 9 Volume Ethics Encyclopedia finally out!

You can't but help think 'wow' when you actually hold the 9 beautiful volumes comprising the Wiley-Blackwell International Encyclopedia of Ethics in your hands. It simply is an amazing feat accomplished by an experienced hand at producing top-quality edited works, Hugh LaFollette. So, to get the disclaimers out of the way, I have three entries in this encyclopedia. I also edit journals for this publisher and I am contracted to produce a couple of books for Wiley-Blackwell.

Conflict of interest or no, you can't help but feel in awe of this reference work. The list of authors truly reads like a list of the Who is Who in academic ethics, ranging from David Archard, Marcia Baron, Roger Crisp, Norman Daniels over Dale Jamieson, Margaret Moore and Rosalind Hoursthouse to the likes of Philip Pettit, C. L. Ten, Rosemarie Tong and Michael Tooley and hundreds of others. It is not the case, by the way, that authors could just send their stuff in and after a cursory review they'd be accepted. I truly battled it out over one entry with Hugh and kind of lost, at last any consequentialist would see it that way. When I refused to add particular content that Hugh wanted referenced and that I genuinely thought wasn't worth citing, we found a way out of this impasse (classic stand-off between editor and author, I've been there on both sides more often than I care to remember).  A co-author was added, said co-author added the content Hugh was keen on, and everyone moved on with their lives. As I said, consequentialists would rightly note that I 'lost' this one.

As you would expect of such a work, it provides a comprehensive index both organized in alphabetical order as well as broader subject areas, as well as further readings following each entry. There is even a limited number of entries on 'Non-Western Ethics', the emphasis here being on limited. I was a bit surprised that no dedicated entries were to be found on secular approaches to ethics and their relationship to religious approaches to ethics. I should not pretend, of course, that I read all or even most of the entries, but at least the available indices didn't point me to anything dedicated to this complicated issue. There are a few entries on religion, but nothing on atheism, secularism or indeed humanism. To be fair, many entirely secular approaches to ethics (eg utilitarianism) are featuring prominently in the encyclopedia, so perhaps this isn't such a big deal after all. In any case, it's all too easy, with a work of this scope, to squibble over 'missing' content, or individual authors' take on a particular issue. Only small-minded reviewers would ponder for too long on such omissions or individual authors' takes on particular subject matters.

Researchers and students in my own field of specialization, Bioethics, will find as contributors the names of many leading academics as well as those of many junior scholars. Hugh LaFollette and his team deserve the highest praise for this astounding product. I have no doubt that this encyclopedia will serve as the reference work both for established researchers as well as for students trying to get a quick overview of particular subjects for many years to come.

Of course, this is the 21st century, so the first hint that this project had come to fruition and that my entries were 'around' came with a google scholar alert telling me that something with my name on it had been published. The link embedded in said alert sent me straight to Wiley's website where an on-line version of the entry was available for download. That's a wonderful thing, of course, and something other encyclopedias offer, too. Wiley plans to up-date the individual on-line entries more frequently than it plans to publish future editions of the print copy. I must say that I am a tad bit puzzled about this. To me this seems to suggest that there could (well, that there will) be distinctly different entries on the same subject matter in the same encyclopedia, except that one will be in the print version, and another in the on-line version. In some ways this won't matter, because you can still choose which one to cite for your purposes. On the other hand, once the first set of revisions is filtering thru into the on-line version, there will be different products out there, under the same name. I'm not too keen on this, but I cannot see how this can be avoided. On the bright sight, as authors we will be able to boycott revisions of our on-line content if the publisher behaves sufficiently badly as to draw the wrath of the academic community on itself (just ask Elsevier). I, for instance, have not updated various entries in two Elsevier owned encyclopedias since the academic boycott of Elsevier got off the ground. It goes without saying that at that point in time things would get even more confusing as the print edition would have an entry from one author, while the on-line edition could well have an entry on the same topic from someone different. It'll be fun to watch how Wiley and its team of editors will deal with such an eventuality.

From Biko to Guantanamo - Doctors' involvement in torture

This Letter to the Editor was published in THE LANCET in September 2007. It was also reported on the Canadian Medicine Editors' blog. They note that only one Canadian signature was amongst the signatories of the Letter. The Letter draws parallels between the conduct of doctors in the case of the torture and eventual murder of South African anti- apartheid activist Steve Biko and the treatment of prisoners on Guantanamo.

The irony of the letter, of which I am a signatory, is that its instigators (David Nicholl, Trefor Jenkins and Steve Miles) chose THE LANCET as the outlet for the Letter. THE LANCET, of course, is at the receiving end of an international boycott aiming at its owner, Elsevier. Elsevier is heavily involved in facilitating international arms trade, a profit driven mission that doesn't gel too well with its academic publishing activities.

From Steve Biko to Guantanamo - 30 years of medical involvement in torture


This week marks the 30th anniversary of the death of anti-apartheid activist Steve Biko while being detained by security police. Initially, the South African Minister of Justice suggested Biko had died of a hunger strike. The inquest revealed that he had died of the consequences of head injuries sustained during police interrogation, and identified gross inadequacies in the medical treatment from the two doctors responsible for his care including the falsification of records. The regulatory authorities failed to take firm action, and it was only grass-roots action by doctors that led, almost 8 years later to Dr Benjamin Tucker being found guilty of improper and disgraceful conduct and being struck off, whilst Dr Ivor Lang was found guilty of improper conduct and was given a caution and a reprimand1.

There are strong parallels with the Biko case and the ongoing role of US military doctors in Guantanamo and the War on Terror. Last year, we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines2. One of us (DJN) lodged formal complaints with the Medical Boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, Dr John Edmondson, was a member3. After eighteen months, there has still been no reply from the AMA, the Californian authorities have stated that “they do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, the Georgian authorities stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”, yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act” (Personal communications to DJN).

The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees4 and, to date, there has been no formal report on the 3 alleged suicides in Guantanamo that took place in June 2006.

The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is quite simply damaging the reputation of US military medicine. No healthcare worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping in detainees who have died as result of failed interrogations5. We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as Dr Tucker who in 1991, in expressing remorse and seeking re-instatement said “I had gradually lost the fearless independence …and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner’s first responsibility is the well-being of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.” (cited in1)
The attitude of the US medical establishment appears to be one of ‘See no evil, hear no evil, speak no evil’.



References

1. Jenkins T McLean GR. The Steve Biko affair: a case study in Medical Ethics. Developing World Bioethics 2003; 3(1): 77-102.
2. Nicholl DJ and 262 other doctors. Forcefeeding and restraint of Guantanamo Bay hunger strikers. Lancet 2006; 367:811.
3. Nicholl DJ. Guantanamo- a call for action. Good men need to do something. BMJ 2006; 332:854-855.
4. Nicholl DJ and 119 other doctors. Doctors at Guantanamo. The Times 18th September, 2006.http://www.timesonline.co.uk/tol/comment/debate/letters/article642161.ece
5. Miles, SH (2006) Oath Betrayed: Torture, Medical Complicity and the War on Terror. Random House, New York

Boycott Reed Elsevier

The British Medical Journal enjoins academics and others, to boycott the publisher Reed Elsevier. Its main reason is that Elsevier (publisher, among other things, of the medical journal THE LANCET and the Encyclopedia of Applied Ethics) organises international arms trade fairs, and is therefore partially responsible for sustaining an industry that thrives on the suffering of others. The BMJ argues that academics should withdraw their support for Elsevier to express their disagreement with its involvement in the arms trade, and its profiteering from the suffering of others.

So, for better or worse, as of today and until the matter is resolved, I will not be submitting manuscripts to Elsevier published journals or books. Least one can do, I guess, and good on Richard Smith, the former Editor in Chief of the BMJ, for blowing the whistle on this one. Find the current BMJ Editorial on the issue here.