Ann Thorac Surg 2007;84:717-719
© 2007 The Society of Thoracic Surgeons
Editorials
Journal Ethics
L. Henry Edmunds, Jr, MD*
* Address correspondence to Dr Edmunds, Editor, The Annals of Thoracic Surgery, 3440 Market St, Suite 306, Philadelphia, PA 19104 (Email: hank.edmunds{at}uphs.upenn.edu).
 |
Introduction
|
|---|
The medical profession depends upon trust. No rational patient, no matter how desperate, empowers anyone to use a knife without trust. The trust is earned by knowledge, training, qualifications, experience, judgment, dedication, loyalty, and a host of attributes that assure the patient that their surgeon is capable and acting solely in their best interests. This trust is the foundation of medicine; without it we cannot practice. Trust also extends to communications between doctors regarding the accuracy, objectivity, and originality of discoveries, experiences, and analyses. Recently, journal editors, whose primary role is to facilitate communication between doctors, have become concerned about behavior that threatens to erode the trust between our patients and ourselves.
In 1999 editors of six major journals in cardiac and general thoracic surgery published a statement defining "redundant" (duplicate) publication [1]. More recently, the public, particularly in the United States, has become aware and alarmed about conflicts of interest between doctors and suppliers of drugs and medical products [2]. In addition, there have been a few instances of scientific misconduct involving fraudulent laboratory records and fictional clinical experience. At a recent meeting of the Council of Science Editors (May 18–22, 2007), editors and managing editors informally discussed the increasing number of ethical breaches across all scientific journals. Scientific journals do not employ detectives; we police ourselves. But what exactly are journal ethical standards?
|
Scientific Misconduct
|
|---|
The Office of Research Integrity (ORI) of the United States Department of Health and Human Services defines scientific misconduct as "fabrication," "falsification," and "plagiarism" and excludes "honest error" and "differences of opinion" (http://ori.hhs.gov/misconduct/definition_misconduct.shtml). Scientific misconduct is the most serious ethical breach and one that may harm patients, tarnish the reputation of the perpetrator’s institution, justify dismissal from the institution, require withdrawal of all relevant published reports, and end research support from government and nongovernment sources. In the United States, the ORI investigates all accusations of scientific misconduct for research funded by government funds and offers technical assistance and quality advice for managing investigations of alleged scientific misconduct to domestic and foreign institutions in which the research was not funded by public money.
Editors may become aware of possible scientific misconduct from a variety of sources, but those who make the accusation must do so in writing (the ORI does not require this). Upon receipt of a written accusation of fabrication or falsification (plagiarism is discussed separately below), the editor reviews the matter and obtains verification of the signatures of each author on the Conditions Form, which is required before acceptance of an article for publication. Forged signatures qualify as scientific misconduct.
If further action is justified, the editor notifies both the senior author of the paper in question and the highest-ranking administrative officer of the institution in which the alleged scientific misconduct occurred. The letter requests that the institution fully investigate the matter to determine whether or not scientific misconduct has occurred. The investigation may require an audit of laboratory notebooks or clinical records by officials chosen by the head of the institution and may take a year or more to conclude.
If the institutional investigation exonerates the authors, no further action is necessary. If the institution finds that data have been fabricated or falsified, usually the institution determines punitive measures and communicates the particulars of the investigation to the funding sources of the research. Journal editors must immediately withdraw the paper by printed notice and by indexing the notice in the journal index. In addition, the electronic version of the paper and relevant indices and databases must label the paper "withdrawn" or "retracted." Parent societies of the journals are also notified of the misconduct, and those authors who are members of the society are referred to the appropriate Standards and Ethics Committees. Separately, journal editors may impose a ban on the receipt of any manuscripts from any authors of the paper. The longest bans are imposed on the senior author and identified perpetrator or perpetrators; lesser or no bans are imposed on authors who may not have been aware of the misconduct. Guidance from the institutional investigation is needed to determine "awareness."
|
Plagiarism
|
|---|
The ORI defines plagiarism as "the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit." The definition is very broad, and unless obvious and specifically identified by laboratory or hospital documents or prior publication, the charge may be difficult to prove in a court of law. In cardiothoracic surgery, plagiarism is usually the result of sloppy scholarship that fails to identify a previously published operation, observation, or discovery. This failure is actually quite common, because literature searches by busy surgeons are often shallow and do not discover the original work. Because neither money nor fame is at stake, the transgression may be pointed out in a letter to the editor but is more often overlooked. Occasionally, a nonnative English speaker who is forced to write in English "lifts" passages from another publication to lighten the language burden. In this circumstance, editors usually ask the chief of service to instruct the culprit, who may not be aware of either the word "plagiarism" or the transgression.
|
Redundant Publication
|
|---|
The exponential increase in medical knowledge has encouraged multidisciplinary research teams in which individual participants with diverse skills and expertise cooperate in a communal research project. Understandably, each participant desires to inform his or her colleagues of this joint work by publishing in the specialty journal of their discipline. The altruistic motive is to bring the results of the investigation to colleagues; a secondary motive is to raise an individual’s stature among their specialty colleagues. Before the era of the Internet and search engines, the altruistic motive may have had some justification, but justification is weak to nonexistent now. Redundant publications are unnecessary, wasteful, inflate individual bibliographies, and contaminate the literature by multiple publications of the same data.
Previous editors established a set of six criteria to determine whether or not two papers were redundant and ruled that all six criteria must be present to support the charge of redundancy [1]. The editor or a third party appointed by the editor makes the determination. The six criteria are (1) the hypothesis is similar, (2) the numbers or sample sizes are similar, (3) the methodology is identical or nearly so, (4) the results are similar, (5) at least one author is common to both reports, and (6) no or little new information is made available [1]. This editor endorses this definition of redundant publication. The previous editors made exceptions, but this editor does not recognize any exceptions (including electronic-only publishing) except for abstracts of less than 400 words.
The outbreak of redundant publications has precipitated a need for redress. If the redundant paper is published in the same or another journal (including those outside cardiothoracic journals), The Annals, if the second journal, will formally withdraw the paper and reveal the cause for this action. Depending on circumstances, the editor may ban the senior author only or ban some authors or all authors common to both publications from submitting a manuscript to The Annals for up to 2 years after discovery of the redundant publication. The editor may also request the editor of the first publication to discipline one or all authors common to both publications. The editor will report the breach of ethics to the Standards and Ethics Committee of the parent society.
|
Submission of an Abstract of a Prior Publication for Presentation at a Meeting
|
|---|
If the ethical breach is discovered before the meeting, the Program Committee of the meeting will be notified of the prior publication. If discovered after presentation, but before publication, the article will be rejected and the Standards and Ethics Committee of the parent society of the meeting notified. If discovered after publication, see "Redundant Publication" above.
|
Conflicts of Interest
|
|---|
In the United States, the Food and Drug Administration (FDA) is empowered by Congress to regulate drugs and medical products. The FDA determines the safety, efficacy, and indications for new drugs and medical items. Independent physicians and scientists and employees of industrial concerns necessarily form partnerships to develop and disseminate many new drugs, prostheses, devices, and related products. Independent physicians and scientists are entitled to compensation for their time, expertise, and efforts in the process of creating and developing new medical items. A conflict of interest arises when physicians and scientists prescribe or use a new drug or medical product in which they have a financial interest [2].
Although not always the case, logic demands that an evaluation of a new drug or medical product be thorough, comprehensive, and objective and be done by individuals who have no connection with the creation or development of the medical product or any financial conflict. The FDA is charged with this responsibility but does not have direct control over evaluation protocols.
Financial relationships between physicians and industry are within the law, but patients have a right to know when their physician prescribes or provides a drug or medical product in which the doctor has a direct financial interest. The issue is not the amount of the financial interest or whether or not a physician’s prescription or services are actually influenced by the existing financial relationship; the issue is the patient’s perception that their physician’s prescription or service may be influenced by the relationship [2].
Journals do not have the resources or the responsibility for regulating financial conflicts of interest, but they are responsible for publishing objective, unbiased information. Currently, many journals discharge this responsibility by requiring full disclosure of any financial relationships between each author of an article and any drugs or medical products featured within the article. In this context "featured’ means that the drug or medical product is the focus of the article or has a major influence on the results and conclusions of the article. When a financial relationship is disclosed, it is up to the readers to evaluate whether or not financial relationships of one or more authors influenced the report. Disclosure raises suspicion of bias; authors can only overcome this suspicion by rigorous, objective evaluation of the new drug or medical product.
Necessarily, disclosures of financial conflicts of interest and verification of freedom of investigation rest with each author. Each journal requires disclosure of financial conflicts of interest, but details vary between journals. Failure to disclose a financial conflict of interest is a serious breach of ethics and punitive action is justified. In all instances the editor will report the breach in ethics to the Standards and Ethics Committee of The Society of Thoracic Surgeons, which is the parent society of the journal. In addition, the editor may impose penalties such as an editor’s letter disclosing the breach, publishing a letter from the authors "explaining" the breach, or banning new submissions for up to 2 years from all conflicted authors.
|
Conclusion
|
|---|
Professional ethics are important and are especially important for the practice of medicine. To earn our patient’s trust, we can brook no compromises of our integrity or ethical standards. Authors, not editors, are ultimately responsible for ethical standards of our journals. Fear of punishment is a weak incentive, but patient trust is a monumental reason to always maintain the highest ethical standards of our profession.
|
References
|
|---|
- Cho BK, Turina MI, Karp RB, Ferguson TB, Bodnar E, Waldhausen JA. Joint statement on redundant (duplicate) publication by the editors of the undersigned cardiothoracic journals Ann Thorac Surg 1999;68:1.[Free Full Text]
- Is your doctor tied to drug makers? NY Times 2007:A18July 2.
Top
Introduction
Scientific Misconduct