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8/3/2019 Ethics Publishing
1/24
Ethics of Publishing: Balancing
the routine and revolutionary
Peter A. Singer, MD, MPH
University of [email protected]
8/3/2019 Ethics Publishing
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
8/3/2019 Ethics Publishing
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
8/3/2019 Ethics Publishing
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
8/3/2019 Ethics Publishing
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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 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
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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.
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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.
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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.
8/3/2019 Ethics Publishing
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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).