Health Affairs, 27, no. 3 (2008): 890-891 doi: 10.1377/hlthaff.27.3.890 © 2008 by Project HOPE	New Online   Obama's Success & Next Steps   3 Health Policy Options for President Obama   A Hybrid Proposal   Bipartisan Compromise

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Book Reviews

The Professionalization Of Editing

Claiming that medical journals "influence the lives of everybody—and not always for the better," Richard Smith, a former editor of BMJ (formerly known as the British Medical Journal), has condensed his knowledge and experience in a trade book for a wide audience. Hoping to reach everyone interested in the quality of medical journals, Smith replaced the book’s initial publisher because it wanted a more academic book. A self-declared "unapologetic populist," Smith appeals to clinicians, researchers, editors, patients, publishers, and journalists to accept that medical journals have many problems and need reform.

A British physician, Smith worked his way up the ranks from assistant editor at BMJ to editor of the BMJ Publishing Group, where he was responsible for nearly thirty journals. During his twenty-five years at BMJ, Smith became aware of the complex problems in medical editing and publishing, including the lack of evidence to guide this work.

Despite the book’s provocative title, Smith loves journals. Part memoir, catalog, history, manual, and editorial, the book notes that journals, like science itself, deal with "provisional truths." Although hesitant to describe himself as a researcher, Smith draws on anecdotes from his long editorial experience and 418 references to support his appeal for more study and improvement of the quality of medical journals. Along the way, he provides a detailed description of BMJ’s editorial practices.

Smith seems to doubt that medical journals are widely read by their subscribers or others. He asserts that most people, including doctors, get their new knowledge of disease and treatment from mass-media news stories that are based on journal articles. Every week British reporters write stories based on the current issue of BMJ or the Lancet, while U.S. reporters do the same from the current issue of the Journal of the American Medical Association (JAMA) or the New England Journal of Medicine (NEJM).

Peer review, a common but poorly defined and poorly studied practice in which journals send manuscripts to specialist volunteers for comments and recommendations, is a major concern of Smith’s book. The 2002 systematic review of the practice cited by Smith called it "an untested process with uncertain outcomes," and another systematic review published one year after his book found the situation unchanged.¹

Stephen Lock, Drummond Rennie, John Bailar, and others realized two decades ago that the nature and effects of peer review could be researched. International scientific congresses on this topic began in 1989, and the sixth one will be held in Vancouver, British Columbia, 10–12 September 2009. (The 2 June 2002 issue of JAMA consists exclusively of studies and presentations from the fourth congress held in Barcelona, Spain, in 2001.) Perhaps reading Smith’s book could motivate more editors from the 5,194 (as of December 2007) MEDLINE-indexed journals to attend the 2009 event. From my experience attending the fifth congress in Chicago, I can vouch for the value to both presenters and audience.

It is unfortunate that virtually no peer review research reports have been published in health services research journals. Of the 2,766 papers with a subject heading of "Peer Review, Research" in PubMed at the time of this writing (December 2007), only 64 (2.3 percent) papers appeared in the 127 health services research journals indexed. In one useful article, Ann Barry Flood, coeditor of Health Services Research, examines her recent experience with peer review and shares one review that improved manuscripts.² In another article, Frank Davidoff, former editor of the Annals of Internal Medicine, reports on his experience with industry-sponsored research.³ His journal decided to require that authors describe in the Methods section of the text the research sponsor’s role in data collection, analysis, interpretation, and publication.

For Smith, a key question is how to improve peer review. Although he does not claim to analyze or solve problems, he does list and describe many concerns that have been raised by various authors, editors, and reviewers. Some examples illustrate the breadth. Should all research manuscripts be reviewed by a statistician? Should authors and reviewers be blinded to each other’s identity? Should reviewers be trained? Should reviewers be blinded to the author’s source of research support? Should ethical criteria be part of peer review?

Peer review of submitted manuscripts is not the only practice in medical publishing that is in need of reform, according to The Trouble with Medical Journals. Should journals appoint an ombudsman, as the Lancet did in 1996, or establish an ethics committee, as BMJ did in 2000? Should journals be more diligent about publishing corrections and retractions, which the New York Times does daily? What role should journals play in identifying and addressing research misconduct? How should journals define and report conflicts of interest of authors, editors, and editorial board members? How can the major medical journals publish more work from and relevant to developing countries? How can journals do a better job of identifying and curbing redundant publication? How can journals involve the public, including patients, in ways that will help doctors and researchers?

Smith recommends several resources that can help authors, editors, and reviewers. These include each journal’s own instructions to authors, the Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication (http://www.icmje.com), the Declaration of Helsinki (http://www.wma.net), the Consolidated Standards for Reporting of Trials (http://www.consort-statement.org), the Committee on Publication Ethics (http://www.publicationethics.org.uk), and the World Association of Medical Editors (http://www.wame.org).

The Trouble with Medical Journals is a well-written, passionate argument for "evidence-based editing." It may be useful to a wide variety of readers, including current and future journal editors, publishers, peer reviewers, and authors. It may also interest scholars of the history of science or medical ethics, research ethics committees, and research sponsors. Smith argues that journals have values, which he believes should include promotion of debate, editorial audit, clear communication, and ethical standards.⁴

David L. Nordstrom

Editor's Notes

 
David Nordstrom (dlnordstrom{at}gmail.com) is a self-employed consultant to medical researchers on study design, data analysis, and report publication. His own research appears in various medical journals.

NOTES

1. T. Jefferson et al., "Effects of Editorial Peer Review: A Systematic Review," Journal of the American Medical Association 287, no. 21 (2002): 2784–2786[Abstract/Free Full Text]; and T. Jefferson et al., "Editorial Peer Review for Improving the Quality of Reports of Biomedical Studies," Cochrane Database of Systematic Reviews no. 2 (2007): MR000016.
2. A.B. Flood, "From the Editors: External Peer Review at HSR," Health Services Research 39, no. 5 (2004): 1235–1250. The example of an effective review is available at http://www.hret.org/hret/publications/prhsr.html (accessed 15 December 2007).[CrossRef][ISI][Medline]
3. F. Davidoff, "Between the Lines: Navigating the Uncharted Territory of Industry-Sponsored Research," Health Affairs 21, no. 2 (2002): 235–242.[Free Full Text]
4. Readers may want to compare Smith’s book with two others: T. Jefferson and F. Godlee, eds., Peer Review in Health Sciences, 2d ed. (London: BMJ Books, 2003); and I. Hames, Peer Review and Manuscript Management in Scientific Journals: Guidelines for Good Practice (Malden, Mass.: Blackwell, 2007).

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