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doi: 10.1111/1742-6723.12176
Emergency Medicine Australasia (2014) 26, 3–5
EDITORS PAST AND PRESENT
Reflections on 25 years at the Journal George A Jelinek1,2 Emergency Practice Innovation Centre, St Vincent’s Hospital, Melbourne, Victoria, Australia, and 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
1
My tenure at Emergency Medicine Australasia over 25 years has encompassed a number of editorial roles, beginning as the founding Editor in 1989 when the journal Emergency Doctor was a mere newsletter, before becoming Emergency Medicine, which was produced at Fremantle Hospital. I was then Scientific Editor when I stood down as Editor and Gerry FitzGerald was appointed Editor-in-Chief under a new organisational structure in 1994, by which time the journal Emergency Medicine was produced at the Australasian College for Emergency Medicine in Melbourne. This was followed by a return to the Editor-in-Chief position at the end of 1999 when the journal Emergency Medicine was now produced by Blackwell. Finally, my role became that of Emeritus Editor when Tony Brown’s tenure as Editor-in-Chief began at the end of 2003 and the Journal finally acquired its current title of Emergency Medicine Australasia. My goals and aspirations for the Journal over that time have understandably reflected where the Journal was in its development during each of those periods, and my role. In the beginning, I was more than happy with a regular newsletter that could enhance clinical communication between geographically dispersed emergency physicians and other clinicians involved in emergency medicine, who were members of the Australasian Society for Emergency Medicine. Fairly quickly though, it became clear that this vehicle could well mature into a bona fide medical journal. My greatest pleasures during this first 5 years of the Journal’s development reflected the same pioneering spirit we all had in developing the nascent specialty. It was exciting, the wealth of possibilities far outweighed any perceived risks, and there was a great sense of camaraderie among those Fellows and supporting staff who were volunteering their time and skills in this great adventure. AnneMaree Kelly, Bryan Walpole, John Vinen and Gordian Fulde were all keen and helpful, and the Annual
Conference chat with Paul Gaudry and Ken Abraham kept things in perspective. By the end of that first 5 years, it was clear that Emergency Medicine was here to stay as a journal, albeit with many hurdles still to navigate; we had published 242 articles in that time, 17% original research, 17% case reports and 14% review articles.1 Gerry FitzGerald convinced me to stay on as Scientific Editor of the Journal when he was appointed Editor-in-Chief in 1994, and over the next 5 years, my goals were able to be much more focused on getting the journal processes right, without the distraction of having to produce the actual copy. As part of that, the Journal sponsors funded my attendance at the World Association of Medical Editors Conference in Prague in 1997. Here I met luminaries of journalology such as Drummond Rennie and Richard Smith, and discovered the evidence base (or lack thereof) around biomedical publishing itself. My interest was particularly sparked by presentations on peer review, conflict of interest, scientific misconduct and the ethics of biomedical publishing; I was amazed and alarmed to find out about the whole issue of guest and ghost authorship, listening to presentations by people who had written papers in major journals but who did not appear in the list of authors or even receive any acknowledgement. It was here that I began to be concerned about the influence of the pharmaceutical industry on medical publishing, and more importantly, on research and clinical practice in medicine. My views on the potential harms caused by secrecy in science became clearer after that conference, and after discussion with the Editorial Board, Emergency Medicine opened its process of peer review so that authors and reviewers knew each other’s identities.2 We continue with open peer review at Emergency Medicine Australasia to this day, and I believe it is one of the most important improvements we have introduced at the
George A Jelinek, MD, DipDHM, FACEM, Director. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
GA Jelinek
Journal. We also adopted more formal requirements for disclosure of conflict of interest, while acknowledging that we will never be able to be free of such conflicts. Although these improvements have been important statements by the journal editors about our stance on such issues,3 we acknowledge that our Journal has been in the enviable position among medical journals of not receiving a significant number of industry-funded trials, largely because emergency medicine is not seen as an important marketing target by industry. As a result, we have not had to face the temptation that many of the bigger journals do when considering the publication of articles that might attract very large income for the Journal, particularly in reprints. The potential for such financial conflicts of interest to affect the likelihood of publication and indeed subtly affect the nature and particular message of the findings is real. Journal editors are no more immune from the effects of conflict of interest than researchers. Many misunderstand the nature of conflict of interest. Indeed, many of our colleagues will say they are not influenced by industry if they have, for example, accepted industry-sponsored meals or pens, despite evidence to the contrary. It is important to realise that conflict of interest operates on a subconscious level for most of us, rather than at a conscious level (ignoring those who deliberately falsify the scientific record for personal gain). To be conflicted in such situations does not generally imply a problem with motivation, but rather a tendency for our judgments to be quite unconsciously biased despite our best intentions. Addressing this is extremely difficult for journal editors, who seek to reduce the effect of bias on our research findings as a matter of course. The better journals of course have systems in place to address this issue, but it would be naïve to think that such systems can really prevent many of these biases in our publications; fundamentally we are in the hands of those who submit their work to us, and we as editors must put our trust in their integrity. My great concern is that we handle and understand conflict of interest very poorly as a profession. It is not enough to simply list commercial affiliations at the end of a paper in which authors present research, or state their opinions about therapies produced by companies with which they have close relationships, such as receiving honoraria or speaker fees or sitting on advisory boards. There is simply no doubt that industry sponsorship distorts the scientific record. We know that drug company-sponsored research is around four times more likely to report results favourable to that company’s 4
drug than independently funded research; and authors of company-funded research are around five times more likely to recommend the company’s drug.4 This then permeates the formulation of clinical guidelines by expert groups for example, where many of the experts have been researchers in these industry-funded trials, and the guidelines become ‘marketing tools of industry’.5 It is highly likely that systematic targeting of particular specialty groups by industry results in the kind of debates we are currently seeing about the effectiveness of thrombolysis in stroke, with neurologists arguing that the evidence supports its use, and emergency physicians arguing that it does not.6,7 It is quite understandable that those who are unconsciously influenced by industry will not be aware of their biases; but it is not reasonable as a profession for us to believe that we are serving our patients adequately by simply making conflict of interest declarations as a way of retaining our independence. My view is that it is impossible for us to eradicate unconscious bias, but to minimise its effect on research findings and hence on practice, we must take active steps to refuse the emoluments in which the profession has been bathed by an industry eager to maximise profits for shareholders, as all good businesses do. In 1999 I returned to the post of Editor-in-Chief with the overriding aim of achieving indexing with Index Medicus® and MEDLINE®. The Journal had had two previous attempts, one very early after inception and the second in 1997, which were both unsuccessful. I, along with the then Editorial Executives Tony Brown, Geoff Hughes and David Taylor, formulated a plan to maximise our chances of achieving indexing, focusing on the issues raised by the National Library of Medicine after our last attempt, particularly as regards our relevance to an international audience and the production quality of the Journal. Through Blackwell Science Asia (now Wiley-Blackwell) taking over the Journal’s production from the College in 1999, the appointment of an International Editorial Board, and a concerted push to solicit articles of high quality and reader interest from international colleagues, we addressed those concerns to the satisfaction of the National Library of Medicine, and thus successfully achieved indexing in 2001. This symbolic acceptance of Australasian academic emergency medicine internationally was the clear highlight of my editing career; its significance in underpinning the academic credibility of our specialty in our region should not be underestimated. The past 10 years as Emeritus Editor of the Journal have allowed me an entirely different perspective. No
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Editors Past and Present
longer directly involved in overseeing the processing of papers, peer review and daily journal issues, I have been able to take a wider and longer-term view. The role of Emeritus Editor is to be available to senior journal staff in the event of major crises, difficult issues and strategic planning, hopefully offering advice based on experience that can only be gained from doing the job for a long time, and hence having made more mistakes than others. From the outside, it might have appeared that all has been plain sailing for the Journal over the past decade; from the inside, there have certainly been some challenging moments. These do not need to be enumerated here; suffice it to say that editing a journal can raise significant ethical and personal issues from time to time. As with most such issues, there is usually no black and white answer. We have had to make a few tough calls on the Journal’s direction, and the inevitable personal differences that can arise when busy professional people passionately volunteer their time to such a worthwhile cause. Sadly, it was not always possible to resolve such difficult issues to the satisfaction of all concerned, or even my own satisfaction, and that has been a source of disappointment. Once it became clear to me in the early 1990s that Emergency Medicine Australasia could be the peak medium for dissemination of emergency medicinerelated research in Australasia, my goal has been to develop the systems, processes and personnel to allow that to happen. My greatest satisfaction has been to watch the development of others in handling peerreview processes, research papers and journal relationships over a quarter of a century. I was extremely fortunate to have been one of the first people to get into this particular elevator as it was waiting on the ground floor 25 years ago; I have enjoyed riding the elevator with the various people who have come and gone, and watching its ascent with gratitude and pride. We have been very lucky to have had emergency physicians of the calibre of Tony Brown, Gerry FitzGerald, Anne-
Maree Kelly, David Taylor and Peter Cameron, to name a few, offer their skill and expertise to oversee the Journal’s growth, many of them still putting in hours of voluntary effort to ensure the Journal is increasingly robust. In its next phase of development, Emergency Medicine Australasia will have strong leadership from others with significant track records in journalology. The team will need to focus now on attracting the most important and influential papers that have gone elsewhere in the past, and to utilise the best of the many new avenues becoming available to disseminate information most effectively, if we are to fulfil our promise.
Competing interests GAJ is Emeritus Editor of Emergency Medicine Australasia and was founding Editor-in-Chief from 1989 to 1994, then 1999–2003.
References 1.
Jelinek GA. Bigger and better. Emerg. Med. (Fremantle) 1999; 11: 213–15.
2.
Jelinek GA. Lifting the veil on the editorial process. Emerg. Med. (Fremantle) 1997; 9: 275–6.
3.
Jelinek GA. Secrecy serves science poorly: the question of conflict of interest. Emerg. Med. (Fremantle) 2000; 12: 83–4.
4.
Jelinek GA, Neate SL. The influence of the pharmaceutical industry in medicine. J. Law Med. 2009; 17: 216–23.
5.
Lenzer J, Hoffman JR, Furberg CD et al. Ensuring the integrity of clinical practice guidelines: a tool for protecting patients. BMJ 2013; 347: f5535.
6.
Bladin C, Levi C, Parsons M. Stroke thrombolysis: leaving the past, understanding the present and moving forward. Emerg. Med. Australas. 2013; 25: 195–6.
7.
Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third International Stroke Trial (IST-3). Emerg. Med. Australas. 2012; 24: 477–9.
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
5
doi: 10.1111/1742-6723.12176
Emergency Medicine Australasia (2014) 26, 3–5
EDITORS PAST AND PRESENT
Reflections on 25 years at the Journal George A Jelinek1,2 Emergency Practice Innovation Centre, St Vincent’s Hospital, Melbourne, Victoria, Australia, and 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
1
My tenure at Emergency Medicine Australasia over 25 years has encompassed a number of editorial roles, beginning as the founding Editor in 1989 when the journal Emergency Doctor was a mere newsletter, before becoming Emergency Medicine, which was produced at Fremantle Hospital. I was then Scientific Editor when I stood down as Editor and Gerry FitzGerald was appointed Editor-in-Chief under a new organisational structure in 1994, by which time the journal Emergency Medicine was produced at the Australasian College for Emergency Medicine in Melbourne. This was followed by a return to the Editor-in-Chief position at the end of 1999 when the journal Emergency Medicine was now produced by Blackwell. Finally, my role became that of Emeritus Editor when Tony Brown’s tenure as Editor-in-Chief began at the end of 2003 and the Journal finally acquired its current title of Emergency Medicine Australasia. My goals and aspirations for the Journal over that time have understandably reflected where the Journal was in its development during each of those periods, and my role. In the beginning, I was more than happy with a regular newsletter that could enhance clinical communication between geographically dispersed emergency physicians and other clinicians involved in emergency medicine, who were members of the Australasian Society for Emergency Medicine. Fairly quickly though, it became clear that this vehicle could well mature into a bona fide medical journal. My greatest pleasures during this first 5 years of the Journal’s development reflected the same pioneering spirit we all had in developing the nascent specialty. It was exciting, the wealth of possibilities far outweighed any perceived risks, and there was a great sense of camaraderie among those Fellows and supporting staff who were volunteering their time and skills in this great adventure. AnneMaree Kelly, Bryan Walpole, John Vinen and Gordian Fulde were all keen and helpful, and the Annual
Conference chat with Paul Gaudry and Ken Abraham kept things in perspective. By the end of that first 5 years, it was clear that Emergency Medicine was here to stay as a journal, albeit with many hurdles still to navigate; we had published 242 articles in that time, 17% original research, 17% case reports and 14% review articles.1 Gerry FitzGerald convinced me to stay on as Scientific Editor of the Journal when he was appointed Editor-in-Chief in 1994, and over the next 5 years, my goals were able to be much more focused on getting the journal processes right, without the distraction of having to produce the actual copy. As part of that, the Journal sponsors funded my attendance at the World Association of Medical Editors Conference in Prague in 1997. Here I met luminaries of journalology such as Drummond Rennie and Richard Smith, and discovered the evidence base (or lack thereof) around biomedical publishing itself. My interest was particularly sparked by presentations on peer review, conflict of interest, scientific misconduct and the ethics of biomedical publishing; I was amazed and alarmed to find out about the whole issue of guest and ghost authorship, listening to presentations by people who had written papers in major journals but who did not appear in the list of authors or even receive any acknowledgement. It was here that I began to be concerned about the influence of the pharmaceutical industry on medical publishing, and more importantly, on research and clinical practice in medicine. My views on the potential harms caused by secrecy in science became clearer after that conference, and after discussion with the Editorial Board, Emergency Medicine opened its process of peer review so that authors and reviewers knew each other’s identities.2 We continue with open peer review at Emergency Medicine Australasia to this day, and I believe it is one of the most important improvements we have introduced at the
George A Jelinek, MD, DipDHM, FACEM, Director. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
GA Jelinek
Journal. We also adopted more formal requirements for disclosure of conflict of interest, while acknowledging that we will never be able to be free of such conflicts. Although these improvements have been important statements by the journal editors about our stance on such issues,3 we acknowledge that our Journal has been in the enviable position among medical journals of not receiving a significant number of industry-funded trials, largely because emergency medicine is not seen as an important marketing target by industry. As a result, we have not had to face the temptation that many of the bigger journals do when considering the publication of articles that might attract very large income for the Journal, particularly in reprints. The potential for such financial conflicts of interest to affect the likelihood of publication and indeed subtly affect the nature and particular message of the findings is real. Journal editors are no more immune from the effects of conflict of interest than researchers. Many misunderstand the nature of conflict of interest. Indeed, many of our colleagues will say they are not influenced by industry if they have, for example, accepted industry-sponsored meals or pens, despite evidence to the contrary. It is important to realise that conflict of interest operates on a subconscious level for most of us, rather than at a conscious level (ignoring those who deliberately falsify the scientific record for personal gain). To be conflicted in such situations does not generally imply a problem with motivation, but rather a tendency for our judgments to be quite unconsciously biased despite our best intentions. Addressing this is extremely difficult for journal editors, who seek to reduce the effect of bias on our research findings as a matter of course. The better journals of course have systems in place to address this issue, but it would be naïve to think that such systems can really prevent many of these biases in our publications; fundamentally we are in the hands of those who submit their work to us, and we as editors must put our trust in their integrity. My great concern is that we handle and understand conflict of interest very poorly as a profession. It is not enough to simply list commercial affiliations at the end of a paper in which authors present research, or state their opinions about therapies produced by companies with which they have close relationships, such as receiving honoraria or speaker fees or sitting on advisory boards. There is simply no doubt that industry sponsorship distorts the scientific record. We know that drug company-sponsored research is around four times more likely to report results favourable to that company’s 4
drug than independently funded research; and authors of company-funded research are around five times more likely to recommend the company’s drug.4 This then permeates the formulation of clinical guidelines by expert groups for example, where many of the experts have been researchers in these industry-funded trials, and the guidelines become ‘marketing tools of industry’.5 It is highly likely that systematic targeting of particular specialty groups by industry results in the kind of debates we are currently seeing about the effectiveness of thrombolysis in stroke, with neurologists arguing that the evidence supports its use, and emergency physicians arguing that it does not.6,7 It is quite understandable that those who are unconsciously influenced by industry will not be aware of their biases; but it is not reasonable as a profession for us to believe that we are serving our patients adequately by simply making conflict of interest declarations as a way of retaining our independence. My view is that it is impossible for us to eradicate unconscious bias, but to minimise its effect on research findings and hence on practice, we must take active steps to refuse the emoluments in which the profession has been bathed by an industry eager to maximise profits for shareholders, as all good businesses do. In 1999 I returned to the post of Editor-in-Chief with the overriding aim of achieving indexing with Index Medicus® and MEDLINE®. The Journal had had two previous attempts, one very early after inception and the second in 1997, which were both unsuccessful. I, along with the then Editorial Executives Tony Brown, Geoff Hughes and David Taylor, formulated a plan to maximise our chances of achieving indexing, focusing on the issues raised by the National Library of Medicine after our last attempt, particularly as regards our relevance to an international audience and the production quality of the Journal. Through Blackwell Science Asia (now Wiley-Blackwell) taking over the Journal’s production from the College in 1999, the appointment of an International Editorial Board, and a concerted push to solicit articles of high quality and reader interest from international colleagues, we addressed those concerns to the satisfaction of the National Library of Medicine, and thus successfully achieved indexing in 2001. This symbolic acceptance of Australasian academic emergency medicine internationally was the clear highlight of my editing career; its significance in underpinning the academic credibility of our specialty in our region should not be underestimated. The past 10 years as Emeritus Editor of the Journal have allowed me an entirely different perspective. No
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Editors Past and Present
longer directly involved in overseeing the processing of papers, peer review and daily journal issues, I have been able to take a wider and longer-term view. The role of Emeritus Editor is to be available to senior journal staff in the event of major crises, difficult issues and strategic planning, hopefully offering advice based on experience that can only be gained from doing the job for a long time, and hence having made more mistakes than others. From the outside, it might have appeared that all has been plain sailing for the Journal over the past decade; from the inside, there have certainly been some challenging moments. These do not need to be enumerated here; suffice it to say that editing a journal can raise significant ethical and personal issues from time to time. As with most such issues, there is usually no black and white answer. We have had to make a few tough calls on the Journal’s direction, and the inevitable personal differences that can arise when busy professional people passionately volunteer their time to such a worthwhile cause. Sadly, it was not always possible to resolve such difficult issues to the satisfaction of all concerned, or even my own satisfaction, and that has been a source of disappointment. Once it became clear to me in the early 1990s that Emergency Medicine Australasia could be the peak medium for dissemination of emergency medicinerelated research in Australasia, my goal has been to develop the systems, processes and personnel to allow that to happen. My greatest satisfaction has been to watch the development of others in handling peerreview processes, research papers and journal relationships over a quarter of a century. I was extremely fortunate to have been one of the first people to get into this particular elevator as it was waiting on the ground floor 25 years ago; I have enjoyed riding the elevator with the various people who have come and gone, and watching its ascent with gratitude and pride. We have been very lucky to have had emergency physicians of the calibre of Tony Brown, Gerry FitzGerald, Anne-
Maree Kelly, David Taylor and Peter Cameron, to name a few, offer their skill and expertise to oversee the Journal’s growth, many of them still putting in hours of voluntary effort to ensure the Journal is increasingly robust. In its next phase of development, Emergency Medicine Australasia will have strong leadership from others with significant track records in journalology. The team will need to focus now on attracting the most important and influential papers that have gone elsewhere in the past, and to utilise the best of the many new avenues becoming available to disseminate information most effectively, if we are to fulfil our promise.
Competing interests GAJ is Emeritus Editor of Emergency Medicine Australasia and was founding Editor-in-Chief from 1989 to 1994, then 1999–2003.
References 1.
Jelinek GA. Bigger and better. Emerg. Med. (Fremantle) 1999; 11: 213–15.
2.
Jelinek GA. Lifting the veil on the editorial process. Emerg. Med. (Fremantle) 1997; 9: 275–6.
3.
Jelinek GA. Secrecy serves science poorly: the question of conflict of interest. Emerg. Med. (Fremantle) 2000; 12: 83–4.
4.
Jelinek GA, Neate SL. The influence of the pharmaceutical industry in medicine. J. Law Med. 2009; 17: 216–23.
5.
Lenzer J, Hoffman JR, Furberg CD et al. Ensuring the integrity of clinical practice guidelines: a tool for protecting patients. BMJ 2013; 347: f5535.
6.
Bladin C, Levi C, Parsons M. Stroke thrombolysis: leaving the past, understanding the present and moving forward. Emerg. Med. Australas. 2013; 25: 195–6.
7.
Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third International Stroke Trial (IST-3). Emerg. Med. Australas. 2012; 24: 477–9.
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
5
