A Note on the Publication of The Magnitude of Hemoconcentration with Eclampsia
This issue of Hypertension in Pregnancy contains an article by Zeeman et al., entitled The Magnitude of Hemoconcentration with Eclampsia (PAGES). To date, the literature has focused on preeclampsia where intravascular volumes are below those of normal gravidae. In this study of women with eclampsia, it appears that intravascular volumes are below those of the nonpregnant state. When the editors received this unique contribution we recognized the potential value of this research in terms of patient management. However, we faced a dilemma.
The authors utilized an approach and measurement that would be considered unethical today (including measuring blood volume with 51chromium-tagged erythrocytes). The authors were also aware that data had been collected between 1958 and 1978 (most prior to the Belmont report), that the fetal exposure to ionizing radiation from 51Chromium was well below the exposure from X-ray pelvimetry (a routine investigation during that epoch), and that several journals had previously rejected the article primarily because of ethical concerns.
We took a different approach and had the article vetted by an eminent ethicist, Mary Mahowald, who focuses on women's health, has been a consultant to the U.S. Presidential Commission on Ethics, and who is a member of the MacLean Center for Clinical Medical Ethics at the University of Chicago. Her review convinced us that the study was ethical when performed, and its importance to clinical management merited its publication now. Her invited commentary accompanies the article (PAGES).
Finally, we are aware that not infrequently, editors are faced with decisions that involve ethical questions when handling potential contributions to their journal. We also note through anecdotal knowledge that journals too frequently find reasons to reject such an article, wishing not to engage on discussions regarding the ethics of research (the easy way out). We are pleased with the path we chose and recommend it to fellow editors.