Ethical aspects of publishing

Ethical aspects of publishing have become a matter of greater interest over the past decade. Consideration of the associated problems led to the formation of respective societies and relevant congresses, for example the International Committee of Medical Journal Editors, The Vancouver Group (Walter and Bloch 2001) and the Committee of Publication Ethics in Great Britain (Smith 1997, 2003). International congresses about publishing in biomedicine with a focus on ethical problems took place as early as 1989, 1993 and 1997 (Rennie 1990; Rennie and Flanagin 1994, 1998).

Ethical problems affect various aspects of publishing. Some of the most important ones will be described briefly below, whereby only aspects related to publishing itself will be discussed and not the original basis for the publication, i.e. not the results of scientific studies and the related problems concerning study methods and execution.

The fact that the quality of a young scientist's research is nowadays measured by the number or impact factor of his publications has resulted in a strong pressure to publish for the individual and his research group. But there are also other sources of pressure to publish, e.g. the interest of the pharmaceutical companies to present the results of their studies as widely and diversely as possible. As a consequence, the results of a scientific investigation or clinical pharmacological study are not published in one paper, as would actually be meaningful and necessary, but as many papers as possible are published, for example by publication in various languages. These publications are either real duplicate publications, or some of them overlap considerably with respect to the presented results. Alternatively, new individual subsections are picked out time and again that are often rather irrelevant but are used to present repeatedly also the main results of the corresponding scientific investigation. Overall, duplication to a greater or lesser extent, or fragmentation (‘salami tactic’), results in the publication of more papers than is actually necessary and meaningful to present the results of a scientific investigation. One of the results of this publication technique is an undesirable increase in the flood of publications, so that even the scientist active in the respective area has trouble keeping an overview of the available data. Furthermore, the joint origin of the various publications, i.e. the actual data source, is frequently not made apparent enough (often on purpose!), so that the reader gains the impression that results of several different studies are being reported. This inflation of publications is often made use of for studies with positive results. Besides the purposeful or accepted deception of the readership, this publication technique also causes difficulties for meta-analyses, since it is often not clear to the meta-analyst how many studies are being reported, thus leading to a distortion of the data in the sense of a positive bias. In the case of negative results, there is a distortion in the other direction in the sense that they are published only very briefly or not at all. The technique of fragmented publication is often so intransparent that it is sometimes not even noticed by journal editors. For example, Walter and Bloch (2001) pointed out that in the case of an antidepressant almost identical manuscripts were published without the editors noticing.

A particularly serious case of ethical problems is the publication of purposefully falsified data or of data that are completely made up and do not have a basis in the sense of an empirical study. Such cases are almost certainly uncommon, but they are probably also rarely discovered and one must assume that a certain number of cases go unnoticed. Several years ago such a case was discovered in German genetic research that caused a great stir, all the more so because the research group had been given generous support by the DFG (“Deutsche Forschungs Gesellschaft”, German Research Association) for years and because it had published in very prestigious international journals. This case shows that despite both the DFG's complicated application process and the careful and extensive review procedures during the publication process at respected journals, it can be difficult to recognise cleverly performed falsifications. Editors, who do not usually have access to the original data, hardly stand a chance of recognising such falsifications, especially when the published data appear to be plausible enough.

Conflicts of interest can also represent a severe dilemma, in particular the conflict between the sponsor of a study, mostly the pharmaceutical industry, and the authors (Helmchen 2003; Miller et al. 1999). The relationship between the author and sponsor and the related financial interests involved on both a personal and research-related level can lead to a biased presentation, which is not a falsification of data in the sense described above, but perhaps a particularly positive depiction of the results to the sponsor's benefit, for example. This can happen in such a way that is not at all evident to the author, in face of the often very good personal relationship to the sponsor, but which is almost subconscious, normally at least unintentional. In order to reveal this “conflict”, most journals these days require the author to describe any relevant conflict of interest through a “disclosure” (Henderson et al. 2003), i.e. the author discloses the source(s) of financial support and assistance with the study, or by whom he was or is supported. He is required to disclose everything that is potentially related to the topic of the paper. This requirement does not infer that the author has a conflict of interest but serves the purpose to reveal to the reader the author's relationships in the matter at hand so that the reader is specially sensitised for a possibly biased presentation.

However, the focus on the sponsoring pharmaceutical industry, which mostly forms the basis of the demand for disclosures, is possibly too narrow. There are definitely other influencing factors which are probably just as important, for example focussing on a certain orientation of the overall subject area (e.g. biological psychiatry versus psychotherapy), rivalries between people, etc. (Horton 1997). However, such factors are much more elusive than the rather “material relationships” with the sponsor of a study or the sponsoring of a scientist's research by the pharmaceutical industry. Since for these reasons a disclosure that is solely aimed at the sponsoring by the pharmaceutical industry cannot fulfil the idealistic demands placed on it, some colleagues completely disapprove of the disclosure in the way it is currently practised and brand it as a “new McCarthyism” (Rothman 1993).

Insufficiently justified authorship is a further problem in this respect. Under the pressure of the need to publish and achieve as high an impact factor as possible, it has increasingly become a habit that many authors are mentioned on a publication who may not be associated with, or who may have only a limited association with the scientific investigation or the publication. In this respect, unjustified senior-authorships as a “favour” as well as unjustified reciprocal co-authorships of members of the same research group or different research groups from the same institution should be mentioned, all of which serve to increase the personal impact factor or the number of an individual's publications. Although the consideration of several publications offers a chance to obtain clues as to which author has perhaps just been named as a favour, it requires a lot of work and the attributes of a detective. Admittedly, it is sometimes difficult to decide who is entitled to be named as a co-author of a publication (Helmchen 2001). Proposals of the Vancouver Group (International Committee of Medical Journal Editors 1997) attempt to describe on different levels the respective contribution that resulted in co-authorship, e.g. contribution to study conception and design, contribution to analysis or interpretation of data and contribution to critical review of the work, etc. However, on the other side these criteria are still seen by some to be too soft. It has thus been demanded that at the end of a paper the respective contribution of each individual author/co-author is described in detail.

Besides the naming of co-authors who have not made a sufficient contribution to the scientific work or the manuscript, there is the other problem that scientists who have worked on a project are not named in the publication for various personal or institutional reasons. A further problem is the order of the authors. One normally presumes that the person who wrote the manuscript is also the first author and therefore takes responsibility for the content. Others also give the senior authors a special role, as he is often head of the research group. The fact that the order of names is not unimportant becomes apparent when problems occur, e.g. in the research falsification mentioned above: the senior author claimed that he could not take any responsibility for the details of the manuscript because he had not been involved in the details of data collection.

Finally, a further bias in the publication process should be mentioned that is not on the level of the authors but on that of the editors: an editor and the reviewers he chooses may follow a certain school of thought of the subject area and promote this direction preferentially by accordingly positive publications.

The editors of scientific journals thus have an important and increasingly complex task, which can hardly be accomplished “on the side”. Great demands are placed on the editor with respect to fair “handling” of the manuscript through to careful execution of the review process under consideration of the special problems mentioned above (Young 2003; Young and Joffe 2004).

An ethical problem of a completely different dimension is the fact that only colleagues from the rich industrial nations of the so-called western world have adequate access to scientific publications in highly respected international journals. Colleagues in economically poorer countries, the so-called developing countries, often have no access to such journals since they do not have the financial means to buy their own copies and often also the university libraries do not have enough money to buy these journals. This problem is being increasingly discussed (Delucchi 2005). As far as I am aware, The World Journal of Biological Psychiatry was the first psychiatric journal to take this matter sufficiently into account. With the help of an unrestricted grant from the pharmaceutical industry (at that time from Janssen Cilag and Organon), this journal was sent free of charge to all members of the WFSBP, so that also colleagues from the economically poor countries could profit from the information it contained. However, this procedure was also criticised at it was feared that the sponsoring companies may find an opportunity to influence the content to their advantage. As Chief Editor of this journal I remain fully convinced that this was not the case, although I must admit that theoretically this could have been the consequence. It is therefore definitely better if sponsoring by one or two companies is replaced by a “pool sponsoring” by several companies as this makes it much easier to avoid the possible development of any bias.

The World Journal of Biological Psychiatry also attempted to deal with another problem, although perhaps in too ideological a way. For several reasons it is often very difficult for scientists from economically poor countries to publish the results of their research. Often, the research is not on an internationally competitive level, due among other things to the poor financial setting or an insufficient tradition or method of research. Another important reason is the fact that scientists in economically poor countries do not have an adequate command of English scientific language and the English publication style. A publication is therefore often rejected by the editor of a respected international journal for reasons of language and style, without it even being sent to reviewers. One of the primary objectives of The World Journal of Biological Psychiatry was to work against this publication bias, which was to the disadvantage of the colleagues from economically poorer parts of the world. One such approach was to increase the likelihood that manuscripts by colleagues from such countries were accepted for publication by assigning them to a member of the Editorial Board or a specially chosen reviewer who helped the author to improve their paper under these aspects. Admittedly, this idealistic approach could only be realised to a very limited extent. It requires so much time and effort that voluntary editors, members of the Editorial Board or reviewers can only be asked to perform such an additional task in exceptional cases. Principally, it would be desirable that a journal provides additional means for this task.

In the context of considerations about how to make up-to-date knowledge available to all interested parties in a fair way, the demand was also expressed that a scientific journal should realise “open access” in the internet right from the start (Smith 2004; Suber 2002). However, this contradicts the economical conditions in which a journal is published and means must thus be sought to achieve a balance of all interests (Möller 2005).

Hans-Jürgen Möller Chief Editor The World Journal of Biological Psychiatry