Ethical Issues in Biomedical Publication

  • Anne Hudson Jones &
  • Faith McLellan
(Editors) Johns Hopkins University Press, 374 pp, $22.50, 2000 ISBN: 0801863147 | ISBN: 0-801-86314-7

Ethics—the word conjures up quite different reactions. For many it suggests a discipline high in an ivory tower where academics mince words as they discuss idealism in a theoretical universe. For others it is a necessary evil that must be tacked on to any discussion of advances toward cloning, stem cells, xenotransplantation or other cutting edge biomedical technology. And some see it as no more than vague hand waving that is at home in an overly bureaucratic international forum, but that has little impact in a world that has bigger problems to deal with.

To be fair, these sorts of cliché reactions were probably more common a few years ago. Today there is a greater understanding of the importance of investigating the ethical dimension of science in part thanks to the efforts of a few ethicists that have sought to popularize the sort of moral issues that keep most ethicists in work, and in part due to a several high profile initiatives such as the NIH's Institute of Human Genome Research Ethical, Legal and Social Implications (ELSI) program that has an annual budget of $12 million.

But perhaps the biggest reason why people are paying more attention to ethics is because of its association with technology and biotechnology in particular. Who, for example, doesn't have an opinion on human cloning? Many can identify, with a little thought, scenarios where the cloning of human tissue is justified and others where it clearly is not. But how many of us can claim to know exactly where we would draw the moral line when faced with so many gray areas of opportunity and risk? This is ethics. It's become very important yet controversial, and is drawing the public into the debate.

Riding this wave of interest comes a book that focuses not on the ethics of science but the ethical issues raised in the course of publishing it. Anyone who has spent a few years in the biomedical community knows that it boasts more than its fair share of bold characters and strong egos and that competition to get published in high profile places brings out the best and worst in them. (To borrow a phrase; when the going gets tough, some people start bending the rules.) To this background of brains, aggression and careers in the making, the book's editors (Anne Hudson Jones—a professor at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston — and Faith McLellan—Managing Editor of the Physicians Information and Education Resource) added an impressive list of authors including Richard Horton (anyone who reads the Lancet, of which he is the editor, knows that Horton can spin a good yarn) and Frank Davidoff (editor of Annals of Internal Medicine).

Given such rich ingredients, it is surprising that the book largely fails to truly engage its reader. Certainly it offers a good view of the publishing landscape and its major pitfalls—chapters are dedicated to issues such as authorship rules, conflicts of interest, scientific misconduct and the like. And in particular the first half of the book offers plenty of case studies, many of which are entertaining as well as informative. But most of the book can be boiled down to lists of the various forms of malpractice that can occur in publishing, examples of these and the rules that each has broken. Nearly 200 pages of this formula becomes tired and unexciting. Although the use of fourteen authors makes some level of overlap inevitable, the editors could have put their red pens to better use by cutting out many repeated sections and even the odd chapter. (Why, for example, was the chapter “Peer Review and the Ethics of Internet Publishing” sandwiched between “The Ethics of Peer Review” and “Ethics in Cyberspace: The Challenges of Electronic Scientific Publishing”?)

Focusing on remedies to the sorry state of affairs described in the first half of the book, two chapters (which again, could have been one) advocate a process of formal education and training in the ways of ethical research and publication behavior for both students and their mentors. But otherwise there is comparatively little space given to attempts to understand the origins of unethical behavior and how it might be changed.

Fortunately, late in the book come two concisely written gems. Paul Friedman puts his considerable experience to good use. (As the former Dean for Academic affairs at the UCSD, chair of the Committee of Research Integrity and a member of the Institute of Medicine's Committee on the Responsible Conduct of Research, he probably has first-hand experience of most of the problems mentioned in the book.) Friedman launches straight into the question 'what causes unethical behavior' and follows this with a brief but to-the-point discussion of where the solution might lie. In essence, a coordinated approach from educational institutions, professional societies and editors is needed to correct the practices of a generation that took its eye off the ball as it learnt to cut corners in its haste to compete for research money and reputation. And finally, Frank Davidoff brings us back down to earth by reminding us that despite the best efforts of those that would persuade us that with the internet we can lose the shackles of traditional manuscript preparation, submission, peer review and publication and simply share all our data in a dream like world of perfect publishing practices, in fact research and traditional publishing, although quite different tasks, still go hand in hand. The one is incomplete without the other and any remedies aimed at improving our ethical well-being must accept this. Common sense indeed.

“Ethical Issues in Biomedical Publication” is an accurate title for this overly long book. 'Better Ethical Approaches to Biomedical Publication' would have been less accurate but more interesting. Nonetheless, if you're a relative new comer to the field, are interested in some of the most celebrated cases of unethical behavior or if you've never stopped to think about how science publishing can go wrong, this book is not a bad place to start. It will give you chapter and verse on the problems facing the science publishing community, but open the window and put the coffee on . . . it's going to be a long night.