Report of the Bellagio Conference

Report of the Conference to Promote International Cooperation among Medical Journal Editors, March 13-17, 1995, The Rockefeller Foundation Bellagio Study and Conference Center, Bellagio, Italy

 

Abstract

The World Association of Medical Editors (WAME) was launched in Bellagio, Italy on March 16, 1995, after a 3-day conference to consider international cooperation among editors of peer-reviewed medical journals. Formal constitutional arrangements for this new organization remain to be agreed upon.

Twenty-two editors, physicians, and scientists from 13 countries met at the Rockefeller Foundation Bellagio Study and Conference Center to discuss the increasingly complex problems that editors face in maintaining and improving the quality of published medical research. Lack of knowledge about the peer-review process, variable standards in medical writing and editing, and inadequate support and training for new journal editors all contribute to the obstacles and challenges confronting editors worldwide. Given that the publication of medical research is the final common path of substantial publicly funded programs, such deficiencies are alarming and must be countered. The World Association of Medical Editors will address these acute needs by stimulating education and promotion of good standards among editors, with the eventual aim of improving the quality of medical science and practice.

A critical component of the new association's activities will be to develop an electronic communication network among medical editors which was established in advance of the Bellagio meeting with the help of the US National Library of Medicine. The Association has created an Electronic Network Task Force to take this initiative forward.

Bellagio participants also elected officers of WAME, a Board of Directors, and committees to define membership, fund-raising and ethical criteria for the new organization. The Board of Directors includes editors from Western and Eastern Europe, North and South America, Africa, and the Asia-Pacific region. Before WAME, no organization existed to tackle the global concerns of medical editors.

Participants

Suzanne W. Fletcher, MD
Conference Coordinator

Department of Ambulatory Care and Prevention
Harvard Medical School and
Harvard Community Health Plan
126 Brookline Avenue, Suite 200
Boston, MA 02215
617-421-6011
617-859-8112 fax
sfletch@warren.med.harvard.edu

Saveli Bachtchinski, MD, PhD

Kardiologiya Editor
General Director of “Cardiosphera” Publishing House
Russia, 101953 Moscow
Petroverigskii per., 10
7 095 927 0325 or 927 0316
7 095 923 0052 (fax)
svl@cardio.msk.su (email)

Lars E. Bottiger, MD

Editor, Journal of Internal Medicine
PO Box 22114
S-104 22 Stockholm
Sweden
001-46-8-650-96-88
011-46-8-650-82-34 (fax)
inger.kull@jim.se (email)

Iain Chalmers, MB

The Cochrane Collaboration
The UK Cochrane Centre
NHS R&D Programme
Summertown Pavilion
Biddle Way
Oxford OX2 7LG, UK
011-44-0-865-516300
011-44-0-865-516311 (fax)
ichalmers@cochrane.co.uk (email)

Lois Ann Colaianni

National Library of Medicine/NIH
8600 Rockville Pike
Room 2WO4-A
Bethesda, MD 20894
301-496-6921
301-496-4450 (fax)
loisann@lhc.nlm.nih.gov (email)

Robert H. Fletcher, MD

Department of Ambulatory Care and Prevention
Harvard Medical School and Harvard Community Health Plan
126 Brookline Avenue, Suite 200
Boston, MA 02215
617-421-6013
617-859-8112 (fax)
rfletch@warren.med.harvard.edu (email)

Robin Fox, MB

Editor, The Lancet
42 Bedford Square
London, UK
WC1B 3SL
011-44-71-436-4981
011-44-71-436-7550 fax

George A. Gellert, MD, MPH, MPA

Director of Medical Programs and Senior Consultant for Epidemiology/Public Health
Project HOPE
The Project HOPE Health Sciences Education Center
Carter Hall
Millwood, VA 22646
703-837-2100
703-837-1813 (fax)
ggelert%projhope@uunet.uu.net (email)

Alejandro Goic, MD

Editor, Revista Medica Chile
Dean, University of Chile Faculty of Medicine
Hernandos de Magallanes 1298
Santiago de CHILE
011-56-2-7775359
011-56-2-7774890 (fax)

Richard Horton, MD

North American Editor
The Lancet
655 Avenue of the Americas
New York, New York 10010
212-633-3801
212-633-3850 (fax)
rhorton@elsevier.com (email)

Edward J. Huth, MD

Editor Emeritus
Annals of Internal Medicine
Independence Mall West
6th Street at Race
Philadelphia, PA 19106-1572
215-351-2620
215-351-2644 (fax)
7033.14@compuserve.com (email)

Dr. Gabor Kapocs

Editor, Hungarian Medical Journal
Literatura Medica Ltd.
1027 Budapest
Frankel Leo ull 11/18
1539 Bp PO Box 603 Hungary
011-36-1-1359600 (fax)

Dr. ST Lee

Editor, Annals, Academy of Medicine,
Singapore
16 College Road
#01-01 College of Medicine Building
Singapore 0316
011-65-2245166
011-65-2255155 (fax)
jessie@solomon.technet.sg (email)

George Lundberg, MD

Editor, JAMA
American Medical Association
515 North State Street
Chicago, IL 60610
312-464-2400
312-464-5824 (fax)
glundberg@delphi.com (email)

Daniel J. Ncayiyana, MD

Editor, South African Medical Journal
Private Bag XI
Pinelands, South Africa 7430
011-27-21-531-3081
011-27-21-531-4126 (fax)
masact@aiml.aztec.co.za (email)

Dr. Samiran Nundy

Editor, The National Medical Journal of India
All India Institute of Medical Sciences
New Delhi 110 029 India
011-91-11-6864851 ext 461
011-91-11-6862663 (fax)
nundy@wipro.nic.in (email)
also always send to shalini@medlar0.mic.in

Magne Nylenna, MD

Editor, Journal of the Norwegian Medical Association
Fjellveien 5
N-1325
Lysaker, Norway
011-47-6-712-4600
011-47-6-712-4800
x.400:/G=Magne/S=Nylenna/P=ccmail/A=telemax/C=NO

Tom Mboya Okeyo, MD, MPH

Editor, African Medical Journal
P. O. Box 19637
Nairobi, Kenya
011-254-2-729504 (fax)
knacp@arcc.kaact.kenya-net.ora (email)

John A. Overbeke, MD, PhD

Executive Editor,
Nederlands Tijdschrift voor Geneeskunde
P.O. Box 75971
Amsterdam, Netherlands 1070AZ
011-31-20-662-0150
011-31-20-673-5481 (fax)
expects connection in October

Drummond Rennie, MD

Deputy Editor, West
JAMA
Institute for health Policy Studies
School of Medicine, USCF
1388 Sutter Street, 11th Floor
San Francisco, CA 94109
415-476-6392
415-381-8829 (fax)
rennie@cardio.ucsf.edu (email)

Richard Smith, MB

Editor, British Medical Journal
BMA House
Tavistock Square
London, UK WC1H 9JR
011-44-71-387-4499
011-44-71-383-6418 (fax)
73064.2044@compuserve.com

Bruce Squires, MD, PhD

Editor, Canadian Medial Association Journal
1867 Alta Vista Drive
Ottawa, ON CN K2P OX2
613-731-8610 x2118
613-523-0937 (fax)

Patricia Woolf, PhD

Princeton University
Department of Molecular Biology
1N1 Greenhall
Princeton, NJ 08544
609-258-2709
gc@math.ias.edu

Background

Overview

Every year, through both public and private channels, the public invests huge sums of money in health and medical research to address questions about the origins of ill health, and the effects of preventive or therapeutic strategies to protect and improve human health and well-being. Medical journals, of which there are an estimated 20,000 worldwide, are the principal medium for primary communication of the outcome of this massive public investment. It is worth pondering the fact that it is not unusual for a mere half dozen pages in a medical journal to represent the main output from a research project which may have cost several million dollars.

The influential position of medical journals between public investment in research and public access to the fruits of this investment places a heavy responsibility on those who control what is published—medical journal editors. Medical journal editors have a public duty to ensure that reports of research provide valid information, in language and formats that are accessible to the wide variety of different consumers of this information.

Unfortunately, although the quality of medical editing may be improving gradually, a growing body of research has demonstrated that substantial problems exist. Investigations of the quality of reports of health and medical research in medical journals and textbooks, and of the process of medical editing, have revealed a variety of serious deficiencies and distortions, some of which pose indirect threats to the health of individuals and the wider public.

This disturbing state of affairs is beginning to be acknowledged more widely within the community of medical journal editors. There is evidence of growing concern about the patchy standards of medical editing, most explicitly manifested in successive statements by the International Committee of Medical Journal Editors (The Vancouver Group), a small group of general medical journal editors, and in a growing body of research on the quality of medical publishing, particularly that prompted by and reported at two recent international congresses on peer review.

A variety of obstacles confront editors who are committed to trying to improve medical editing. These include lack of formal training for their work, isolation from their peers, lack of ready access to information about how they might improve their practice, lack of the resources that are often required to secure statistical and methodological advice which is so often necessary, and increasing external pressure that could distort their editorial and ethical responsibility to ensure publication of full and honest accounts of research.

Medical journal editors in developing countries and of small journals face additional obstacles. Most editors of such journals edit only part-time and have had little previous experience. Often, high quality manuscripts for their journals are difficult to obtain, partly because competition for such manuscripts comes from large circulation journals, partly because medical science and medical writing may be at earlier stages of development. These editors also face scarce financial resources and have limited access to publishing and printing expertise. Those publishing in languages other than English have difficulty getting the articles in their journals indexed in the world's main medical data bases.

Recognizing their crucial role in ensuring that valid information derived from health and medical research is made publicly accessible, increasing numbers of medical journal editors are agreed that something must be done to improve the standards of their work and that of their colleagues. They understand that to achieve higher standards there is a need to improve the professionalism of medical journal editors. The skills involved in medical journal editing are not obtained during a medical career before entering the publishing field or simply through the process of editing, but are acquired through deliberate attention, study and practice. As with all professions, there is a special body of knowledge that must be expanded and refined through research. Mechanisms are needed for training newcomers to the field. Self-regulating methods must be developed to identify and help editors who perform below reasonable standards and to deal with those who do not improve.

A number of scattered initiatives have been taken to try to help the community of medical editors to raise the standards of their important work. This paper, developed by 22 medical editors and scientists from 13 countries of Western and Eastern Europe, North and South America, Africa and Asia, proposes the creation of a global organization of medical journal editors, The World Association of Medical Editors (WAME). WAME will help to coordinate and give impetus to efforts to improve medical editing worldwide, and, as a result, ensure that public investment in health and medical research yields greater dividends for the public good.

 

Common Purposes of Medical Journal Editors

The overarching purpose of medical journals (and thus of editors), regardless of language, region of the world or type of journal, should be to promote the science and art of medicine and the betterment of the public health. To achieve this purpose, key elements that editors consider include public health, science, ethics, economics, rigor, balance and breadth. Different journals and editors would have differing mixtures of these objectives and requirements according to their individual circumstances.

Specific critical objectives for medical journals include the following:

  1. To publish original, important, well-documented, peer-reviewed clinical and basic research articles.
  2. To provide physicians and other health professionals with continuing education in basic and clinical science to support informed clinical decisions.
  3. To enable physicians to remain informed in one or multiple areas of medicine.
  4. To improve public health internationally by elevating the quality of medical care, disease prevention, and medical research.
  5. To foster responsible and balanced debate on controversial issues and policies that affect medicine and health care.
  6. To promote peer review as a vehicle for scientific discourse and quality assurance in medicine and to support efforts to improve peer review.
  7. To achieve the highest level of ethical medical journalism.
  8. To promote self-audit and scientifically supported improvement in the editing process.
  9. To produce a publication that is timely, credible, and enjoyable to read.
  10. To forecast important issues, problems, and trends in medicine and health care.
  11. To inform readers about nonclinical aspects of medicine and public health, including political, philosophic, ethical, legal, environmental, economic, historical, and cultural issues.
  12. To recognize that, in addition to these specific objectives, a journal has a social responsibility to improve the total human condition and to promote the integrity of science.

The achievement of the above objectives varies greatly with the type of journal, different regions, culture, and level of socioeconomic development. The extent to which self-criticism of medical science through peer review of published material, the role of continuing medical education, the impact of traditional and alternative systems of local health care delivery, and the financial sustainability of journals may be far more critical issues in some nations and with some journals than with others.

Skills Editors Need

Few persons acting alone possess the diverse set of skills necessary to achieve the above goals and objectives, but certain skills are key.

Scientific and peer review skills. A medical journal editor must first be a medical doctor by training, should have clinical or research experience, and should have a substantial knowledge base in the journal's particular area of medicine. A medical journal editor must have knowledge of the scientific method, research, statistics, and epidemiology, and principles of evidence-based medicine, and how they are applied and evaluated. The editor must understand the science and art of editorial peer review, should promote self-criticism, and be capable of selecting, collecting, using, grading, and discharging peer reviewers from a wide range of fields. The editor must be able to evaluate the quality of the peer review itself and make decisions based on objective as well as intuitive assessment of these reviews. A personal knowledge of every scientific discipline in which one receives papers is not usually possible, even in relatively narrowly focused journals.

Organization and management skills. Editors must cooperate with numerous other individuals to guide their journal toward meeting their objectives. Editors are judged by the way they select, evaluate, motivate, and lead other individuals. In some cases, these individuals may comprise large numbers of editorial staff; in all cases, these individuals will be authors, reviewers, and editorial board members. Success or failure in this complex work will depend on the editor's knowledge of human behavior; ability to choose the right people, delegate effectively and comfortably, and evaluate the work of others; and willingness to value and reward others. A medical journal editor should be a good manager, able to organize people to achieve efficient work flow, and able to hire, supervise, lead, motivate, discipline, and dismiss people as needed. The editor should also have a sound understanding of the business of publishing, including finances, budgeting, production, circulation, and advertising.

Substantial disagreement exists over the extent to which editors should be involved in evaluating the quality and validity of advertising carried in a journal. Some believe that this is an editorial function; many believe it should be managed entirely separately by advertising and publishing staff except in areas of clear error, dishonesty, or gross lack of taste. Editors should be aware of international standards for evaluating advertising.

Communication skills. Editors of medical journals should themselves be effective communicators in the spoken and written language in which they work, possess a keen appreciation for the opinions of others, and maintain a willingness to examine different viewpoints to choose the one or several that are best for readers. A medical editor need not necessarily be an excellent writer but such a skill is helpful. Editing the language and style of manuscripts to improve clarity and readability after acceptance is necessary and must be practiced by someone in the organization. With small journals, the editor may be that person. With larger journals such duties may be delegated to editorial specialists. Editors must have open lines of communication with everyone involved in the journal's production, including copy editors, proofreaders, production operators, and all members of publishing staff (circulation, fulfillment, and promotion), and, particularly, the publisher.

Leadership, professional, and public relations skills. Medical journal editors may be called upon or have opportunity to exert leadership on issues of import to national and international health care. As visible representatives of their fields, medical journal editors may be asked to speak publicly to individuals or to groups, and sometimes to a mass audience by way of radio and television. Thus, experience in public speaking, and the ability to think adroitly and promptly in response to questions are great benefits. A medical editor needs to possess political sensitivity, exercising due judgment. Primary-source medical journals must have editorial independence from the owners of the journal. However, the editor must cultivate a healthy relationship with, and respect for, that owner to achieve successful function. In some cultures, it is of great benefit for an editor to possess enough legal knowledge or sensitivity to prevent the organization from being sued for libel or defamation or, if so sued, to be correct enough to win in a court of law. Other helpful skills include a transcultural appreciation of individuals and groups, familiarity with the medical education and research communities in the country of the journal, understanding of quality control and assurance methods, and knowledge of health economics, health policy issues and governmental politics. Perhaps, above all else, an editor must possess a high level of integrity, vision, and courage, be willing to set the agenda for a discipline or field, and demonstrate great tolerance for conflict.

Belonging to the press. Editors of medical journals should regard themselves as members of the fourth estate. Though most editors of scientific journals look upon themselves as belonging to the scientific community rather than being associated with media, they should also recognize the general principles that allow the press to flourish. Medical journals are no more neutral transmitters of information than newspapers and magazines. We select, alter, present—and sometimes produce—information, just as other media do. We are susceptible to the same kinds of infringements upon, and threats to our liberties. We depend to the same extent on the preservation of our editorial freedom to maintain our credibility among our readers and their trust in us. Medical journal editors must understand these issues to maximize their effectiveness.

 

Obstacles, Challenges and Needs of Medical Journal Editors

Most of the world's medical editors work with limited support, no training, and inadequate contacts with other editors. In many countries, editors are experienced doctors who are selected on the strength of their clinical and/or research achievements rather than on experience and knowledge about editing. In developing countries, medical journal editors share these same problems, but in addition, they often must work with limited resources and in professional cultures that do not set a high value on researching, writing, and publishing. All medical editors have needs that are not being presently met.

Information. Many medical journal editors work mostly in ignorance of the large body of knowledge and experience of medical editing. Problems arise with peer review systems, medical writing, ethical issues, production, copy editing, marketing, and, indeed, with all aspects of the complicated process of publishing medical journals. Usually medical editors must cope alone; there is no clearly defined organization to help. Some editors seek help from established colleagues of the larger journals. In one week the editor of the BMJ was contacted by an editor asking about getting his journal into Current Contents, another worried by the possibility of a libel action, and another wanted to know what to do about a possibly fraudulent paper. Most editors struggle on alone, doing the best they can. The result of the isolation of editors is that many of the medical journals that serve doctors, and so patients, are of poorer quality than they need be.

Electronic communication. A closely related need of medical editors is for easy access to information. An isolated editor might want advice on a reviewer for a manuscript or insights into electronic publishing. At the moment editors cannot find their way easily to the information that does exist on medical editing. This is especially true if they do not personally know another editor whom they can consult. The available information is scattered and often published in journals that are not read regularly by doctors. A new editor might want to be put in contact with another editor working in similar circumstances, to have a dialogue on common problems. This type of communication could be made available most cheaply and easily through a global electronic network of medical journal editors. Such an approach would be in addition to more traditional methods of communication because many editors will want information in paper form for the foreseeable future.

Editorial freedom. Perhaps the most difficult and important part of an editor's job is the maintenance of independence and integrity. Editors must have full authority to determine the editorial content of their journal. Editorial freedom is, first and foremost, a freedom from a number of threats. Government interference and censorship are relevant even to medical journals. Pressure from owners and publishers has been experienced by many editors. Most medical journals are, at least partly, financed by advertisements. Direct attempts from the advertisers—usually the pharmaceutical industry—to influence the editorial contents of a journal seem to be uncommon, but it would be naive to believe that the industry has no interest in, or impact on, what is published. The medical establishment may threaten the editor's position when new ideas are aired which do not fit in with the conventional wisdom of the medical profession, and which may be regarded as dangerous. Funding agencies and sponsors could influence the editorial process. Threat of lawsuits against journals and editors seems to be an increasingly relevant and chilling factor in some countries. Even authors and readers may, for example through boycotts, influence the contents of a journal in a way that is not consistent with editorial freedom.

Editorial freedom is, however, not only a freedom from a number of potential threats, but freedom to make the best possible, high quality, reliable and readable journal. To achieve this, the editor must have the freedom to define editorial policy, standards for scientific quality, originality, relevance and importance of papers, and must be able to put the interest of the readers before the interest of others. The editor must have the freedom to assure open debate in order to air any opinions of relevance and interest to the readers, and to offer fair treatment to authors by providing space for comments and debate. The editor must also have authority over administrative routines in the editorial office and a decisive role in the appointment and dismissal of editorial staff.

Because of the central importance of editorial freedom to high-quality medical editing and the publication of high-quality medical science, medical editors who are pressured by owners, advertisers or authors need support and advice, and, if necessary, an organization to speak up on their behalf and to publicize the facts in such cases.

Standards. The need for advice on standards and on how to raise them is paramount. Many medical editors, although keen to reach high standards, do not know what those standards are or how to achieve them. Editors, for instance, ask for advice on standards for statistical presentation or on who should be an author on a paper. Some standards have been set for medical editing—for instance, by the International Committee of Medical Journal Editors (the Vancouver Group)—but these have been set by full time editors without reference to the particular problems of isolated medical editors or editors in different parts of the world. The standards of the Vancouver Group, therefore, may have been set too high in some cases. The Vancouver Group has not organized research into many of the issues on which it sets standards, and so those standards have not been evidence based. Editors need standards that are described after wide consultation and that are based on evidence.

Education and training. One of the greatest needs of medical editors is for education and training. While no doctor would contemplate undertaking abdominal surgery without training, most doctors edit journals— and so supervise the flow of information that is vital for health care—without former training. There are many examples of doctors without any experience of editing being appointed as editors by medical societies. Training is needed before medical editors assume responsibility for a journal and while they are doing the job. New editors need courses, apprenticeships with or visits to established journals, and distance learning programs.

Medical journal directory. At the moment no directory exists of medical journals and medical editors. Nobody knows how many medical journals exist, and no mechanism exists to transmit a message to all medical editors. Such a directory could be useful to editors, authors, researchers, funders of research, and organizations like WHO or the World Medical Association. The directory would need to contain much more than the name and address of the journal and the editor. For example, it might include information on target audience, types of material published, peer review systems, frequency of publication, and subscription information.

Research on medical editing. One need that has been identified by some long-standing editors but which may not be felt by new medical editors is the need for research into the processes of publishing scientific material. Although medical editing is at the heart of the scientific process, many of its decisions - for instance, on how many reviewers to use and whether to blind them to the identity of the authors - are made with little or no research evidence. A new organization of medical editors could promote research into medical editing worldwide.

A voice for medical editors. Currently, organizations who want to consult with medical editors must speak to individual editors rather than any organization which can speak for a large number of medical editors. Medical editors need an organization to represent their interests, allow them to speak together on matters of importance to the health of the public and science, and provide a place where international organizations could consult them.

Data-bases. A particular need of editors in the non-English speaking world and the developing world is to have their journals recognized internationally. Currently their journals often are not listed on the otherwise excellent databases kept by organizations in the English speaking developed world. These editors would like regional databases.

Other important needs. Other significant obstacles to achieving an editor's defined goals are lack of financial resources and good manuscripts. These obstacles may be given different priorities in different journals and at different times of development of a journal

Two basic resources are money and manuscripts. Newly established journals and journals in developing countries are economically vulnerable. The advertising market for these journals is mainly restricted to the pharmaceutical industry, and even for a well established journal like Revista Medica de Chile, established in 1872, issues may occasionally be delayed while waiting for advertisements. The African Journal of Medical Practice, which was established from scratch in 1994 without any grant support, has had a very hard time funding the first issues. In new journals, erratic publishing deadlines can lead to the publication of suboptimal papers. Lack of sufficient financial resources not only threatens the technical standards of the journal and the frequency of publication, but may even undermine editorial freedom

Most journals depend on spontaneously submitted manuscripts, and a shortage of good manuscripts will have serious consequences. The competition for high quality manuscripts is especially stiff for medical journals in the developing world, since authors want the maximum exposure for their papers. This means that they tend to submit their best manuscripts to international journals with a high "impact factor", leaving journals publishing in languages other than English, journals with a low circulation and journals not indexed in the main data bases with fewer manuscripts, usually of lower quality.

How much collaboration among editors can help individual editors deal effectively with limited financial resources and the shortage of good manuscripts is an open question. However, in a global organization, editors can exchange information on their experiences and make suggestions to each other.

 

Existing Organizations

There are already at least 4 organizations that meet some needs of medical journal editors. The Council of Biology Editors (CBE) is based in North America, has about 1200 members, and runs courses and produces useful publications. The European Association of Science Editors (EASE) has 950 members, most of whom are British, Dutch, or Scandinavian; the Association holds conferences and produces a regular Bulletin. The International Committee of Medical Journal Editors (the Vancouver Group) comprises about a dozen, largely full-time, editors of large general journals. It meets once a year and produces statements on editing practice. The International Federation of Science Editors (IFSE) is directed more to Southern Europe, the Middle East, and Asia and holds a conference every two years.

These organizations have done good work in offering standards, training and educational opportunities, but they cannot meet most of the needs of international medical editors. The biggest problem with CBE and EASE from the point of view of medical editors are that their membership covers editors working across the whole field of science, as well as managing and copy editors. A large part of the agenda of these groups, therefore, only indirectly relates to medical editors. In addition, they are not global. The Vancouver Group is concerned with medical editors but is not global and has few members, a limited aim (primarily to produce statements on important topics in medical editing), and no resources or secretariat to meet the needs of medical editors worldwide. IFSE is an organization that is known to very few medical editors.

Proposal

Overview

We propose the creation of a global organization of editors of peer-reviewed journals, to be called the World Association of Medical Editors (WAME). The purpose of WAME is to facilitate worldwide cooperation among editors of peer-reviewed medical journals; to enhance the exchange of educational information; to improve editorial standards; to promote the professionalism of medical editing through education, self-criticism and self-regulation; to expand the voice and influence of medical editors; to develop mutual support; and to encourage research on the principles and practices of medical editing; so as to improve the quality of medical science and practice.

Membership in the organization is to be 1) editors or former editors who make or have made decisions about the intellectual content of manuscripts, who subscribe to certain general ethical and scientific principles, and whose journals also subscribe to these principles and use peer review, and 2) scientific scholars with research interest and activities in the field of medical editing.

Permanent governance arrangements for the Association will be decided over the next two to three years, along with a constitution and by-laws. For an interim period until September, 1997, governance will be by elected officers (Richard Horton of The Lancet - President, Daniel J. Ncayiyana of the South African Medical Journal - Vice President, John Overbeke of the Nederlands Tijdschrift voor Geneeskunde - Secretary Treasurer, and Drummond Rennie of JAMA - Officer at Large) and a Board of Directors (ST Lee of Annals, Academy of Medicine, Singapore, Chair, Saveli Bachtchinski of Kardiologiya, Robin Fox of The Lancet, Alejandro Goic of Revista Medica de Chile, Edward Huth of Annals of Internal Medicine, George Lundberg of JAMA, Samiran Nundy of The National Medical Journal of India, Tom Mboya Okeya of the African Journal of Medical Practice , Richard Smith of BMJ, Bruce Squires of the Canadian Medical Association Journal, and Patricia Woolf of Princeton University). The officers are to carry out day-to-day tasks and the Board of Directors are to be concerned with policy issues and the drafting of a constitution and by-laws for the Association. The Officers report to the Board.

Three committees and a task force will help in developing the Association and carrying out short-term action plans: committees on Membership, Ethics, and Fund-raising, and an Electronic Network Task Force.

Short-term action plans include the following:

  1. Publish a Report of the meeting in as many journals as possible.
  2. Contact existing editor groups (CBE, EASE, Vancouver Group, IFSE) and let them know our plans. Also, work with emerging regional groups of medical editors, such as the new group of editors in the Asia-Pacific region, APSEA.
  3. Contact world organizations such as WHO, PAHO, World Bank, WMA, NAS, and MRC to explore how we might work with them and to explain our plans.
  4. Decide on final membership criteria and a mechanism to recruit and accept members.
  5. Work with JAMA, BMJ, and Project Hope to determine what part WAME can play in the September, 1997 Prague Congress on Biomedical Peer-Review and Global Communications.
  6. Develop a global electronic communication network, which will contain a "library" of key references and articles on medical journal editing, accessible to members at any time, and an electronic bulletin board to aid individual editors in communicating with each other on relevant issues and questions.
  7. Begin creating a global directory of medical journals and their editors.
  8. Draft and conduct a needs assessment survey of medical journal editors around the world.
  9. Publish the first of periodic newsletters, both electronically and in paper form for editors not yet connected to the network.
  10. Obtain funding to begin the organization, staff a small administrative office, develop the electronic network, and plan a future meeting of Association leaders.
  11. Make preliminary plans for periodic world congresses of WAME.

Long-term plans for WAME include encouraging research into medical editing, developing world-wide standards for medical editing, providing educational workshops and meetings in various parts of the world, and fostering regional development of medical editor groups.

Detailed Deliberations Regarding Various Aspects of WAME

Electronic Network Task Force. One of the main questions the Conference addressed was how medical journal editors can create a global electronic communication network, to discuss goals and needs and share information, ideas, and solutions. A beginning network was created in preparation for the Conference. With this experience and during discussions at the Conference, it became clear that an electronic network linking all members of the Association is key to the functioning of a global group of medical editors. Other forms of communication, such as conferences, newsletters and workshops were thought to be too infrequent and too expensive for the vast majority of editors who might be members of the Association.

An Electronic Network Task Force was therefore created, with the following members:

  • Edward Huth, Chair
    Saveli Bachtchinski
    Iain Chalmers
    Lois Ann Colaianni
    Suzanne Fletcher
    George Gellert

A Working Document was produced during the Conference to guide the early work of the Task Force. The Document focused on both conceptual and practical issues in creating and running an electronic network.

Conceptually, it was decided that international cooperation among medical journal editors will depend on efficient and effective communication. A critical mass of shared editorial interest has emerged in recent years and we now have compelling reasons to collaborate on several fronts. A global organization can only survive with vigorous dialogue among its widely dispersed members. An electronic network is one means to promote such cooperation.

In preparation for the Bellagio Conference, good progress was made in establishing the infrastructure for this network, by creating a listserver with the help of the US National Library of Medicine. Several things were learned from this early experience. The advantages were clearly identified. The listserver provides a rapid, inexpensive, and inclusive means of communication. However, we encountered several difficulties. Access is not universal; taking part in an electronic network demands active effort on the part of the user; and editors have differing levels of skills to make the most of the listserver. Nevertheless, the network is in place and it has provided a valuable means for communication among many Bellagio participants.

The next step is to devise priorities for the development of the network. These are five-fold:

  1. Create a journalology database
  2. Open and operate a bulletin board
  3. Begin a directory of members/editors
  4. Provide a forum for editorial working groups, and
  5. Provide a forum for regional collaboration

For the program to be successful, more must be learned about the access that medical journal editors have to Internet. The Vancouver Group affiliation list would be an excellent place to begin such a survey.

Once the infrastructure of the electronic network is established, administration of the content of the database must be determined. The likelihood is that we will eventually need a systems operator to manage the listserver (maintain the subscriber list, change addresses, monitor use, and resolve problems). Although the US National Library of Medicine may be able to continue to help the network in the short term, in the long term, personnel will be necessary. It is likely that local help from individuals knowledgeable about computers and networks will be necessary to help some editors connect to the network. Local experts would also be valuable for regional collaboration. Finally, an editorial panel is needed to decide what should go on the network "library" database. Once substantial documentary content is available on the database, editors may be more motivated to join and use the network.

Funding of the network is an important issue. An organizational annual subscription of $100 would probably be acceptable to most journals editors, with something less for individual editors. One of our goals must be to provide on-line access for those editors not already connected to Internet. The acquisition of hardware to connect to the network will demand substantial investment for some editors, and efforts to seek such funding must be a central component of any strategy WAME uses in its efforts to gain outside support.

Membership in WAME. A Membership Committee was formed for the Association:

  • Bruce Squires, Chair
    Alejandro Goic
    George Lundberg
    Gabor Kapocs
    ST Lee
    Samiran Nundy
    Magne Nylenna
    Tom Mboya Okeyo

The Committee's task is to develop membership criteria and application forms and recruit and determine eligibility of applicants. Two categories of membership were agreed upon: Regular Members and Honorary Members. It was unanimously agreed that of the many individuals involved in editing and publishing medical journals, the membership of WAME was to be primarily medical editors of peer-reviewed journals who make decisions about the intellectual content of manuscripts. In addition, scholars and researchers who have carried out investigations into journal matters, such as editing standards, statistics in journals, informatics, and journalology, would be eligible for membership. Such members would not have a majority representation on the Board of Directors. Honorary members would be proposed to and accepted by a governing committee and would be distinguished past editors who have made significant contributions to medical editing or journalology. Honorary members would not be eligible to hold office in the Association.

Because the World Association of Medical Editors is committed to high editing and ethical behavior, it was agreed that the Membership Committee would work with Pat Woolf of the Ethics Committee to develop, for approval by the Officers and Board of Directors, a Statement of Principles for prospective members of the Association. Such principles might include:

For medical editors and former editors: 1 Accepting and supporting the Purpose and Goals of WAME, 2. Abiding by the rules of the Association, 3. Agreeing that the health of the public is paramount and dedication to excellence and fairness and to fostering and publishing truthful and accurate reporting of scientific and medical studies, 4. Committing as a medical editor to behave ethically towards colleagues, authors, reviewers and readers, and 5. Being associated with, or having been associated with, a journal that has published its ethical principles, its commitment that published articles conform to the Declaration of Helsinki as revised in 1983, its policy for peer review (this policy must, at a minimum, state that manuscripts reporting scientific and medical data are sent to independent expert reviewers and that decisions about publication of such manuscripts take such expert reviews into account), and a position supporting editorial freedom.

For scholars and researchers: 1. Accepting the Purpose and goals of WAME, 2. Abiding by the rules of the Association, 3. Accepting that the health of the public is paramount and dedication to excellence and fairness and to fostering and publishing truthful and accurate reporting of scientific and medical studies, 4. Committing as a professional to behave ethically towards colleagues, authors, reviewers, and readers, and 5. In research, abiding by ethical and other rules of relevant institutions and granting agencies.

Funding of WAME. Establishing WAME will require external funding in addition to the unpaid efforts and hidden office support that made the planning meeting possible. Indeed, many essential activities cannot be begun on a large scale until basic infrastructure, such as an electronic network with useful contents, is in place. A Fund-raising Committee was therefore appointed for the Association:

  • John Overbeke, Chair
    Robert Fletcher
    George Gellert
    Richard Smith

Two kinds of financial support are needed: start-up funds and continuing revenue.

1. Start-up funds should be requested as soon as possible to get the organization launched. The likely sources of support are foundations (such as Rockefeller), government organizations (such as NLM or the European Community) and perhaps industry (especially for WAME's work in communications). Funding might come jointly from several sources, or different donors might be asked to support distinct parts of the organization, such as a region or a technology. It is unlikely to get start-up funds for more than three years; funders will want a plan for how the organization can be self-supporting after that time.

Categories of start-up expenses are hardware, software, and technical support for the central components of the electronic network; administrative assistance and office expenses; and communication and travel costs. It may be necessary to support start-up for individual editors in resource-poor areas of the world and to set up regional list servers.

2. Continuing revenue and self sufficiency are important once the Association is established. If it makes a strong effort, the organization can expect to bring in revenue to support its own activities. Potential sources of revenue are similar to those of other such organizations: membership dues, meetings and courses, publications, and unrestricted support from industry. Decisions must be made on appropriate criteria for accepting support from industry and foundations relatively quickly.

Most foundations can give grants only to formally established, tax-exempt educational organizations. To set up such an organization will require considerable effort, time and money - for legal services to incorporate, agreement on bylaws, auditors, etc. Because this may not be possible in the short run, there may be need for an interim solution, such as affiliation with a parent organization that does meet these requirements.

WAME's Participation in the Prague 1997 Congress. An international Congress on Biomedical Peer Review and Global Communications is to be held in Prague in September, 1997, sponsored by the American Medical Association and JAMA, the British Medical Association and BMJ, and Project Hope. The purpose of the Congress is to combine the third International Peer Review Congress (with research papers on peer review) with a one-day didactic workshop on how to set up and run editorial peer review systems (with a venue for exploring various forms of peer review) and a one-day Conference on a Global Communications Network for Biomedicine (to discuss how electronic technologies will affect the dissemination of peer-reviewed biomedical information with the goal of creating a global network). Congress participants will include editors, researchers, scholars, publishers, communications experts, librarians, journalists and industrial representatives. Approximately 300 paying participants and 200-250 sponsored scholars from the South and East are anticipated.

Because many of the aims of WAME and the Congress organizers overlap, plans will be developed for the two groups to work together as appropriate. Drummond Rennie will lead this effort. It may be possible for WAME to sponsor a portion of the Congress.

Relationships of WAME to regional editor organizations. WAME could become an umbrella organization linked to existing regional groupings of medical editors as well as help with the formation of new regional groups of medical editors. Perhaps WAME could also link with project-oriented groups, such as the Vancouver Group, Peer Review Congresses, and Locknet. Collaboration could prevent fragmentation and duplication of activity. With coordination, decisions of each group could be relayed rapidly to editors via WAME's electronic network.

Long-term strategies must be considered to ensure the growth of useful linkages among all these organizations. One useful link might be to hold WAME Congresses once every four years in conjunction with regional or other medical editor meetings. If the timing of WAME meetings could be dove-tailed with regional meetings (biennially) and project oriented task-force meetings (annually), medical editors would be able to attend a major editorial gathering at least once each year.