Editorial independence at the journal.

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The title of this editorial honors Richard Smith, the outgoing editor of BMJ, who recently published a spirited and honorable editorial of his own, “Editorial Independence at the BMJ.”1 That short piece helped crystallize for us a common underlying principle as we wrangled over issues of guest editorship, outside funding for Journal publications, and peer review of various categories of papers. We began writing this editorial in March 2004 at the annual spring meeting of the Journal’s editorial board and editors. Allocating 12 months for preparation and publication of this editorial allowed us to gain additional input from the American Public Health Association’s executive board in addition to the Journal editorial board and editorial team members during the 132nd Annual Meeting and Exposition of the Association in November 2004. Genuine collaboration takes time and many drafts to get it right. The motivation for writing this piece at this particular time came not from outright threats to continued editorial independence at the Journal, but rather from our collective desire to reaffirm the core value of editorial freedom. Together, we represent the editor-in-chief (M.E.N.), the outgoing editorial board chair (K.R.M.), the incoming editorial board chair (M.L.H.), the executive editor (N.J.J.), and the publisher (G.C.B.) of the Journal. This is not our first attempt at coauthorship,2 nor will it be our last. We honor the process and enjoy the struggle of working together to uphold the scientific integrity and ethical principles that form the common mission of the Journal and the Association, that is, to continue to strive to improve public health for everyone.3 Nonetheless, we wish to underscore the very real need for a clear separation between the Journal and the Association on editorial matters, as elaborated below. As representatives of both the Journal and the Association, we agree with Smith when he asserts, “Journals should be on the side of the powerless not the powerful, the governed not the governors. If readers once hear that important, relevant, and well argued articles are being suppressed or that articles are being published simply to fulfill hidden political agendas, then the credibility of the publication collapses—and everybody loses.”1(p0) Furthermore, we want to avoid even the appearance of threats to editorial independence vis-a-vis new Journal and Association initiatives and to reassure our readers and members that editorial freedom is alive and well. This is no small affirmation. We live in a time when there are increasing attempts to censor or restrict information provided to the public under the auspices of national security.4 Limitations on societal resources for health care have reduced funding from medical schools and hospitals for the infrastructure of continuing medical education (CME); commercial support now constitutes more than 50% of the total income of accredited CME providers.5 The cumulative influence of this support is increasingly biasing CME development, presentation, and participation toward topics that benefit commercial interests.5 Smith, unconventional editor and original thinker that he is, believes that “[u]ltimately . . . editorial independence is a space in editors’ heads, a complex function of their personality, courage, power, and the pressures they feel from owners, business people, and others.”1(p0) We appreciate this belief. But given how fundamentally important editorial independence is to safeguarding the public’s health and upholding the scientific integrity of the Journal, we have elected to go public with our plan to defend editorial independence now and in the future by making this statement of our collective position.