Richard Smith: A ripping yarn of editorial misconduct

Richard Smith In what has been called the age of accountability, editors have continued to be as unaccountable as kings. But stories of editorial misconduct are growing, and another story, nothing less than a ripping yarn, has recently appeared in the Harvard Health Policy Review (2008; 9: 46-55.)
The story is told by Donald Light and Rebecca Warburton, the injured parties, and if vengeance is dish best served cold then this is a frosty but magnificent meal.

The villains are the three editors of the five editors of the Journal of Health Economics. All are professors at Harvard: Joe Newhouse, Richard Frank, and Tom McGuire. In 2003 the journal published a much quoted study from Tufts Center for the Study of Drug Development that claimed that it cost $802m in 2000 dollars to bring a new drug to market. This claim is important to the pharmaceutical industry, which uses it to justify high prices for new drugs.

Light and Warburton were skeptical of the claim and in 2004 submitted a paper to the journal arguing that the claim was unfounded. They had multiple reasons for doubting the claim, including that it depended on confidential data that could not be verified. They also pointed out that the Tufts center had received funding from the pharmaceutical industry – which was declared on its website – but that this was not disclosed to readers of the Journal of Health Economics. In addition, Light and Warburton sent the editors evidence, some of it from the BMJ, of how competing interests strongly influence study findings.

The editors of the journal agreed to publish the paper with “major modifications,” and in particular they wanted removed the “unfair claims about the motives of the … authors.” It also emerged that the editors had sent the paper to the Tufts authors for review, and they had asked for corrections of “errors,” which Light and Warburton saw as facts “fully documented” on the Tufts website. The editors insisted that the “errors” be “corrected,” and Light and Warburton gave in – wanting their paper published in the prestigious journal.

In September 2004, five months after their paper was accepted, Light and Warburton were sent a copy of a reply from the Tufts authors that was twice as long as their commentary and full of material they regarded as dubious together with “personal attacks on our professionalism and competence.” They had two weeks to produce a response, which they did, but the editors insisted on removal of material that suggested that the results may have been influenced by competing interests.

McGuire in an email to Light and Warburton used a phrase that became very significant: “basically accept my chops on your rejoinder and get it published soon in the JHE” or take your critique elsewhere. Light and Warburton describe this as “ultimatum editing” but decided to accept under protest.

But then in January 2005 the editors pulled all the papers out of production without giving a reason. In March 2005 the editors said they would publish the papers but only if 100 of the 132 lines in Light and Warburton’s rejoinder were deleted.

With great reluctance, Leigh and Warburton accepted what they regarded as grossly unfair treatment – but simultaneously “searched frantically for some avenue of recourse or appeal.” Professional bodies were of no help, and “eminent editors reaffirmed that we were powerless.”

But then – it’s the American way – they turned to lawyers. Alan Milstein, “a litigator known for his creative and aggressive style,” offered help without a fee because “this is an important case.” Milstein through that McGuire’s reference to “accept my chops … and get it published in the JHE” amounted to a contract, He drafted a complaint that alleged “multiple breaches of contract and violations of academic freedom by the editors personally, the Journal, its Editorial Board, and Elsevier [the publishers].”

At this point Light and Warburton though that they may be going too far and sought help from Tony Culyer, a British economist and member of the editorial board of the Journal of Health Economics. They did, however, let McGuire know that a prominent trial lawyer was ready to litigate against him and the journal in a federal court. Unsurprisingly he was “stunned” and thought something could be worked out.

A combination of the threat and Culyer’s diplomacy meant that the papers were eventually published in July 2005, but Light and Warburton felt betrayed in that unbeknownst to them the editors had allowed the Tufts authors “greater length and latitude” for a last word response.

Leigh and Warburton believe that the editors of JHE have “violated … almost every ethical standard established for editors.” No doubt the editors will have another view, but there has until now been no forum for deciding whether there has been misconduct.

The story does, however, have a happy ending in that Elsevier has now signed up all of its journals to be members of the Committee on Publication Ethics (COPE). Whether they like (or even know) it editors of all of these journals are now required to follow the codes of COPE and complaints against them can be considered by COPE. Self regulation is underway – about 200 years after it began for doctors.

Postscript: Since I drafted this blog and disappeared for a few days into the wilderness of the Scottish borders, access to the website of the Harvard Health Policy Review has been blocked.

Competing interest: RS has written repeatedly on editorial misconduct, is quoted in Light and Warburton’s article, and was one of the founders of COPE. Not only will he not benefit financially from this article but he has lost – because he has spent time when he could have been earning money writing this blog for which he will not be paid.