An edited excerpt from Chapter 5 (the 1990s), with photographs taken on medical journal editors' courses in the UK and Australia.
One lunch-time in the middle of the 1990s I strode up the imposing staircase in the Regent’s Park headquarters of the Royal College of Obstetricians and Gynaecologists. Half way up I realised that something was amiss. On the wall, among the pictures of college presidents, each dripping with gravitas, was a dust-lined gap as stark as an extracted tooth. The portrait of Professor Geoffrey Chamberlain, president until recently, had been taken down.
Professor Chamberlain had found himself in disgrace, not for the usual reason of hands in awkward places (bodies or bank accounts), but for the relatively new offence of publication fraud. As editor of a prestigious medical journal he had been imprudent enough to agree to fast track (without sending out for peer review) a ‘breakthrough’ paper from a colleague, Malcolm Pearce. He had also allowed his name to appear as a co-author.
After a tip-off it emerged that the successful resolution of an ectopic pregnancy, as described in the landmark paper, never happened. Malcolm Pearce was struck off the medical register. Professor Chamberlain was stripped of his presidency and went into exile at a university in Wales. These events startled the medical establishment, and helped to push me deeper into the world of science – to be precise into the world of medical journals, of which I knew very little.
Medical journals had boomed since the end of the second world war. One of the first to benefit was the publisher Robert Maxwell, later proprietor of the Daily Mirror and embezzler of some of my former colleagues’ pension funds, who later disappeared off his own yacht. The fortune he squandered was founded on his shrewd realisation that a good business to be in was one that obtained its raw material – in this case academic and scientific papers – without having to pay for them.
By the 1990s thousands of journals were making billions of pounds in profits for their publishers and playing key roles in the world of medicine and health care: validating science, disseminating knowledge, helping to market pharmaceutical products, influencing the careers of doctors, and determining where research funds would be invested.
The Pearce case, and other deceptions, suddenly made it clear that the trust put into medical journals had to be re-established, and fast. In the UK the charge was led by two new and dynamic editors, Richard Smith of the British Medical Journal and Richard Horton of the Lancet. They encouraged research into journal custom and practice, and set up an ethics committee to look at breaches. They also started to think about training.
Editors of most medical journals were essentially amateurs, though they hated the description. They were chosen for their knowledge of their specialty. Like their authors, they were not paid, and their main reward was the enrichment of their CVs. In stark contrast to their medical and clinical activities there was no qualification needed to become an editor, and indeed few (if any) training courses to help them in their role.
The two Richards asked me to design and run a course. I worked out a programme, based on four themed sessions - publishers, readers, authors and the public – and assigned parts of it to a distinguished faculty of five, including my two sponsors. We held the first two-day course for medical journal editors in 1996 in a hall of residence at Nottingham University, where Richard Smith was a visiting professor.
The faculty riffed gloriously and were immensely entertaining. At the end of the course participants were enthusiastic. ‘Excellent teachers – lively and supportive and witty atmosphere,’ wrote one.
But there was a downside: as one of the participants noted afterwards, some of the content was a ‘little skewed’. The faculty largely ignored the dreary constraints of time-keeping, leaving my carefully designed curriculum in tatters. The sessions we never got to included one on press releases and (embarrassingly) another on time management.
Another problem was that the faculty came from successful and profitable journals with large staffs, copious funds and a stream of unsolicited high-quality submissions. But most of the participants, they pointed out, were part-time editors of small specialist journals, struggling for profits and contribution.
We all did the course again the following year, with mild modifications. The same problems arose, and once again we had no time for press releases and time management. ‘The editors were very good value but they did occasionally take over’, wrote one participant afterwards. And another: ‘Writing press releases would have been helpful. Stick to the programme’.
I had a bullet to bite. I proposed that the course should change from being a loose succession of talks and exercises to an integrated, strictly timetabled event with clear learning goals – and only two facilitators, myself and my mate Harvey.
A proposal that the country’s two most influential medical journal editors should fire themselves was unlikely to be a good career move. But they kindly agreed, accepting (as editors should) that it was unfair to give me all the responsibility without any power.
So on the third year I found myself standing in front of a room-full of distinguished scientists. I tried telling myself that when it came to communications I was the professional and they were the lay people; it helped but only up to a point.
I was able to apply the training techniques I had learnt from my course with John Townsend. I got rid of the U-shaped table and place the 24 or so participants seated in small groups around tables – the so-called ‘cafeteria style’. We increased the amount of time for the groups to tackle joint exercises and come up with group solutions.
One reason for devolving the learning into the groups was that, as our pre-course questionnaire clearly showed, what the editors wanted to learn was very different from what we wanted them to learn. For many the main priority was how to send their journal moving upwards in the highly competitive league tables. These were based on a metric called the Impact Factor, based on the assumption that the value of a journal could be measured by how often its papers went on to be cited in other journals.
The flaw, I later learnt, was succinctly summed up by Goodhart’s law: ‘When a measure becomes a target, it ceases to be a good measure.’ Editors were beginning to use all kinds of tricks to massage their figures – one shameless wheeze involved accepting papers for publication only on condition that they had several references to their journal.
Harvey and I headed for the moral high ground. We argued that the best way of improving a journal’s ranking was not to manipulate it but to publish good quality articles that would be read and talked about. We encouraged them to identify ways of doing this, such as trawling conferences for interesting papers, treating authors well (a novel idea for some), and holding good parties. Quite a few of the editors remained unconvinced. Sadly the impact factor continues to dominate academic publishing, which is fine for those with higher scores, but makes it needlessly difficult for others.
Conscious of research suggesting that advances in papers often took several years before they were used in clinical practice, we were particularly interested in nudging editors towards improving the ways they communicated their findings. We spent one of the four sessions going through the basic journalistic techniques of attracting readers, such as adding pictures, using clear English (that caused some concern), and using the front covers to entice people to look inside.
When we did a course for Scandinavian editors this last suggestion proved to be an idea too far. The editors were horrified, and made it clear that in their view anything other than a title and a date on the front cover would be inexcusably vulgar.
Fortunately this was to be an isolated case. Somewhat to my surprise many participants said they found this brief foray into the tricks of communication most interesting. One editor went so far as to admitting: ‘I have been an editor for many years but I have never thought of my readers before’.