Medical publication policies and guidelines offer a framework for best practices, but there may be situations when more than one approach seems reasonable. The primary purpose of “What Would You Do?” is to explore examples of such situations. With the limited information provided to interpret the scenarios, you may find yourself agreeing with one, more than one, or none of the proposed actions. And that’s the point ‒ you should debate, contemplate, and communicate (with a comment) before selecting your “best” answer.
Now let’s find out how you responded and read through some commentary (for context only; not meant to be comprehensive) to the below scenario:
You are a medical publication professional and have achieved acceptance of a manuscript into a top-tier journal after much discussion among authors and peer reviewers, resulting in several rewrites of the manuscript and its associated conclusions. You have now received page proofs for which comments need to be returned to the journal within 48 hours. The journal editor has made additional substantial changes to the authors’ approved text – not only for journal style, but also changing the meaning of many of the concluding statements. The authors do not agree to the changes and have complained that the journal’s actions breach ICMJE authorship criteria and Good Publication Practice.
- Accept the editor’s suggested changes so that the manuscript can get published in a top journal without further delay
- Reject the editor’s suggestions and request that the journal reinserts the original concluding statements and sends revised page proofs to authors for approval
- Reinsert the original concluding statements but modify them and/or add text to also address the editor’s comments
- Report the editor’s actions to ICMJE to solicit guidance on next steps
A total of 69 respondents replied to this poll.
According to ICMJE recommendations for publishing in medical journals,1 editors are responsible for the selection of its journal contents and have the authority to reject an article at any time prior to publication. Editorial decisions may be (and often are) driven by considerations unrelated to the quality of a manuscript, such as suitability for the journal, but are also significantly based on the quality and integrity of the work. Thus, editors may base accept/reject decisions on the validity of the work to its readership/scope and are afforded opportunities to suggest edits based on their own expert views about the therapeutic area, data, and medical interventions under evaluation to ensure the publication will be more relevant for the journal.
However, authors own the intellectual contributions and accountability for all aspects of the work to ensure accuracy and integrity.1 Therefore, the key communication points and conclusions must be approved by the authors. Editors may certainly recommend edits to improve clarity of the text or modify the content so that the communication points are more relevant to the journal’s readership, but the key results and conclusions must reflect the views of the authors. Ultimately, if the proposed editorial edits were required for the work to be within scope for publication, then the journal choice was likely inappropriate.
With these points in mind, we can now explore the different options:
Accept the editor’s suggested changes so that the manuscript can get published in a top journal without further delay. (0% of responses)
While it may be tempting to simply accept the edits and move forward with the acceptance, this would clearly be inappropriate and unethical given that the authors do not approve of the conclusions. Any edits that alter the key results or conclusions to such an extent that the authors do not approve of them should not be accepted, even if it results in a rejection.
Report the editor’s actions to ICMJE to solicit guidance on next steps. (7.2% of responses)
The ICMJE represents a small group of medical journal editors who meet periodically to discuss and establish recommendations to help promote good authorship and medical publication practices. It is not a formal oversight or regulatory body, so it would probably be ineffective to report the actions of any given journal to ICMJE. Any concerns related to editorial actions or decisions should follow any escalation or appeals process as established according to the policies of the individual journal/publisher in question.
Reject the editor’s suggestions and request that the journal reinserts the original concluding statements and sends revised page proofs to authors for approval. (40.6% of responses)
If the suggested edits alter the meaning of the conclusions to the extent that the authors no longer approve of them, then the authors/publication team should inform the editor that the proposed changes cannot be accepted, even if that means the manuscript will be rejected. However, this communication should be managed with care and respect, as it may not be well received if the editorial comments are rejected outright without context. Often, there is an opportunity to work with the editor to agree on final content that is acceptable to both parties; alternatively, the editor may withdraw the comments if the authors are firm that the conclusions cannot be changed.
Reinsert the original concluding statements but modify them and/or add text to also address the editor’s comments. (52.2% of responses)
This may be the most tactful approach. By reinserting the original concluding statements, the authors/publication team maintain the key takeaways that were originally approved. The proactive modifications made to address the editor comments would be done in a way that is under the control of (and to an extent acceptable by) the authors. Of course, it is best practice to ensure the editor is informed of how the individual comments were addressed by the authors in a point-by-point response letter.
Eric Y. Wong, PhD, MBA, ISMPP CMPPTM, Janssen Scientific Affairs, LLC
This article was prepared by the author in his personal capacity. The opinions expressed within are the author’s own and do not necessarily reflect the views of Janssen Scientific Affairs, LLC.
- Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals (updated December 2018): http://www.icmje.org/icmje-recommendations.pdf