The author of an accepted research paper (that showed some benefits for a controversial treatment) contacted the journal shortly prior to publication of the paper. It is the policy of our journal not to share commissioned editorials with authors ahead of time. This author had, however, received a copy of the journal press release in preparation for a press briefing. The press release quoted statements from a commissioned accompanying editorial that concluded that "a clinically useful effect [for the treatment] remains uncertain..." and pointed out some shortcomings of the paper.
The author contacted the editorialist directly to obtain the full text of the editorial, and complained to the editorialist and the journal about its content. The editorial was revised to take some but not all of his complaints into account. The author requested that he be allowed to read the revised editorial and suggested that it should be sent for peer review. These requests were refused.
However, at a press briefing just prior to publication, the authors saw a final version of the revised editorial. They contacted the journal and indicated they were dissatisfied with the revised editorial. They asked to have a lengthy letter rebutting the editorial posted online simultaneously with publication of the editorial.
They were directed to follow normal procedures for posting a response to a paper, which includes waiting until it is published and adhering to other standard procedures for commentary on a published paper. The authors were not satisfied with this suggestion. After negotiation, a compromise was reached which allowed posting of a longer than usual letter the morning after the editorial went online.
Questions for the COPE Forum
• Does the Forum think it is good practice to share the content of linked editorials with the authors of the relevant paper? Should the journal change its long-standing policy not to share? • What is the Forum’s view on whether commissioned editorials should be sent for peer review? If not routinely, then should that have been done in this case? • How should the journal respond to the behaviour of the lead author? Contacting the editorialist directly to obtain a copy of the editorial, and corresponding with that person directly over the holidays, is not typical behaviour and clearly made the editorialist feel uncomfortable. • The journal declined to publish the authors' rapid response alongside the editorial when it went online. The journal decided that the authors should go through the usual process of posting a rapid response to the editorial after publication, and that it should be vetted in the usual way. Was this the right decision? • Should the journal have allowed the editorial authors to see this very critical rapid response before publication, so they had the chance to respond quickly?
The Forum suggested that journals do have a journalistic role—they commission editorials—and hence have a right to voice their view. However, it is important to manage expectations, to ensure all parties are aware of the situation and the process for linked editorials, and to treat everyone the same. For example, were the authors aware they might have a commissioned editorial on their paper and that this would not be shared with them before publication? It can be alarming for authors if they do not know there is going to be a press release related to their article, especially as the author contact details are often in the press release so that they can be contacted for interview by the media. If it is a third party issuing the press release, there is little the journal can do. For high profile research, with extracts from the paper leaked, it can provide an opportunity for the author to influence process. In these situations, the journal can only manage expectations in relation to its own journal processes.
The Forum agreed it is fine for authors to have the right of reply post publication (via comments/rapid response) if that is made clear in the journal policies, and as long as the editorial is appropriate and fair. Some journals limit communication to one round of exchanges only, published online or in print.
If it is a straightforward commentary, it should not need to be peer-reviewed. Standard practice is not to peer review commentaries. Several Forum members stated that standard practice in their journal was for authors not to see linked editorials or commentaries, although authors are informed there is a linked commentary to their article. Informing authors is important, especially if there is a delay in publication or if the two articles are published simultaneously.
If a journal thinks an editorial might be controversial, the editor should consider having it peer-reviewed. Many journals have provenance statements, indicating whether or not an article has been peer-reviewed. The editorial can be peer-reviewed by the reviewers of the original article, or it may be appropriate to use different reviewers if the piece is very critical of the original article.
In summary, the editors should manage the expectations of the authors by having guidelines in place for their process of issuing press releases and how they alert authors, along with their policies for handling post publication commentaries. The process needs to be very clear so that the authors are not taken unawares.
We discussed the matter with our internal ethics committee who were supportive of the journal’s approach to linked editorials—specifically, they agreed that the journal should not share them before publication. We have now started writing to the authors of papers scheduled for press release, explaining why we do not share, and asking them not to contact editorialists directly. Our press officer has agreed not to put links to editorials in the press release sent to paper authors for approval. The link goes back in before release to journalists.
We have been sending authors these letters for several months, and the editorials’ editors have commented that "most authors seem appreciative”.
A letter to the editor from reader A was received by our journal concerning a published case history from author B. Reader A questioned the choice of treatment and author B's conclusion regarding the reason why the patient died. We believe this case raises at least two interesting questions.
Firstly, the patient, or in this case the patient's relatives, could possibly suffer an additional burden by having their understanding of the course of events challenged. Speculations about treatment and course of events from health personnel or others, who do not know the patient beyond the published history, may expose the patient/relatives to groundless concerns. Our journal requires consent for publication from the patient/relative(s) when publishing case histories, but the consent applies to the published article as such. Hence it does not include further discussion or comments from others in the journal or elsewhere after publication. One could argue that this is implicit when giving consent, but one cannot expect patients to know or reflect upon such matters. In other words, is the consent truly informed?
Secondly, the authors have access to a lot more medical information about the patient than they have chosen to publish. The consent only applies to the published material. In further discussions, they cannot answer properly without breeching confidentiality or collect further consent. Hereby the risk of a delayed debate, a debate that gets too general and in which the opponents (who are only able to speculate about the further details) get the last word.
The case was resolved by carefully moderating the letter to the editor in cooperation with reader A.
Planned further steps by the journal for future cases:
• Such debates must be modified with the patient's interest in mind. • Include a sentence in the consent form informing the patient about the possibilities of post publication debate. • Possibly include a disclaimer on such debates, informing about the limits of such debate? • Possibly include a reminder about the patient's perspective in the author guidelines for debate?
Question(s) for the COPE Forum
• Is it justifiable, ethically, to let readers speculate on the patient's diagnosis, the choice of treatment, etc? • Have any of the Forum members had similar discussions in their respective journals? • Are the steps taken/planned reasonable? • Does the Forum have additional advice on how we can avoid such problems in the future?
The Forum suggested that the steps outlined by the journal as a way of proceeding are good and reasonable. If the post-publication comments are informed, then it may be fine to publish them but this must be done carefully. Peer review can be helpful here.
Letters to the editor commenting on case reports could include disclaimers, and it is important to remind people to think about the patient and their family.
While an ethical framework is needed, the journal also has a responsibility to encourage debate, but in a sensitive and cautious way. For example, this can be an opportunity to allow input from people with whom the patient might not ever have access. The framework within which this happens is important.
The most intriguing case reports often have an aura of ‘mystery’, treading a fine line between the ‘obvious’ versus the ‘suspense’ of whether the patient did get the right treatment but this should not compromise accurate reporting or condoning poor practice. Authors need to be upfront about the details of the case, including the diagnosis. Authors should not disclose additional information after publication. Post-publication speculation must be handled carefully as it can be distressing for the patient and the patient’s family.
The first author of a paper rejected by our journal publicly identified one of the four peer reviewers for the paper by name. She did this during a media interview conducted after the paper was published by another journal. The first author implied in that interview and subsequently on Twitter that the paper was rejected because of that person's review and also claimed the reviewer did not reveal relevant COIs.
This complaint received a great deal of attention because the rejected paper had a direct bearing on a very bitter medical/political matter, and its results were felt to bolster the case for one faction. The authors had not lodged a formal complaint with our journal about this matter. We usually do not comment on papers that we do not publish, so when contacted by the press about this accusation our initial response was to "neither confirm nor deny" that we had considered the paper. It soon became clear, however, that the reviewer was the subject of much unpleasant comment on social media and other vindictive behaviour. A colleague of the reviewer, for example, tweeted that he was "ashamed" to be a professor in the same institution as the reviewer. The reviewer also received two freedom of information requests asking for any correspondence with the journal and anybody else concerning the rejected paper.
What the journal did:
1. We immediately contacted the authors to let them know we were disappointed in their behaviour. The authors acknowledged their mistake and had already contacted the reviewer to apologise. The reviewer accepted the apology but expressed the hope that we would make his review public, saying "I am continuing to get emails from people who are assuming that I wrote negative reviews for the paper and raising questions about conflict of interest. I believe my reviews to have been supportive of publication and not to comment on whether the journal should accept or not. So from my point of view it would be helpful if you could publish my reviews regardless of whether the other reviewers agree to this..."
2. The other reviewers and the authors agreed that we could make this matter public, so we broke with precedent and published a blog. We received mostly positive comments on Twitter and in the comments section for the blog.
3. We have also amended our instructions for authors on the journal website to say "For rejected research papers, we expect that authors will keep the identity and comments of peer reviewers confidential. They may, however, share the peer review comments (although not peer reviewer names) in confidence with other journals. Authors should contact the editor who handled their paper if they have any complaints about the peer review process or the behaviour of the peer reviewers."
4. We have also amended our rejection letters to say "Although the journal has an open peer review process, in which authors know who the peer reviewers were, we expect that you will keep the identity and comments of the peer reviewers for this paper confidential. You may, however, share the peer review comments in confidence (although not the names of the peer reviewers) with other journals to which you submit the paper. If you have any complaints about the peer review process or the conduct of the peer reviewers, please contact the editor who handled your paper. Please do not contact the peer reviewers directly."
5. We continue to follow-up periodically with the reviewer to make sure he is not suffering any additional ill effects from this incident.
6. We are submitting this case to COPE and will also be referring it to the journal's internal ethics committee. The matter now seems to have died down, but it raises many questions.
Question(s) for the COPE Forum
• Should the journal have handled this differently?
• Should the journal formally notify the first author's institution about her behaviour?
• Are the additional instructions to authors on our website and in rejection letters adequate? Should we do anything else to prevent this from happening again?
• Should peer reviewers who do research in the same field as authors of a paper declare this as a COI? If so, when? Almost all reviewers are chosen because they have expertise in the same field, and commonly their conclusions have differed in some respects from those of the authors. At present very few reviewers list this among their COIs.
The Forum agreed that the journal did a good job here, and has taken reasonable steps to change their process and avoid a similar situation in future
The Forum discussed whether the author was under pressure by a media interview and gave a comment afterwards for which they later apologised, or was it deliberate on the part of the author as the paper was published in another journal and this was an “attack” on the reviewer for the journal that rejected the paper. The Forum was ambivalent on whether the first author's institution should be contacted. It is possible that the institution is already aware of the case (because of the media coverage) but the institution could be contacted in neutral terms although it is unlikely that the journal could expect much action from them.
Regarding conflicts of interest, being in the same field is not in itself a conflict of interest—in fact it is usually a reason to pick a reviewer. Because experts in the same field have interests that are similar, they may unfairly be perceived to have a conflict of interest. However, sometimes reviewers do have conflicts of interest so it may be helpful to include instructions with some clarifying exemplars to help reviewers to identify conflicts of interest. For example, if a researcher has built a career on a particular view and are ‘famous’ for holding that view, that could be a conflict of interest. The advice was to ensure that the journal’s guidelines to reviewers regarding conflicts of interest are up to date. The COPE discussion document may be helpful in this regard (http://publicationethics.org/files/u7140/Discussion_document__on_handling_competing_interests.pdf)
Peer review in all its forms plays an important role in ensuring the integrity of the scholarly record. The process depends to a large extent on trust, and requires that everyone involved behaves responsibly and ethically. Peer reviewers play a central and critical part in the peer-review process, but too often come to the role without any guidance and unaware of their ethical obligations. COPE has produced some guidelines which set out the basic principles and standards to which all peer reviewers should adhere during the peer-review process in research publication.