Editors' personal agendas endanger credibility of journals

Medical editors no longer seem happy to sit behind a desk, report the news, and take a neutral stance. Increasingly, they are making headlines themselves and achieving near-celebrity status.

Take the case of Dr. Richard Horton, editor of The Lancet. Throughout this year, he has robustly defended his decision to publish controversial research about the number of civilian deaths in Iraq since 2003. In late September, he condemned "Anglo-American imperialism" at a demonstration against the wars in Afghanistan. Such is Horton's public prominence that if he were to Google himself, over 150,000 items would pop up in the search engine.

Horton claims he is merely publishing epidemiological research. He points to the role of The Lancet since 1823 as a reforming medical newspaper and an independent voice. His personal reputation was badly tarnished in 2004, however, when he was forced to make a public apology for publishing a flawed study by ex-colleague Dr. Andrew Wakefield, who alleged that the MMR (measles, mumps, and rubella) vaccine was linked to autism. It remains to be seen if Horton can survive.

Other editors of international journals are also making the news. In August 2005, Journal of the American Medical Association editor-in-chief Dr. Catherine DeAngelis was at the center of a dispute surrounding publication of a review of fetal pain. There was widespread criticism of JAMA's failure to disclose the authors' abortion-related work. The former interim editor-in-chief of The New England Journal of Medicine, Dr. Marcia Angell, caused a storm with her 2004 book, The Truth About Drug Companies: How they deceive us and what to do about it. She sought to expose what she saw as the stranglehold drug companies have over clinical trials and the practice of medicine.

Dr. Fiona Godlee, the first female editor of the British Medical Journal, has played a leading part in the current debate over publication ethics. Over the coming weeks, she is running two master classes for general practitioners. In some respects, these developments are healthy. They show the medical press is alive and well and addressing issues of public concern.

Nonspecialist journals face a battle for survival in a harsh commercial environment, particularly because the trend toward subspecialization in medicine shows no sign of slowing down. Librarians face constant budget cuts, and competition for doctors' reading time is intense. To maintain circulation and profile, the editor's strong views and a distinct editorial stance are a title's crucial weapons.

The danger, however, is that the cult of personalities takes over, as is happening in so many walks of life. Editors exist to serve their readers, not to pursue personal campaigns and their own agenda. As soon as they lose sight of this golden rule, their publications' credibility will fall dramatically.