© 2004 American Thoracic Society
Taking Leave of an Agreeable CompanionThis is my last editorial as editor of AJRCCM. As such, it is an opportunity to cast a backward glance and look at our journey over the past five years. As I write I am looking at my first editorial in September 1999, which contained a vision for the subsequent five years. In it, I commented on the importance of rigorous peer review, the need to capitalize on electronic technology, cross-fertilization between physicians and Ph.D. colleagues, a plan for more review articles, and a desire to provide readers with a sense of community. We followed many aspects of that overall strategy, as I discussed in a recent editorial (1). To develop tactics for that strategic plan, I read everything I could find on medical editing in the ten months between my appointment and starting the job. I recall being struck by a sentence of Franz Ingelfinger's. He commented that a physician who takes over as editor faces questions and decisions for which life in medical schools and hospitals provide little training. But he gave no specifics. I probably thought his words did not apply to me, as I felt fortunate in having served a seven-year apprenticeship as an associate editor under two excellent AJRCCM editors, Bob Klocke and Alan Leff. Not long after starting, I encountered several challenges that fell under the rubric of integrity of the literature—a concept to which I had previously given little serious thought. As an associate editor, I had received much confidential information (mainly reviewer critiques). Now, however, I was receiving messages from whistleblowers about ethical problems. I was startled when a reader said we had published a study (involving considerable risk to patients) containing no mention of ethical committee approval. I was more startled when I looked up our Instructions for Authors, and saw we did not require such a statement. Subsequently, I received several allegations of duplicate publication, excessive data fragmentation, disputed authorship, plagiarism, undisclosed conflicts of interest, and fraud. I now understood the point Ingelfinger had been making. To get advice on problems posed by one manuscript, I spent more than a hundred hours talking to individuals dispersed across the country. Some of the advice was conflicting. I realized at the end of the day only the editor would carry responsibility for the final decision. Based on these experiences, and to educate readers about challenges to the integrity of the literature, I wrote editorials explaining the Journal's policies on duplicate publication, retractions, conflicts of interest, and peer review. Research is viewed as objective and impersonal. Yet it depends more on social interactions than most endeavors. Over the past twelve years, I have gained a deeper appreciation of the social infrastructure of science. Progress in science is achieved through the collective activities of authors, reviewers, and editors. And being able to see this community of scholars in operation was my single greatest inspiration over the years. First is the enormous number of authors. It is the succession of small contributions by non-famous individuals, rather than the occasional breakthrough, that accounts for most of our scientific understanding. Each scientist is functioning like a dot on a Pointillist painting. Up close, the points of color are amorphic and inconsequential. Only when you stand back does the beauty and coherence of the canvas emerge. Likewise, the interaction among researchers as a community—authors and reviewers—achieves a collective effect far exceeding the sum of individual efforts. Next come reviewers. I cannot imagine any experience in biomedicine that tells you more about individual researchers than asking them to review manuscripts. Being anonymous, the task has no external rewards. Some reviewers have no sense of social responsibility: they invariably refuse, or are constantly late or superficial—or, worse, capricious. Editors avoid these individuals. An experienced editor identifies another group that is thorough, judicious, demanding—but fair. Editors treasure the latter group, and learn that these reviewers determine the overall standing of a journal. Many authors, however, fail to recognize how reviewers improve their manuscripts. It is only after reviewers have forced authors to explain more clearly what it was they did that the greater significance of their work commonly emerges. I recall a phone call from an experienced, senior investigator who wanted me to disclose the name of a reviewer of his manuscript. Such requests—which are never granted—usually stem from fury toward the reviewer. This author, however, said that the reviewer's critique had led to such fundamental changes in the data analysis, interpretation, and conclusions of the manuscript, that he believed the reviewer should be a coauthor—perhaps even first or senior author—on the paper. Associate editors constitute the third layer in the social structure of a journal. From the outset, I knew that picking this team, more than any other factor, would decide the success of AJRCCM over the subsequent five years. Accordingly, I spent months getting candid advice from respected scientists around the world. I then followed the advice in leadership manuals and appointed individuals more talented than me in several respects. I recall chairing our first day-long retreat, and finding the assembled talent most intimidating. The associate editors had one over-arching goal: to leave AJRCCM in better shape than they received it. Their only agenda was to raise every aspect of the Journal's performance, and not simply look after the interests of their own subdiscipline. Whether they succeeded or not, is for others to say. If they failed, it is not for lack of hard work. In my career, I have never seen individuals coming from so many different backgrounds who were more committed and more selflessly devoted to one common goal. Only from an editor's perch can you get a broad panoramic view of this community of scholars—authors, reviewers, associate editors—in action. Only an editor can see the countless hours that reviewers and associate editors spend in trying to improve another person's manuscript. Although a community encourages members to help one another, it also sets standards of expectation for individual members. Over the past five years, reviewers and associate editors raised the bar for acceptance of manuscripts at AJRCCM; by so doing, they motivated fellow researchers to a higher level of excellence. Members of a community want to belong to a process larger than themselves, but the sense of wholeness or togetherness should not smother diversity. And a community must never allow dissent to be viewed as disloyalty. Before starting the job, I never imagined my most profound experience would be in seeing, first-hand, the fundamental importance of free speech. Freedom to express unpalatable viewpoints assumes greatest importance when the ideas impact patient safety. When new ideas are reported, the way to respond is to verify or refute them through additional study, not to censor them. Individuals wanting to suppress dissident views believe the general readership is not sufficiently sophisticated to properly interpret the information, and the field would be better served if an elite group of experts were to make a pronouncement on the subject. Over the past five years, many viewpoints were published in AJRCCM with which I disagreed—but an editor must never allow personal bias to control such discourse. All the daily activities of authors, reviewers, and editors are directed at one purpose: to better serve readers—who through their silence and invisibility risk going unnoticed. Without readers a journal has no meaning. When starting as editor, my greatest wish was to create an expectation that each issue would contain something of interest, so that readers would want to open the plastic bag as soon as the journal arrived. Today, most readers see the Journal online before it arrives in the mail. I would like to think that the twenty-fold increase in number of hits over the past five years is an electronic surrogate for the sound of more plastic bags being ripped open. Steering the Journal over the past five years has been a challenge. We sailed into uncharted waters when switching from paper manuscripts to online submissions. We encountered several choppy and unpredictable waves, and came close to foundering on the rock of relocating the peer review office. The voyage involved a lot of work, but most of all it was exciting and exhilarating. We wish Ed Abraham and his team every success as they sail to the next port, and hope they enjoy the voyage as much as we did. Any human endeavor contains flaws. I know we fumbled and failed in attempting to achieve some of our ideals. It is impossible to evaluate more than 8,000 manuscripts and not make some wrong decisions. To authors who got their manuscripts unfairly rejected, I am sorry. Completing a difficult task brings happiness, but also a sense of loss. That mixed feeling was well described by Edward Gibbon, author of The Decline and Fall of the Roman Empire, the greatest prose epic in the English language. When laying down his pen after writing a million-and-a-half words over twelve years, Gibbon felt proud: "But my pride was soon humbled, and a sober melancholy was spread over my mind, by the idea that I had taken an everlasting leave of an agreeable companion." I know I likewise will miss this job. But I feel extremely fortunate in having had the opportunity to serve the authors and especially the readers of AJRCCM over the past twelve years. FOOTNOTES Conflict of Interest Statement: M.J.T. is editor of AJRCCM. He receives a fixed stipend from the American Thoracic Society. He does not receive financial support for research from pharmaceutical, biotechnology, or medical device companies. He does not serve as a consultant to or on the advisory board of any company. He receives royalties for two books on critical care published by McGraw Hill, Inc. REFERENCES
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