Can you trust what you read in journals? How would you know if you couldn't? Consider the following examples that illustrate how information presented in professional journals can be compromised.
In 2004 Joseph Herman, then executive editor of Dialysis and Transplantation, solicited a guest commentary on a study, which noted that the data showing the effectiveness of high doses of epoetin alfa in patients with end-stage kidney disease were insufficient. When the marketing director learned of the article, he demanded it be pulled.
"Unfortunately, I have been overruled by our marketing department," Herman wrote in an e-mail message to the author. The marketing director knew what the drug's manufacturers had to lose: on May 9 of this year, the New York Times revealed that erythropoietic agents are the "single biggest drug expense for Medicare" and that worldwide sales in 2006 reached $10 billion. But in March the Food and Drug Administration issued a public health advisory, saying that these drugs can hasten the progression of cancer and heighten the risk of deep vein thrombosis, cardiac problems, and death.
In 1999 editor-in-chief of the Journal of the American Medical Association (JAMA) George Lundberg was fired for publishing a study of college students' perspectives on oral sex, at the time President Bill Clinton's affair with Monica Lewinsky was making headlines. The AMA accused Lundberg of "inappropriately and inexcusably interjecting JAMA into a major political debate." The AMA was roundly criticized, and the journal subsequently formed a journal oversight committee (JOC) to ensure the independence of editors.
In June 2006 AJN published a letter signed by 60 editors of nursing journals that was sent to the American Nurses Association (ANA) expressing concern about its decision to end its relationship with AJN. Several editors of society journals e-mailed me to say that their societies told them they couldn't sign the letter.
One wrote an editorial about the split that was edited by her journal's society against her wishes (although not all of the society's changes were made). Several editors told me that their societies didn't want to anger the ANA.
AJN and other nursing journals are not exempt from pressures to skew the information they publish. While I haven't been pressured to skew information, with the loss of the ANA contract in 2006, AJN has experienced financial pressures that I worry could undermine the journal's integrity. AJN's publisher, Lippincott Williams and Wilkins, a division of Wolters Kluwer Health, has agreed to form an AJN JOC-the first for a nursing journal-to ensure that we continue to publish articles that readers can trust.
AJN's JOC will
* review the journal annually to ensure the excellence of its editorial content and overall direction.
* review the performance of the editor-in-chief.
* make recommendations on the retention of the editorin- chief and future hiring of editors-in-chief.
* assist in conflict resolution between the editor-in-chief and the publisher that can't be resolved otherwise.
On the first AJN JOC are Annette Flanagin, MA, RN, FAAN, managing deputy editor of JAMA; Donna Diers, PhD, RN, FAAN, Annie W. Goodrich professor emeritus of the Yale University School of Nursing and senior clinical coordinator, Yale-New Haven Health System; Faith McLellan, PhD, North American senior editor, the Lancet; Cheryl Smart, MA, MBA, publishing consultant; and Kevin Fitzpatrick, RN, PA-C, vice president of business development, Lippincott Williams and Wilkins. I'm grateful for their commitment to this important work.
This step is in line with others we've taken: adopting the standards set by the International Committee of Medical Journal Editors, requiring authors and reviewers to disclose conflicts of interest, and editing to ensure that published articles are balanced, accurate, and free of plagiarism (see page 78). Other publishers and nursing societies should follow suit.