Our study's low response rate inhibits our ability to draw robust conclusions. It demonstrates in the respondents a high degree of consensus that editors would comply with the Declaration of Helsinki in rejecting publication of ethically suspect research submitted for review. This would seem to be consistent with the findings of Brackbill and Hellegers published 30 years ago but is similarly limited to by a relatively poor response rate. We have attempted to identify the rationale given by editors in considering rejection of ethically suspect research. Those editors that did respond indicated that deterrence to future submission of unethical research, a desire to comply with international regulations and a feeling of responsibility to the public and scientific community all play a roll in their decision to reject such manuscripts.
Given the high degree that the responding editors indicated they would not publish ethically suspect research, one might expect that nearly all of the respondents and their journals would specifically instruct reviewers to examine submitted manuscripts for adherence to applicable ethical regulatory guidelines and indeed most do. We have corroborated this finding in a separate study that directly examined instructions to authors [15]. We further noted that just 38% (n = 13) of journals would specifically instruct their reviewers to reject manuscripts based on ethical grounds alone. Again, we cannot draw a definitive conclusion but believe this may be a lost opportunity to proactively harness the strength of the scientific community in assessing and recommending rejection of unethical research. This could be rectified with relatively simple additions within the instructions to reviewers.
In an editorial in the British Journal of Medicine in 2004, Fiona Godlee states that "editors have no mandate" to govern their conduct [16]. Although agencies such as the Committee on Publication Ethics (COPE) and the World Association of Medical Editors (WAME) have attempted to publish codes of conduct for editors specifically, breeches of them are unenforceable as they have no legal jurisdiction [17–19]. Such codes have been in existence long before we conducted our survey. Should we be encouraging mandatory membership of all medical journals to a regulatory body that holds each accountable? Or does this dissuade the high degree of academic freedom that many editors enjoy?
Although editorial adherence to guidelines is encouraged and even expected, it remains variable how such codes are interpreted and implemented. Godlee as one of the founders of the first iterations of COPE guidelines, states that editors may be tempted to simply refuse to publish a paper based on "other" (presumably ethical) grounds alone [17]. COPE mandates that this alone, is not appropriate and states that editors should investigate all serious allegations fully so as editors take their role as "guardians" of the biomedical literature seriously [17]. Of interest, the majority of editors in our survey will not only reject a paper on ethical grounds but also take measures to inform the host institution and/or funding agencies. This more specifically adheres to the ICMJE, COPE and WAME recommendations on how to approach such submitted research.
Editorial obligation is extensive. Do they have time to act as "responsible social agents" and hold authors accountable in all cases for possible ethical infractions [19]? Once research misconduct is identified one may argue that handing over responsibility to an agency whose mandate it would be to deal with such allegations would be a more efficient model. This may be reflected by the 61% (n = 21) of respondents in our survey who viewed themselves as "rule-makers" versus the higher proportion of 89% (n = 31) who viewed themselves as "gate-keepers". By defining editorial obligation in publication, aforementioned agencies such as COPE, ICMJE and WAME are serving as the foundation upon which renewed calls to editors are sounded. There have been efforts to re-examine consequences, such as impact upon membership, by members who do not comply with these guidelines [17]. Does this constrain editorial freedom or ensure scientific accountability?
Limitations of our study include a relatively small response rate. Although average response rates of email surveys have been quoted at roughly 30%, we expected a much higher return given the study content and sample population [14]. It is distressing that editors did not take the opportunity to publically share their editorial practice in a transparent way. This we feel was a lost opportunity to add transparency to the editorial process of scientific review and therefore underpin public confidence in the research enterprise. We theorize that because editors often have many demands on their time, the emailed survey may have been overlooked or deleted without further attention. Given the importance of the ethical questions raised, one should consider the implications such dismissal has on what is indeed published within the medical literature. Is ethically suspect or concerning material dissected appropriately at all times?
Attempts to rectify our response rate were made by contacting editorial offices directly by telephone. This was also a challenge as many editors would either not respond to the call or fail to return our repeated attempts at contacting them. We considered that non-respondents were hesitant to participate in such a survey given potential responses having a high degree of visibility within the bioethical community. This seems unlikely given the number of respondents that consider themselves 'gatekeepers' of the literature. The possibility that responses were biased by social and editorial acceptability, which may not reflect actual practice, may have also impacted the results we obtained. We feel this is unlikely however, given the confidential nature of the survey, a typically strong sense of academic freedom in individuals charged as editors and that editors-in-chief intrinsically have positions that require a high degree of integrity and accountability. Although there was editorial representation from a variety of specialty and general medical journals publishing original human research, generalizability was compromised given our sample size.
