Ethics at the BMJ

doi:10.1136/bmj.39133.472199.43

BMJ 2007;334 (24 February), doi:10.1136/bmj.39133.472199.43

Editor's Choice

Editor's choice

Ethics at the BMJ

Fiona Godlee, editor

fgodlee{at}bmj.com

One of the BMJ's assets is its ethics committee. The committeemeets every three months to provide the editor with broad ethicalguidance and consider ethical dilemmas arising from articlessubmitted to and commissioned by the journal. Chaired by IonaHeath (a GP, ethicist, and BMJ columnist (BMJ 2007;334:341 doi:10.1136/bmj.39125.448287.59)), its members are appointed afteropen application and competitive interview. Rather than publishingthe minutes of the meeting, which presented problems of confidentiality,we now publish an annual report (http://resources.bmj.com/bmj/about-bmj/ethics-committee).

In the report for 2005 (2006 is coming shortly), Liz Wager describesthe issues raised by the year's 11 new cases. Several casesraised the perennial question of what constitutes research ratherthan innovative practice or audit. Should the use of unlicensedtreatments require prior approval from a research ethics committeeor institutional review board? The ethics committee judged thatit should. These cases also raised concerns about whether patientshad given fully informed consent, and led to a discussion aboutwhether verbal consent can ever be adequate—the committeeconcluded that it could, provided there was adequate documentationand a witness. The committee also helped resolve two cases inwhich submissions underwent significant and troubling changesin authorship in the course of publication.

In almost all cases considered by the committee the editorialdecision has already been made and the committee is being askedfor advice on how to handle residual ethical concerns, usuallyabout articles we have decided to reject. This is in keepingwith the BMJ's commitment not simply to reject a paper if thereare ethical concerns but to pursue the matter as far as possiblewith the authors and if necessary their institutions. We askthe authors for their explanation of events and let them knowthat we have referred the case to the ethics committee to seewhether any further action is needed. Our aim is to supportand educate authors rather than condemn them, since in manycases the ethical problems seem to have arisen out of ignoranceor honest error.

Where a serious reprimand or retraction of a published paperis needed, the ethics committee's expert support in reachingthis decision is a huge comfort. The editors of the two journalsembroiled in the disputed trials of mannitol in head injury,described in this week's BMJ (doi: 10.1136/bmj.39129.611516.80,doi: 10.1136/bmj.39118.480023.BE) might well wish they had sucha body to confide in. Perhaps they may turn for advice to theCommittee of Publication Ethics, which holds its annual seminarin London on 16 March (contact cope{at}bmjgroup.com).

Almost all the BMJ's ethics committee cases relate to researchpapers, which gives me the opportunity to emphasise the importanceof research to the BMJ. Some readers have commented on the apparentdownplaying of research in the new print journal. This is quitethe opposite of what we are doing. Original research remainsat the core of this academic journal. In her recent editorial,Trish Groves outlined the sorts of research we are keen to publishand the reasons why authors should submit their best clinicalresearch to us (BMJ 2007;334:4, doi: 10.1136/bmj.39057.516250.80).Not least among these is the fact that the BMJ is that rarebeast among the major international medical journals—anopen access journal that lets authors and readers share researchfor free. That's another asset we definitely don't want to hide.