Independence and other things

Last week we heard from Richard Smith that revenues from drug advertising may be an important pillar of editorial independence (doi: 10.1136/bmj.39259.472998.AD). His article, and a news story this week, have got me thinking about what independence means, what its limits are—since limits there must be—and what it's for. On the previous page in the print journal (and at bmj.com/bmj/about-bmj if you're online) you'll see some small but crucial words: “The BMA grants editorial freedom to the editor of the BMJ.” Why are these words crucial? Because they mean that what you read in the BMJ has been judged by the editor to be in the best interests of science, medicine, and patient care.

Not so for America's former surgeon general, Richard Carmona, who now that he has left office has told a Congressional committee that he was effectively silenced by the Bush administration for four years (doi: 10.1136/bmj.39279.393345.BE). Is this just that he overstepped his remit, moving from medicine into politics, demanding power without responsibility, as Christopher Caldwell wrote in the Financial Times on 13 July? Or that medicine and politics are more than ever inextricable? Either way, if he felt the pressures were damaging, he misled the public by tolerating them for so long.

Is it in the best interests of science, medicine, and patient care for journals to fast track research? The BMJ has always been ambivalent about this (BMJ 1999;318:620), and despite Chris Martyn's eloquent invitation to authors to have their articles slow tracked (BMJ 2005;331:1551-2), we are still waiting for someone to request this facility. So we continue to offer fast track. We're in no doubt about our reasons: we hope it will serve readers by helping us to attract better papers. You can request fast track if you believe there is a clinical or public policy reason for urgent publication. Two of the three research papers in this week's print journal were fast tracked (doi: 10.1136/bmj.39247.447431.BE; doi: 10.1136/bmj.39093.464190.55). From submission to publication takes between four and six weeks.

Like all our research papers, the three studies in this week's print journal were published online ahead of print with immediate open access to the full text, and we are now putting linked editorials online ahead of print as well. This ensures that research is set in context at the time of publication. By the time an article appears in print it will already have attracted some post-publication peer review in the BMJ's rapid responses. The responses to the QRISK score paper are particularly interesting: critics question the underlying premise while competing risk scores vie for supremacy.

The interplay between print and online publication is constantly on our minds these days. Some things don't immediately translate. As their name suggests, fillers were invented to fill space in the print journal, but that's a meaningless concept online. This week we hear about MRI's potential as an egg timer (doi: 10.1136/bmj.39199.659352.BE) and about the risks of extreme neck movement when riding on an elephant (doi: 10.1136/bmj.39248.639375.AD). Perhaps to secure their online future all that's needed is a change of name—Diversions? Discursions? Outliers?