WAME Report: An Agenda for the Future

The Rockefeller Foundation Bellagio Study and Conference Center, Bellagio, Italy, January 22-26, 2001

SUMMARY

The information on which health professionals treat their patients is based on what is published in medical journals. There are perhaps 20 000 regularly published medical journals in the world; their quality is highly variable and there are few generally recognized standards. Most medical journal editors work in isolation, usually without training or access to useful support systems and information about how they might improve their practice.

The World Association of Medical Editors (WAME) was formed in 1995 at the Rockefeller Foundation Bellagio Study and Conference Center in Italy, with the aim of improving the standards of medical editing in the world's medical journals, especially those that have difficulty meeting high standards because of limited resources. WAME took advantage of the World Wide Web to address the problems of editors, so that its evolution would be independent of expensive face-to-face association meetings. There are now almost 500 editors in WAME, representing journals in 52 countries. They form an electronic community that shares problems and solutions experienced by medical journal editors around the world. The rapid growth in participation and activity reflects the fact that editors can join WAME at no cost and have full access to WAME's web site (http://www.wame.org/) and electronic discussion groups. It also suggests that WAME meets a widely felt need.

Over the past 5 years, WAME has conducted a global survey of medical editors' needs, assembled a bibliography of relevant books and articles, published a guideline on editorial independence, and established a forum for dealing with ethical problems raised by editors. WAME leaders have facilitated regional editing workshops around the world.

During a second 3-day meeting at Bellagio in January 2001, a group of 20 editors from 12 countries in 5 continents met to map out a strategy for WAME's continued development in the service of medical editors over the next several years. The group

Developed a statement of principles on the standards of professionalism and responsibilities of editors (this statement will be posted on the Web site after electronic consultation with and comment by WAME editors)
Agreed to assess the extent to which these principles are reflected in practice and to explore barriers to their adoption, using data from a survey and focus groups
Developed and outlined an on-line program for distance learning, targeted at new editors
Planned for formal evaluation of the educational outreach program
Agreed to support regional initiatives to strengthen local editorial capacity

Underpinning all past and proposed future activities is the WAME Web site. The ambitious plans outlined above will require extensive development of the site, plans for which were made at the Bellagio meeting.

WAME was designed to be cost-free for editors because most editors do not have the resources to join organizations. Thus far, WAME's development has been supported by voluntary work and by support from major journals,* as well as from the Rockefeller Foundation, the Reuters Foundation, and the US National Library of Medicine. But the ambitious plans outlined above for WAME's further development will require specific funding. This funding will allow WAME to reach out to more editors worldwide to help them improve standards in medical publishing and therefore in medical research and health care.

*Annals of Internal Medicine, BioMed Central, BMJ, Current Controlled Trials, Finlands Lakartidningen, JAMA, The Lancet, Lakartidningen (Swedish Medical Journal), Medical Journal of Australia, Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine), New England Journal of Medicine, Obstetrics and Gynecology, Tidsskrift for Den Norske Laegeforening (Norwegian Medical Journal), and Ugeskrift for Laeger (Danish Medical Journal).

(Summary in Spanish below)

MAIN REPORT

Background

As outlined in WAME's 1995 report, the public invests huge sums of money in health and medical research to address questions about the origins of ill health, and the effects of preventive or therapeutic strategies to protect and improve human health and well-being. Medical journals, of which there are an estimated 20 000 worldwide, are the principal medium for communicating the outcome of this massive public investment.

The influential position of medical journals between public investment in research and public access to the fruits of this investment places a heavy responsibility on those who control what is published—medical journal editors. Medical journal editors have a public duty to ensure that reports of research provide valid information, in language and formats that are accessible to the wide variety of different consumers of this information.

A variety of obstacles confront editors who are committed to trying to improve medical editing. These include lack of formal training for their work; isolation from their peers; lack of ready access to information about how they might improve their practice; lack of the resources that are often required to secure statistical and methodological advice that is so often necessary; and increasing external pressure that could distort their editorial and ethical responsibility to ensure publication of full and honest accounts of research.

Medical journal editors in developing countries and of small journals face additional obstacles. Most editors of such journals edit only part-time and have had little previous experience. Often, high-quality manuscripts are difficult to obtain, partly because of competition for such manuscripts from journals with large circulations, partly because medical science and medical writing may be at earlier stages of development. These editors also face scarce financial resources and have limited access to publishing and printing expertise. Those publishing in languages other than English have difficulty getting the articles in their journals indexed in the world's main medical data bases.

Recognizing their crucial role in ensuring that valid information derived from health and medical research is made publicly accessible, there is growing feeling among medical journal editors that something must be done to improve the standards of their work and that of their colleagues. They understand that to achieve higher standards there is a need to improve the professionalism of medical journal editors. The skills involved in medical journal editing are not obtained during a medical career before entering the publishing field or simply through the process of editing, but are acquired through deliberate attention, study and practice. As with all professions, there is a special body of knowledge that must be expanded and refined through research. Mechanisms are needed for training newcomers to the field. Self-regulating methods must be developed to identify and help editors who perform below reasonable standards and to deal with those who do not improve.

WAME aims to coordinate and give impetus to efforts to improve medical editing worldwide, and, as a result, ensure that public investment in health and medical research yields greater dividends for the public good.

Section I: Education and Training Outreach

WAME's main objective is to improve standards of medical editing around the world, and so to improve standards of health care. Editors' needs for education and training have so far been met by

A listserve, set up and maintained by the US National Library of Medicine, which links all members together electronically. Editors use it in particular to pose questions about editorial policies and practices to which interested persons can respond.
An Ethics Committee that editors can consult about matters of publication ethics.
A "Resources for Editors" section on the Web site, containing a selected bibliography of articles about authorship, peer review, editing, publication ethics, and related topics, and a listing of other organizations and resources for editors.

To fulfill its mission, WAME needs to provide as many editors as possible with access to effective educational resources. Appendix I below outlines a strategic plan for achieving WAME's educational mission.

1. Online distance learning package
WAME plans to develop and evaluate an on-line distance-learning package, targeted primarily at new editors. This will involve:

An educational syllabus, which will include sections dealing with relationships between editors and owners or publishers of journals, editorial content and publication policies of the journal, evaluation of manuscripts and editorial decision-making, understanding the needs and interests of readers, and dealing with error and allegations of misbehavior.
A series of case studies posing, and answering, common questions faced by editors.
A questionnaire to help new and potential editors obtain important information about the running of the journal from its owner or publisher.
Regular revision and expansion of the existing "Resources for Editors" section of the Web site, with emphasis on articles available on the internet that describe research studies of editing and editorial practices.
A mechanism for searching the educational resources.
A plan for evaluation of WAME's educational activities.

2. Regional workshops
WAME will also support regional initiatives for building local editorial capacity. This support will include:

A plan for seeking funds for a series of regional workshops or short courses, to be held wherever local demand and motivation is high—funds to be matched by local funding, in conjunction with other groups, such as regional organizations of editors, university or health agencies, and foundations.
Development of fellowship programs whereby editors could study with other editors.
Publication of educational materials developed by WAME.

Section II: Ethics and Editorial Policy

In fulfilling its mission to improve standards of medical editing, WAME has assembled online statements on editorial standards by other organizations, books about editing, and a bibliography of opinion articles describing good editorial practices and research articles assessing the effectiveness of these practices. WAME has also developed its own statement on the relationship between editors and the owners of their journals, and how editorial freedom can be preserved while respecting the business and political roles of medical journals (http://www.wame.org/policy-statements#Relationship between Editors and Owners). WAME has also established a system for members to consult experienced editors and ethicists about ethical dilemmas they experience in their work.

1. The responsibilities of editors
WAME believes there is a great need for a widely agreed-on statement of standards for the responsibilities of medical editors, one that is relevant to all the world's medical journals. Agreement on principles for the responsibilities of medical editors would establish a basis for efforts to improve the level of medical journalism. A draft of this statement (see Appendix III below), which is soon to be reviewed by members, includes 4 main responsibilities:

Respect for editors' constituents (authors, readers, reviewers, and the people who participate in clinical investigation) by making journal processes transparent, thanking reviewers, and protecting the confidentiality of people who participate in research.
Promotion of self-correction in science and participation in efforts to improve the practice of scientific investigation by publishing corrections, retractions, and critiques of published articles and by taking responsibility for improving the level of scientific investigation and medical writing in the larger community.
Assuring honesty and integrity of the content of the journal, and minimizing bias, by managing conflicts of interest, maintaining confidentiality of information, and separating editorial and business functions of journals.
Improving the quality of journals by becoming familiar with the knowledge base for editing, peer review, research ethics, and methods of clinical investigation, and by establishing appropriate programs to monitor journals' performance and receive external feedback.

2. Exploring barriers to improvement
WAME believes that all journals should strive to meet these standards, although the ability to do so depends on the resources and individual circumstances of the journal. WAME plans a worldwide effort to learn more about existing practices for the world's medical journals and barriers to meeting high standards. WAME plans 2 complementary ways of gathering this information: a survey of editors about the extent to which they currently meet WAME standards and the reasons for failing to do so; and focus groups in a representative sample of regions and journal types to learn in a qualitative fashion about the same phenomena. With this information, WAME will be in a better position to create educational programs that help editors improve their standards.

3. Ethical guidance and support
WAME will ensure that edited versions of the discussions generated by the ethics committee's consultation procedure are made available via the Web site. It will also encourage the setting up of regional committees on publication ethics where more in-depth and culturally appropriate ethical advice and discussion can take place.

Section III: Web Site and Listserve

1. Purpose
The purpose of the WAME Web site (www.wame.org) is to provide resources for teaching and learning about editorial policies, procedures, and ethics for medical journal editors, and to communicate information about WAME for WAME members and others. As a virtual organization, the WAME Web site must provide the technological capability for WAME to realize its goals of education and outreach to medical journal editors worldwide.

2. Achievements to date
To date, the WAME Web site has served as a resource for medical journal editors by providing a bibliography of important resources for editors, including books, journal articles, and related organizations, and providing contact information for WAME and its members. The WAME Listserve has provided a forum for editors to pose questions and receive answers from other editors. However, to meet WAME's goal of providing educational outreach through distance learning and exchange among members, a state-of-the-art Web site is needed.

3. Plans
Such a Web site will:

provide interactive distance learning modules based on WAME's educational syllabus, using case studies for demonstrating how the components are applied in practice, and an evaluation process whereby participants provide feedback to the creators of the modules
provide worldwide access to WAME's core statements and policies
provide links to high-quality resources in related fields
include questions posed by members and the ensuing discussions from the WAME Listserve
post discussion of ethical issues and how the WAME Ethics Consultation Service resolved them
enable medical journal editors to exchange ideas via discussion groups, providing the opportunity for debate and discussion of the compelling issues faced by medical journal editors
provide a powerful search engine, permitting efficient access to pertinent resources available on the site
facilitate election of officers to the organization
serve as the virtual meeting site for WAME members worldwide, providing the means for international discussion, debate, and education

Appendix III outlines the initial steps required to make the current WAME Web site a better resource and focus for WAME activities, as well as the steps necessary to realize the long-term strategic plan for the site.

Section IV: Administration, Membership, and Funding

Established in 1995, WAME is now a fully functional virtual organization. It has by laws, membership criteria, elected officers, and standing committees responsible for the Web site, educational resources, ethical standards, editorial policy issues, membership, and finance. Members are linked by an electronic list serve, which is in frequent use for exchange of information, ideas, and advice. The listserve facilitated, for example, the rapid and influential worldwide outcry against the removal of the editor of a major international medical journal and helped to resolve a case of suppression of publication of research for political reasons.

1. Reach out to editors around the world
To fulfil its mission, WAME needs to identify and contact editors in need of educational support in areas of the world and areas of health care currently underrepresented among its membership.

2. Develop administrative procedures
To provide an efficient and fully accountable service to its members, WAME needs to further develop its administrative procedures for installing new members, keeping organizational records, coordinating activities of the board and committees, administering funds, accounts, and audit, and coordinating regional activities, including educational workshops.

3. Create a members' database
To maintain adequate records of members, and to maintain the listserve, WAME needs to create an interactive electronic database of members.

4. Achieving a sustainable financial base
WAME is committed to providing a free service that reaches out to medical editors in all regions of the world and all areas of health care. To fund this service and to develop it further, WAME needs to achieve a sustainable financial base for its core activities and for implementing its strategic plans.

APPENDICES

Appendix I: Strategic plan for achieving WAME's educational mission

Most people who become chief editors of biomedical journals do so because they have an established scientific reputation and have served as reviewers, editorial board members and perhaps assistant or associate editors of a journal. As such they are likely to have little experience or understanding of the role of chief editor, and their editorship is probably part time and time limited. Their needs for readily accessible, straightforward information and education about the roles and responsibilities of editorship are thus substantial. These roles and responsibilities are generic, and therefore are largely independent of the size and nature of the journal.

This appendix outlines what an educational program for editors should include, how it might be delivered, and finally how new information on journalology and other educational opportunities could be brought to the attention of editors, new and old.

It is important to note that this plan requires close collaboration with the Editorial Policy Committee and is highly dependent on availability of a high quality Web site.

1. What an editor needs to know

1.1 Relationships between the editor and the owner of the journal (scientific society or association, university, governmental organization, commercial publisher)

History of journal and of previous editors
Owner's policies and objectives for journal—content, education, demands for space (society papers, etc), profit
Is owner also publisher?
Editor's terms and conditions of service—duration of appointment, pay, oversight
Reporting arrangements—publications committee, corporate president, etc
Commercial issues—circulation, marketing and advertising policies
Publication procedures and policies—frequency, available space, delivery (print, electronic), publication details, separation of editorial and advertising content
Support for editor and editorial office—staff, equipment, e-mail and internet access, education and training for editors
Organization of editorial process—associate editors, editorial board
Independence of editor

1.2 Determination of the editorial content of the journal

Editor's vision for scientific discipline and for journal
Types of material to be published
Original research, reviews, editorials, letters, news, etc.
Society publications—association material, and its identification
Breadth of scientific content
Needs for change in subject matter
Attracting and soliciting manuscripts
Theme issues, supplements
Roles of associate editors and editorial board

1.3 Publication policies

Criteria for authorship
Policies for submission
Information for authors—specifications for content, format, style, illustrations
Responsibilities of editors to authors
Maintaining integrity and confidentiality of author's work
Prompt review and decision making
Constructive evaluation—improvement in manuscript and in research
Policies for review—number of reviewers, type of review (masked/unmasked)
Manuscript editing and final approval policy

1.4 Manuscript evaluation and decision-making

Establishment and maintenance of evaluation process
Variations according to type of manuscript?
Roles of associate editors and editorial board
Identifying, training, evaluating and rewarding reviewers
Establishment of rational decision-making process
Policies and procedures for acceptance, revision, and rejection of manuscripts and for dealing with appeals of rejections
Role of editor in determining specific content
Constructive communication with authors

1.5 Other editorial responsibilities

Maintaining and publishing records of evaluation process
Establishing and maintaining systems for readers' comments/letters to the editor
Understanding needs and interests of readers
Avoiding financial, personal and other conflicts of interest
Dealing with error
Dealing with allegations of misbehavior
Planning for future of journal

2. Forms of the educational outreach program

2.1 Syllabus
To be prepared by the Education Committee

2.1 Questionnaire for use by newly appointed editors in dealing with owners-publishers
To be prepared by the Education Committee, based on the syllabus

2.3 Case studies

Series designed to complement education syllabus to be prepared by Education Committee
Series based on material submitted to WAME Listserve or Ethics Committee, to be prepared by Editorial
Policy, Ethics or Education Committee

2.4 Feedback
Establish area for feedback by users—free text or questionnaire

2.4 Review by Editorial Policy Committee and Board of Directors

3. Delivery of the educational outreach program

3.1 Incorporate into the Resources area of the Web site
Subdivide Resources area into subsites

Bibliography
Syllabus
Questionnaire
Scenarios
Case-of-the-month or -quarter

3.2 Courses

Develop courses co-sponsored by WAME and other groups
Explore possibilities for funding for courses

3.3 Dissemination

Explore possibilities for funding publication of educational materials
Ensure that all educational material is freely available, in as many languages as necessary

4. Maintenance of the educational outreach program

4.1 Regular review by the Education Committee and Board of Directors

5. Other educational activities

5.1 Maintenance and expansion of the Resources for Editors section of the WAME Web site

Focus on research studies rather than opinion
Focus on material for which full text or abstract is available electronically
Organize search for relevant articles on regular basis
Organize search on regional basis
Make the resource less selective, with search capability
Regular review and revision (and deletion) by Education and Editorial Policy Committees
Add link to relevant material in Cochrane Collaboration Web site

5.2 Establish and maintain calendar of courses for editors and other types of educational programs for editors (fellowships) on Web site

6. Publicizing WAME educational activities

6.1 Create a worldwide list serve of all organizations that publish journals and notify them periodically of WAME and its services for editors

6.2 Seek incorporation of material about WAME and what it offers into the Uniform Requirements of the International Committee of Medical Journal Editors, plus links to its web site

6.3 Seek publication of 'fillers' about WAME and its programs in journals of EASE, CSE and other editor's groups

7. Regional workshops
Editors of medical journals from financially less-privileged and developing countries share the same problems as editors in the developed world, but they almost always work with limited resources. They may also work in professional cultures that do not set high value on researching, writing, and publishing. They also sometimes do not have access to the Internet and would not be able to use all resources provided on the WAME Web site. WAME has decided to dedicate its efforts to support for and organization of workshops or short courses for editors in regions that most need education in editorial matters.

7.1 Courses
WAME will co-sponsor courses organized locally by individual editors, regional organizations of editors, university of health agencies, or foundations. WAME can offer its auspices, teachers, and educational material and policy statements from its Web site as a framework for the course.

7.2 Design and funding of courses
Through its members in different parts of the world, WAME will explore the need for regional courses and apply for funding to interested agencies. Immediate actions will be the following:

Seven participants of the Bellagio meeting, who come from regions interested in such courses, will investigate the needs and interest for a workshop in their country/region and come back to the Board with a brief proposal for the local course, and ideas on obtaining of local funding (report by April 2001).
The survey of WAME members will also help to identify the needs for regional educational activities.
Announcements will be posted on the WAME Web site and also distributed by the list serve, asking editors to identify their interest in educational courses.
Depending on local interest, WAME will propose a series of courses and approach funding agencies.

7.3 Training fellowships at larger journals
Using the Web site, listserve, and individual regional activity, WAME will identify editors of small or new journals who are interested in spending some time as training fellows at established journals. WAME will also identify established journals willing to host such training fellows. WAME may integrate this into the proposal for courses and apply to interested agencies for funding.

8. Schedule for implementing WAME's educational mission

Seek funding (see Appendix IV)
Prepare outline of syllabus for education of editors—Done at meeting
Complete syllabus and have it reviewed by Editorial Policy Committee and Executive Committee—Education Committee, within 6 months of receiving funding
Establish library of scenarios—Education Committee, within 12 months of receiving funding
Plans for additions to and maintenance of "Resources for Editors" page of WAME Web site—Done at this meeting
Develop plans for delivery of educational program—Done at this meeting
Implement educational program—Within 2 years of obtaining funding

This statement and schedule was prepared during the Bellagio Conference by Mohamed El-Badawi, Ana Marusic, Magne Nylenna, Drummond Rennie, Peush Shani, and Robert Utiger.

Appendix II: Strategic Plan for Achieving WAME's Ethics and Editorial Policy Mission

WAME aims to develop a range of methods for providing guidance on the ethical and policy issues currently facing editors of peer reviewed medical journals around the world. The ethics and editorial policy committees agree to undertake the following activities:

Establish guidelines for developing official WAME statements and endorsing statements from other organizations
Develop and prioritize a list of potential WAME statements
Write a statement outlining the responsibilities of editors
Develop standards for publication of articles supported by and including investigators from industry and other organizations that are in a position to distort the research record
Offer on line help for individual editors with ethical questions
Develop sections for the Web site on clinical research methods and scientific writing
Develop a plan for disseminating and translating WAME statements

1. The preparation and endorsement of WAME statements

1.1 Statements written by WAME members become official positions of WAME by the following process:

The need for new statements is suggested by the Executive Committee, other committees, or members
One member takes primary responsibility for drafting the statement in English
That member seeks the opinions of other WAME members, including but not limited to members of the appropriate committee
The Executive Committee reviews the revised document and provides feedback to the authors, who prepare revisions as needed
The Executive Committee decides when the document is ready for posting on the list serve for review and comment by members
Members are given a set period, typically 2 to 4 weeks, to provide feedback
The original author revises the document to take into account the feedback received
The Executive Committee decides whether the document is an official document of WAME and if so arranges for it to be sent to all members and posted on the web site
Members are invited to suggest changes in the statement at any time after posting
The document is revised as needed after a preset period—for example, 2 years

1.2 Each statement should be accompanied by a description of the intent of the statement, its rationale, the process by which it became an official statement of WAME, and key issues that were considered when preparing it.
This information should be prepared and submitted with the initial statement.

1.3 Translations of WAME statements are welcome as long as the person who prepares the translation informs WAME, includes with the translation information about who prepared it and the date of translation, and provides WAME with the reference for the translated version.

1.4 Statements not written by WAME members may be endorsed by WAME by a similar process, except that the writing has been done by other organizations.

This statement was prepared during the Bellagio Conference by a subcommittee including Saveli Bashinski, Iain Chalmers, Fiona Godlee, Humberto Reyes, Shouchu Qian, and Robert Fletcher (chair), revised by Michael Callaham, and endorsed by all participants.

2. The responsibilities of editors: a WAME statement of principles
This statement represents the consensus of WAME members on the responsibilities of the medical journal editors who make editorial decisions on manuscripts. WAME believes that all journals should strive to meet the standards for medical editors described in this document, but recognizes that the ability to meet these standards depends on the resources and circumstances of individual journals.

2.1 Editors should express respect for their constituents (authors, reviewers, readers, and the people who participate in clinical investigation) by:

Making journal processes transparent by publishing such information as the kinds of articles considered, the number of reviewers per article, how editorial decisions are made, rejection rates, and processing times.
Thanking reviewers by such means as letters of thanks, sharing co-reviewers' comments and editorial decision letters, and publishing lists of reviewers' names.
Ensuring that the review process proceeds as rapidly as possible without sacrificing quality
Requiring authors to obtain consent to publish from patients who might be identified in an article.

2.2 Editors should promote self-correction in science and participate in efforts to improve the practice of scientific investigation by:

Publishing corrections, retractions, and letters critical of articles published in their own journal.
Playing an active role in investigating and preventing fraud.
Taking responsibility for improving the level of scientific investigation and medical writing in the larger community of potential authors.
Giving authors an opportunity to review and approve edited manuscripts before they are published.
Participating in efforts to detect and prevent publication bias—for example, by collaborating with registries of controlled trials and publishing protocols.

2.3 Editors should assure honesty and integrity of the contents of the journals they edit and minimize bias by:

Defining, implementing and publishing standards for the journal
Managing conflicts of interest by:
- assuring that they and reviewers have no financial arrangements with for-profit organizations involved in the research on which they make editorial decisions.
- withdrawing themselves from editorial decisions in which personal relationships or intellectual passion might substantially affect their judgments.
- declaring the existence of potential conflicts of interest in editorial decision-making where they exist.
Publishing descriptions of the peer review practices of their journals, such as whether most original articles published have been reviewed by external consultants or the proportions of the various kinds of articles that are externally reviewed.
Ensuring that manuscripts are treated as confidential documents—by themselves, other editors, and by reviewers.
Maintaining strict separation between the editorial and business activities of the journal.
Developing a formal, written agreement with sponsoring societies or journal owners about governance and responsibilities.
Encouraging authors to describe their individual contributions to the work they have submitted and publishing this information with their articles.
Publishing clear notices if articles have already been published elsewhere.
Avoiding publication bias by judging articles according to the importance of the question and strength of the methods, not whether the results are "positive" or "negative."
Providing disclosure of authorship, ownership, and funding sources for editorial content of the journal and for the journal as a whole.

2.4 Editors should improve the quality of the journals they edit by:

Developing policies for recruiting, orienting, training, and evaluating peer reviewers.
Keeping up with the knowledge base for medical editing, peer review, and research and publication ethics.
Continually improving their own understanding of the methods of scientific investigation.
Arranging for submitted manuscripts to be reviewed both by methods and content experts.
Monitoring and periodically reviewing the quality of the journal's editorial practices.
Establishing and using an oversight group to review the journal's practices.
Publishing studies of the quality of the editorial content of the journals if valid studies are submitted.

3. Schedule for implementing WAME's ethics and editorial policy mission

3.1 Seek funding.

3.2 Establish guidelines for developing official WAME statements and endorsing statements from other organizations. [At this meeting]

3.3 Develop and prioritize a list of potential WAME statements:

Write a "Responsibilities of Editors" statement. (Drafted at this meeting, post within 6 weeks—Bob Fletcher)
Develop standards for articles supported by and including investigators from industry and other organizations that are in a position to distort the research record. (A WAME project for the future, as time and funding permits.)
Others to be recommended by the Executive Committee.

3.4 Offer online help for individual editors with ethical questions (the Ethics Committee has begun this) and plan how these exchanges will be summarized on the web site.

3.5 Add to the "Resources" section of the Web Site a section on clinical research methods and scientific writing.
(The present committee will draft this, under Bob Fletcher's leadership, and send to Bob Utiger for a second opinion before sending on to the Executive Committee. To be completed within 4 months of obtaining funding.)

3.6 Develop a plan for how WAME members are notified about new WAME statements and how translations can be encouraged. (At this meeting).

Appendix III: Strategic Plan for WAME's Web Site

1. Web site policies and procedures
The purpose of the WAME Web site (www.wame.org) is to provide resources for teaching and learning about editorial policies, procedures, and ethics for medical editors, and to communicate information about WAME for WAME members and others. The goal of this document is to plan improvements in the content and functionality of WAME's Web site to be more useful for editors, especially for new editors and those in developing countries.

The WAME Board assumes overall responsibility for the WAME Web site content. The WAME Web Editor, who reports to the Board, assumes responsibility for maintaining the functionality of the site and updating the site with new content from the Board and WAME Committees in a timely fashion. Because WAME is a virtual organization, the role of the Web Editor is central to WAME and the roles and responsibilities must be well defined.

2. Web editor roles and responsibilities

To act as primary contact for the Web site.
To receive, review, and evaluate content, with consultation as required.
To post reports received from the Board and committees.
To determine, with input from committees, content that is appropriate to remove from the site.
To maintain Web site standards, including functionality (making sure links work, etc).
To monitor traffic to the site.
To evaluate possible new site functionality and features, including cost implications (new functions include search engines, interactivity, streaming video, direct updating of member information, etc).
To maintain contact with the Secretary regarding Listserve content.
To report to the Board every 6 months.

3. Web site content development and review
The usefulness of the WAME Web site to medical journal editors in general and members specifically depends on the development of new content and regular review and updating of existing content, in addition to maintaining and upgrading functionality such as a search engine and interactive features. The following section outlines the content areas on the Web site that currently exist or will be developed by the committees indicated. Review of the content of each area will be the responsibility of the group listed. Each group is expected to complete review of existing content for accuracy and provide updates or deletions as required every 6 months. Those responsible for content that requires Board approval must receive Board approval for new content prior to posting.

4. Existing content
Bibliographic Resources. Bibliographic references include Policies of Organizations pertinent to medical journal editors; Books and Monographs; journal articles addressing the areas of authorship, media, peer review and editing, publication, publication ethics, relationships with industry and advertising, and style and format; and other organizations for editors. The members of the Education Committee select these resources, with input from other committees and from members.

How WAME Works. How WAME Works provides information about WAME Governance and Committees. The Committees and the Board maintain the section.

Acknowledgments (now Sponsors). Acknowledgments lists the organizations that are provided financial or in-kind support to WAME. This list will be updated and revised to reflect ongoing vs one-time support. The Finance Committee maintains this list.

WAME People. WAME People lists the members of the WAME Board, Directors, and Committees. The members of the Committees maintain this section.

Members. This section lists all current WAME members with contact information. This list is maintained by the Membership Committee, specifically by the Secretary.

Join WAME. Join WAME provides criteria for membership, the membership application form, and the WAME Listserve. This section is maintained by Membership.

Related links. Related links are introduced throughout the Web site as appropriate, to maximize the usefulness of the site for users. The Web Editor maintains these links.

WAME Talk. WAME Talk describes the WAME Listserve and provides information about participation and Listserve etiquette. The Secretary maintains this section.

WAME Journal List. The Journal List provides the journals to which WAME members belong, along with links to journals that are online. This list is maintained by the Membership Committee, specifically by the Secretary.

5. New content
WAME Policy Statements. WAME Policy Statements are drafted by the Policy Committee, reviewed by experts in the field to which the statement pertains, and finally reviewed and approved by the Board for posting. Next, members and others post them on the WAME Web site for comment. After a predefined comment period, the Statement is revised taking into account comments received and then approved by the Board as an official WAME Statement. Thus, this section will include 2 types of statements: those already approved by the Board as WAME Policy and those posted for public comment. Each type will be clearly indicated. The Editorial Policy Committee via the Board will maintain this area.

Endorsements of Other Groups' Statements. Organizations that work in areas related to WAME have issued statements pertinent to WAME members (such as the International Committee of Medical Journal Editors, the Council of Science Editors, and the Office of Research Integrity). When the WAME Policy Committee believes that such statements have direct implications for issues important to WAME, WAME may consider such statements for official endorsement. Such statements will also be cited, and if possible, posted on the WAME Web site. The Editorial Policy Committee via the Board will maintain this area.

WAME Educational Syllabus. The WAME Educational Syllabus will be prepared by the Education Committee (see Appendix I) and, along with the Bibliographic Resources section, forms the core of WAME's online educational efforts. The Syllabus addresses issues related to the editors' responsibilities, ethical behavior, journal management, reporting arrangements, and other issues. The Education Committee via the Board will maintain this area.

Ethics Consultation Reports. Ethics Consultation Reports will include summaries of cases brought before the Ethics Committee for comment and input. If the editor responsible for bringing the case agrees, the issue raised and the Committee's comments will be posted on the site as an educational tool for editors. The Ethics Committee via the Board will maintain this area.

Listserve Summaries. Listserve Summaries will present a question raised by a member via the Listserve believed to be important to other members, followed by pertinent answers provided by other Listserve members. The answers will include the name of the respondent, the journal, and the date of reply. The Secretary and the Web Editor will maintain this area.

Research. The Research section will provide an area for those interested in conducting research to raise possible research topics and identify potential collaborators. The Board will maintain this section.

Committee Updates. Committee Updates provides information from Committees without space elsewhere on the site to present important issues that have been raised in the groups. This area will not include Committee minutes but only issues believed to be of interest to members. Each Committee will maintain this area.

Case of the Quarter. Case of the Quarter will pose a case created by the Ethics or Education Committees, or raised by a member, that poses a particularly important or difficult issue for editors. This area will provide a discussion group format to enable an interactive discussion to take place. The Web Editor will serve as the moderator. Cases that have generated useful insights for other editors may be considered for permanent posting on the site. The Ethics and Education Committees will maintain this section.

Board Communications. Board Communications will serve as a source of communication with members and as an archive of communications from the Board distributed via the Listserve. The Board will maintain this section.

WAME Reports. WAME Reports will consistent of brief summaries followed by full documents created at WAME meetings and integral to the founding and development of WAME, for use by members and others who wish to learn about WAME in greater depth. The Board will maintain this area.

WAME News. This section will appear on the WAME Home Page to highlight new features and content on the site for site visitors. This section will include upcoming meetings of interest to WAME members. When a critical mass of new features and content is available, WAME News will be used to create a short message to be sent via the Listserve to WAME members, with brief descriptions of and links to the new content. The Web Editor will maintain this section, with updates as often as possible.

6. Specific policies and procedures
The following Policies and Procedures for the Web site policies and procedures have been created to maintain the highest possible standards for the Web site to serve WAME's mission. The Web Editor will implement the Policies and Procedures with oversight from the Board, except where indicated otherwise.

Review
Content areas of the site will be reviewed at least every 6 months by the groups listed as being responsible for individual areas (Web site Content Development and Review), and any changes will be given to the Web Editor. The Web Editor will review links and other functionality at least every 3 months.

Updates
All requests for site updates/deletions will be made in writing to the Web Editor, via e-mail or fax (e-mail being first choice unless the change is a minor edit and easier to indicate on a faxed copy).

Advertising
It is against WAME Policy for the site to carry advertising. Links from books listed in the Resources section to Web sites about the book are permitted.

Publicity
The site will be publicized using reciprocal links with other organizations, as arranged by the Secretary; links from journals to the WAME Web site, as encouraged through the Listserve; and through ads in CSE, EASE, and other editor organizations, as well as filler ads in journals. Other means of publicity will also be explored.

Linking
To improve the site's usefulness, linking is to be used wherever possible, with the understanding that links from the site do not imply endorsement of the content to which the WAME Web site links. Specifically, links will be provided to related organizations, related Web sites, and journal and other resources. To maximize accessibility, links to journal articles will be provided wherever possible, journals will be asked to provide the articles to which WAME links free of charge, and PDFs to articles not available online in full text will be provided if possible.

7. WAME Listserve
As a virtual organization, WAME depends on its Listserve to maintain communication with and among members. To date, the Listserve has served primarily as a tool for members to ask questions and advice of other editors. In the future, the Listserve will also be used to alert members to new content on the WAME Web site and communicate important information to members. In addition, important exchanges that take place on the Listserve will be edited in a question and answer format for posting on the WAME Web site. The following plan formalizes procedures for the Listserve:

The WAME Secretary will serve the role of Listserve Editor.
WAME News (a section on the WAME Home Page) will be circulated via the Listserve, with a brief summary of the content and a link to the specific content area when a critical mass of new information has been posted.
Members will be requested to provide information updates regarding journal links and personal e-mail address.
Members will be asked to create a link from their journal Web site to the WAME Web site.
Each Listserve message will include a link to the WAME Web site.
Regional or specialty Listserves will be operated independently but in collaboration with WAME. These Listserve organizations will be listed on the WAME site.
Listserve compilations of communications on a single topic will be sent from the Secretary to the Web Editor, who will edit the communications for posting online in a question and answer format. The author of the comment, the journal with which the author is affiliated (if any), and the date of the communication will be included with each posted reply. The posting will include a disclaimer that comments have been edited to aid the reader; if authors responsible for the original comment disagree with the editing they will be instructed to contact the Web Editor.

8. Long-term strategic plan
This long-term strategic plan is intended as an aid to planning financial resources, staff, and content for the Web site. The plan should be updated as the organization, the site, and the Web evolve.

Identify and implement a search engine for the site
Register related URLs (particularly wame.org)
Back up and archive the Web site for historical purposes
Create a Web site survey to distribute to members, with question(s) that can be updated on a regular basis
Develop distance learning modules from Education and Ethics Committee content, with evaluation of the program
Develop interactive features on the Web site based on survey of members regarding what features would be useful

9. Schedule for implementing decisions about WAME's Web site

Seek funding (see Appendix IV)
Draft process for posting, reviewing, and removing content from WAME Web site in a timely fashion. (At this meeting)
Develop job description for Web Editor. (At this meeting)
Develop list of immediate updates to site. (At this meeting)
Write brief description of each committee for posting on the site. (At this meeting)
Develop a long-term strategic plan for the Web site. (At this meeting)
Complete immediate updates to site. (In next month)
Track traffic to Web site. (Within 3 months of obtaining funding)
Register additional URL(s). (Within next 3 months)
Develop new content for site based on work of other committees. (Within 6-12 months of obtaining funding)
Implement search engine for site. [Within 12 months of obtaining funding]

This draft document was prepared during the Bellagio conference by the Web site Committee including Suzanne Fletcher, Daniel Ncayiyana, Pia Pini, Roy Pitkin, John Overbeke, Bruce Squires, and Margaret Winker (chair).

Appendix IV: Strategic Plan for WAME's Membership, Administration, and Funding

WAME is now a fully functional virtual organization, with by laws, membership criteria, elected officers, and standing committees responsible for the Web site, educational resources, ethical standards, editorial policy issues, membership, and finance. Members are linked by an electronic Listserve, which is in frequent use for exchange of information, ideas, and advice.

To maintain and develop this organization further requires a higher level of administrative structure than currently exists. WAME also needs to reach out to more editors around the world if it is to realize its aims of providing educational, ethical, and practical support to those most in need. Because WAME is a free organization without membership fees, all of its activities require funding. WAME therefore needs to make proactive efforts to seek funding based on realistic estimates of the cost of running WAME and of further development.

1. Soliciting new members and updating members' contact information

1.1 Ask current regional editors' associations to encourage their members to join WAME:

EASE, Cochrane, Specialist societies
IFSE
Chinese Association of Medical Editors (Done)
Indian Association of Medical Editors (Peush Sahni)
Asian Pacific Association of Medical Editors (ST Lee)
Africa (Dan Ncayiyana)
Canadian (Done)
Chile (Humberto Reyes)
Ecuador (Dalton Avila)

1.2 Identify other editors from lists in NLM/ISI etc (Committee)

1.3 Ask NLM/ISI to include invitation to join WAME in the material they circulate to applicants for indexing, and on their Web sites

1.4 Regularly update Listserve to ask members to check their contact information on the Web site

2. Accommodating members with no access to the Internet and e-mail

2.1 Letters to those who joined without having access, to ask if they now have access and if so, what is their e-mail

2.2 Those without access to be identified and if possible linked to those near them with access

2.3 Drop those without 2.1 or 2.2

3. Membership criteria

3.1 Present criteria maintained

3.2 Journal membership and use of the WAME logo is forbidden

3.3 Journal editors may indicate in their journal that they are members of WAME and adhere to WAME's principles

4. Involving members in decision making and voting

4.1 Web site editor to explore mechanism through Web site

5. Survey of members' needs and resources

5.1 Ana Marusic to devise a questionnaire survey based on 1996 survey, explaining purpose and benefits of the survey

5.2 Letter to members via Listserve encouraging them to participate in survey by clicking through to Web site

5.2 Notice on WAME homepage inviting members to participate in survey on the web

6. Negotiate with executive committee for administrative support
Executive committee to arrange for administrative support, once funding is obtained

7. Achieving a financial base for WAME's core activities

7.1 Based on the strategic plans for the other 4 objectives, produce a target for annual funding for the next 5 years.
(Action: Fiona Godlee, Bruce Squires, and John Overbeke, report to the board, by end March 2001.)

7.2 Establish a funding committee for WAME.
(Done. The funding committee comprises Suzanne Fletcher [chair], Iain Chalmers, and Drummond Rennie.)

7.3 Explore the possibility of establishing links with INCLEN, to enable donations from US-based funders to be tax deductible.
(Action: Iain Chalmers and Suzanne Fletcher, report to the board end March 2001.)

7.4 Explore the possibility of converting WAME into a not-for-profit trust, in order to facilitate donations from non–US-based funders.
(Action: funding committee, report to the board end March 2001.)

7.5 Explore the possibility of applying for funds from the following bodies:

the Gates Foundation. (Action: Fiona Godlee [via Richard Smith, BMJ])
WHO, in light of its new initiative to improve the quality of scientific research in the developing world. (Action: Ana Marusic.)
the Soros Foundation. (Action: Drummond Rennie—done, no funds forthcoming.)

7.6 Pursue funding opportunities.
(Action: funding committee, report to the board twice a year: first report, end March 2001; second report, Barcelona, September 2001.)

8. Schedule for implementing WAME's strategy for membership, administration and funding

8.1 Solicit new members and update members' contact information—within 3 months of obtaining funding

8.2 Involve members in decision making and voting—in time for election in September 2001

8.3 Survey of members' needs and resources—within 6 months of obtaining funding

8.4 Administrative support—once funding obtained

8.5 Achieve a sustainable financial base for WAME's core activities—target: by end 2004

Appendix V: List of Participants

Fiona Godlee
BioMed Central/Current Controlled Trials
Middlesex House
34-42 Cleveland Street
London W1T 4LB, UK

Drummond Rennie
JAMA
9627 Sterling Creek Road
Jacksonville, OR 97530-9333 USA

Suzanne Fletcher
Harvard Commmunity Health Plan
126 Brookline Ave, Suite 200
Boston, MA 02215, USA

Bruce Squires
96 Frank St, Apt 1
Ottawa ON K2P 0X2

John Overbeke
Nederlands Tijdschrift voor Geneeskunde
PO Box 75971
Amsterdam 1070 AZ, The Netherlands

Daniel Ncayiyana
South African Medical Journal
Private Bag XI
Pinelands 7430, South Africa

Shouhu Qian
Chinese Medical Journal and National Medical Journal of China
Publishing House of Medical Journal
Chinese Medical Association
42 Dongsi Xidajie
Beijing 100710, China

Humberto Reyes
President of the Chilean Association of Biomedical Journal Editors
Universidad de Chile
Facultad de Medicina
Departamento de Medicina Experimental Oriente
Casilla 16038
Santiago 9, Chile

Robert Fletcher
Harvard Commmunity Health Plan
126 Brookline Ave, Suite 200
Boston, MA 02215, USA

Roy Pitkin
Obstetrics and Gynecology
409 12th Street SW
Washington DC 20024-2188, USA

Robert Utiger
New England Journal of Medicine
10 Shattuck St
Boston, MA 02115 USA

Saveli Bachtchinski
International Journal of Medical Practice
PO Box 54
127238 Moscow, Russia

Iain Chalmers
The Cochrane Collaboration
The UK Cochrane Centre
NHS Research and Development Programme
Summertown Pavilion
Middle Way, Oxford OX2 7LG, UK

Peush Sahni
The National Medical Journal of India
All India Institute of Medical Sciences
Ansari Nagar, New Delhi 110029, India

Pia Pini
The Lancet
84 Theobald's Road
London WC1X 8RR, UK

Magne Nylenna
Journal of the Norwegian Medical Association
PO Box 1152
Sentrum, N-0107 Oslo, Norway

Ana Marusic
Croatian Medical Journal
Zagreb University School of Medicine
Salata 3, 10000 Zagreb, Croatia

Margaret Winker
JAMA
American Medical Association
515 N State St
Chicago, IL 60610, USA

Mohamed El-Badawi
Suez Canal University Medical Journal
Faculty of Medicine
Suez Canal University
Ismailia, Egypt

WAME: An Agenda for the Future (Spanish)

This is a Spanish translation of the Summary of a Report of the World Association of Medical Editors (WAME): An Agenda for the Future, after a Conference held at The Rockefeller Foundation Bellagio Study and Conference Center in Bellagio, Italy, January 22-26, 2001. This translation was prepared by Humberto Reyes, MD, Editor of Revista Médica de Chile, WAME Member, and participant at the Bellagio Conference.

Resumen del Informe de la Reunión de la Asociación Mundial de Editores Médicos (WAME): Una Agenda Para el Futuro

Enero 22 al 26 de 2001, en el Centro Bellagio de Estudio y Conferencias de la Fundación Rockefeller, Bellagio, Italia

La información de que disponen los profesionales de la salud para tratar a sus pacientes aparece en las revistas médicas. En el mundo se publican alrededor de 20 000 revistas médicas, su calidad es notoriamente variable y se dispone de muy pocos estándares editoriales con aceptación universal. La mayoría de los editores de revistas médicas trabajan aislados, es habitual que no hayan sido entrenados formalmente para esta labor, y no tienen acceso a sistemas de apoyo o de información útiles para mejorar su práctica editorial.

La Asociación Mundial de Editores Médicos (World Association of Medical Editors [WAME]) se fundó en 1995 en el Centro Bellagio de Estudios y Conferencias de la Fundación Rockefeller, en Bellagio (Lago de Como), Italia, con el propósito de mejorar los estándares de edición de las revistas médicas en el mundo, especialmente en aquellas revistas que tengan dificultades para mejorarlos por limitaciones de sus recursos. WAME aprovechó la red mundial de comunicaciones (World Wide Web) para enfrentar los problemas de los editores, de tal modo que su acción pudiera independizarse de costosas reuniones cara a cara. Actualmente los editores miembros de WAME suman alrededor de 500, representando a revistas médicas en 52 países. Estos editores forman una comunidad electrónica que comparte los problemas experimentados y las soluciones aplicadas por editores de revistas médicas en todo el mundo. El rápido crecimiento en su participación y actividades refleja el hecho de que los editores pueden ingresar a WAME sin costo y tienen acceso total al sitio de red de WAME (http://www.bmjpg.com/wame/) y a grupos de discusión por esta vía electrónica. Ello también sugiere que WAME satisface una necesidad ampliamente sentida.

Durante los últimos 5 años, WAME efectuó una encuesta mundial sobre las necesidades de los editores médicos, preparó una bibliografía con libros y artículos relevantes, publicó una guía sobre la independencia de los editores y estableció un foro para discutir problemas éticos planteados por editores. Los líderes de WAME han ayudado a organizar talleres regionales para editores, en distintos lugares del planeta.

Durante una segunda reunión de 3 días en Bellagio, en enero de 2001, un grupo de 20 editores de 12 países y 5 continentes, diseñó una estrategia para el progreso continuo de WAME al servicio de los editores médicos, durante los próximos años. Este grupo

Preparó una declaración de principios sobre los estándares de profesionalismo y las responsabilidades de los editores. Esta declaración será difundida en el sitio de red de WAME después de consultar electrónicamente a los editores-miembros y recoger sus comentarios.
Aprobó analizar la magnitud con que estos principios se reflejan en la práctica y explorar las barreras que dificultan su adopción, utilizando datos que se obtendrán de una encuesta y en grupos de discusión.
Diseñó y desarrolló un programa en-línea para el aprendizaje a distancia, destinado a editores noveles.
Planificó una evaluación formal del programa educacional.
Aprobó apoyar iniciativas regionales para fortalecer la capacidad editorial local.

El sitio de red de WAME ha sustentado todas las actividades pretéritas de la Asociación y sostendrá también las que se han propuesto para el futuro. Los planes bosquejados en este documento requerirán un desarrollo extenso de este sitio electrónico, para lo cual también se propuso una estrategia en Bellagio.

WAME fue concebida como una organización gratuita para los editores, quienes generalmente no disponen de recursos para financiar su ingreso a asociaciones. Hasta ahora el desarrollo de WAME se ha conseguido con el trabajo de voluntarios y con el apoyo y financiamiento de algunas revistas importantes,* de la Fundación Rockefeller, la Fundación Reuters, y la Biblioteca Nacional de Medicina de los EEUU de NA. Pero los ambiciosos planes para el desarrollo futuro de la Asociación, expuestos en este documento, requerirán un financiamiento específico. Estos recursos permitirán hacer WAME accesible a más editores en todo el mundo, para ayudarlos a mejorar los estándares de las publicaciones médicas y con ello contribuir al progreso de la investigación y la asistencia médicas.

*Annals of Internal Medicine, BioMed Central, BMJ, Current Controlled Trials, Finlands Lakartidningen (Revista Médica de Finlandia), JAMA, The Lancet, Lakartidningen (Revista Médica de Suecia), Medical Journal of Australia, Nederlands Tijdschrift voor Geneeskunde (Revista Médica de Holanda), New England Journal of Medicine, Obstetrics and Gynecology, Tidsskrift for Den Norske Laegeforening (Revista Médica de Noruega), y Ugeskrift for Laeger (Revista Médica de Dinamarca).