Publishing an Article Despite Commercial or Legal Threats

I crave your indulgence regarding a dilemma I am having in my role as an author. In January 2005, I submitted a paper to a pharmacy journal. It reported a pseudo-patient (shopper) study of pharmacists' recommendations about smoking cessation aids (a person visited pharmacies and asked what the attending pharmacist would recommend as a cessation aid. The pseudo-shopper then produced a promotional brochure for a heavily advertised preparation, asking the pharmacist's opinion of that product. There is no published evidence about the efficacy of this product. It sails close to being snake oil.)

Results: In a nutshell, a large proportion of pharmacists jettisoned their initial evidence-based advice upon the pseudopatient/shopper asking about the "snake-oil" product, some actively recommending it and others offering to order it in.

Despite pharmacy being said to be an evidence-based profession, many pharmacists will abandon professional judgement in favour of the ethics of the cash register.

The paper was reviewed, revised, and accepted. At proof stage, the publisher requested that the editor refer the paper to the snake-oil manufacturer for comment. The snake-oil manufacturer sat on it for months, finally producing a series of objections that revealed a total lack of understanding of what "evidence" means (they have user testimonials and internal company reports that the product works … therefore, they argue, there is evidence etc). I eviscerated their response in a rebuttal and await publication.

Months drag into months. Correspondence with the diplomatic editor suggests frustration on his part with the publisher's cautiousness (presumably fearing legal action from the snake-oil manufacturer).

I fear the publisher will buckle under legal threats.

What would you do? I want to see the paper published. I'm half wondering if I should present a formal case history to a WAME subcommittee or to COPE, with the (confident) view that their adjudication would lend some muscle to the publisher-pecked editor. Another part of me is wondering if there is any editor out there who is interested in the wider cause of commercial pressures being exerted on publishers and editors, who might want to run the issue as a case study (along with the paper!). I would do it in my own journal, except that would look far too self-indulgent. Interesting story, and one I hope to see told.

Simon Chapman

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Great question, Simon: What would I do?

As an author, I would pull the paper from that journal and send it to another. Sounds like a great study and one that perhaps needs wider circulation than in a pharmacy journal. The editor with whom you are dealing is not being cautious. He is being a weenie and committing editorial malpractice and should be ashamed.

As an editor, I would never have sent it to the manufacturer for comment in the first place. As long as you are correct that there is no "published evidence in the peer reviewed literature" (which is easily documented) then there is very little legal risk. Of course one can get sued for anything, which is why publishers have lawyers and carry liability insurance anyway. Our contract with our publisher says that the editors have complete control over the editorial content of the journal. It would never occur to me to ask the publisher whether we needed to be careful about the manufacturer of the product (which was not the focus of your paper anyway), and if the publisher objected, I would simply send him/her a copy of the text from our contract that says the editors have complete control of editorial content and ignored the request/demand to send the paper to the manufacturer of the product in question. The publisher should be ashamed as well.

Bill Tierney
Co-Editor-in-Chief, Journal of General Internal Medicine

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Simon, I strongly agree with Bill. There is no reason that editors under the influence of publisher should have sent your paper to the manufacturer for comment. The editors should have full editorial independence on the contents of the paper; the publisher should not have any influence on the way the paper is written.

You should withdraw the paper from that journal and submit to another; the Journal of General Internal Medicine might be a good choice.

Ijaz A. Khan
Associate Editor, International Journal of Cardiology

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What is ironic and mildly amusing about this (though I suspect Simon will not be amused) is that it is vaguely reminiscent of the Plan B story issue that in part prompted the firing of the editor of the CMAJ. In that situation, as I understand it, the objection to the story came from the pharmaceutical association and the publisher put pressure on the editor to modify the story. Unfortunately, the editor agreed and this may have been the thin edge of the wedge. But I certainly agree; the paper should be withdrawn or Simon should threaten to do so and see if the editor will respond appropriately. Sadly, Injury Prevention may not be the best alternative venue for this study.

I. B. Pless
Editor, Injury Prevention

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I doubt whether Int Psychogeriatrics (which I edit) would be the best vehicle for this, but I cannot see how a journal can in all conscience accept a paper then not publish it—John Maddox got into trouble for that sort of thing at Nature a few years ago I recall (Chernobyl papers I think they were). If I were you, I would ask for it back or to be published forthwith.

And I'd think of writing up this story with players named in a letter to a general journal such as MJA.

Shame is a powerful force.

David Ames

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You have 3 options before you:

1. Wait for publication in the same journal, but suggest a way out to the editor there. Let your study be published with a response from the manufacturer presenting his side of the story. Suggest a disclaimer from the editor as a note below your paper that absolves him/publisher from any agreement with your conclusions.
2. Publish in another journal, but be ready to face rejection because no one would want headaches. Please note none of those who have sympathized with your condition have offered publication. Which means the obvious. Hope I can be corrected here.
3. Publish in your own journal, but let it go through the regular review process. And to make it fairer still, offer the concerned manufacturer a chance to write his side and juxtapose it with your paper so the reader can judge for himself. Only there should be provision for this in your journal, and you should not land into problems with your own publisher for doing so. The CMAJ case of editors writing in their own journal and falling foul with publishers since it was contrary to their deemed interests is fresh in our minds.

If you have reached the end of your patience, the third alternative is better. But before so doing, offer the first to the editor and see what happens.

It's no use calling the concerned editor names. He has a job at hand, and he may not feel it prudent to cross swords with his publisher. Knowing what happens to job positions when you do, I think he is being abundantly cautious.

Not many can be brave like the CMAJ editors when it comes to the crunch.

You can try the second method too. If you do, our publication, MSM, will consider it for publication. We have a special issue coming up on "What Medicine Means to Me." But of course the choice is yours.

I hope you receive some such offer from wherever you consider it worthwhile to publish your paper.

All the best.

Ajai

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