18: American Journal of Bioethics

Interview with Dr. Glenn McGee, Editor-in-Chief, December 2007

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Our periodical for this installment of Periodical Radio is the American Journal of Bioethics, a scholarly journal that publishes serious discussion of the social implications of biomedicine. Quoting from bioethics.net, the companion web site to the journal,

“Every issue of the American Journal of Bioethics contains peer-reviewed Target Articles that zero in on tough questions, answered by Open Commentary articles from scholars across disciplines and cultures.”

My guest is Dr. Glenn McGee, Editor-in-Chief of the American Journal of Bioethics. An internationally recognized expert on bioethics, Dr. McGee holds the John A. Balint Endowed Chair in Medical Ethics at the Albany Medical College in Albany, New York. Dr. McGee has published several books and numerous articles, serves on several boards of directors and ethics advisory boards, and has received awards for his scholarship, teaching, and service. I am honored to have Dr. McGee as my guest.

Steve: Dr. McGee, welcome to Periodical Radio.

Dr. McGee: Thank you.

Steve: The American Journal of Bioethics began publication relatively recently, in 2001. What need does the journal fill?

Dr. McGee: Well, it’s true, it is relatively recent, although I’m 40, so I like thinking of this as a quarter of my life, or something like that, now. We are in volume 10, so for all intents and purposes we’ve been working the equivalent of ten years, and it feels like much, much more than that. We came into existence a long time ago, because Massachusetts Institute of Technology’s Press company, somewhat independent of MIT, contacted me through an American philosopher that I had trained with years and years ago. They said, “Hey, we do all this mind stuff and that sort of thing, why aren’t we doing bioethics? And I said that’s an interesting question. I did a little PowerPoint for them, and showed them what was going on in the world of bioethics. And I said three things. First, books in bioethics, which at the time were still a big deal—people read books back then. Even medical people did. I said books in bioethics are targeted at a tiny audience at a time when Dolly the sheep has been born. That’s stupid. Why aren’t scholars writing to a more general audience? In part that’s has to do with the kind of editing that people do. So the dissemination of really thoughtful scholarship has got to be rethought. Second, I said, it’s interesting and odd that with the number of journals in the field, and a field that’s only thirty years old, that most people will say that a field like communication or sociology makes the turn inward. Nursing is the best example of this. Very quickly they begin writing to each other, so that they can legitimate their Ph.D. programs, so that everybody speaks a common language, etc. For thirty years now, bioethics journals have been written by people who work in this field, for people who work in this field. In physics that’s easy to explain. In bioethics, people have claimed for thirty years that they were writing to a general audience. That is, if Senator Kennedy were in interested in the future of medicine, that’d he’d pick up a copy of the Hastings Center Report or the Cambridge Quarterly in Bioethics, to just name a couple of the journals really are standouts in the field. And they’d read them and do something. The truth is that never happened. When we initially made our proposal, we said this--when people in the world of bioethics are rising, today--and this is back in 1997 when we had our first conversations--today they go before deans and promotions committees and they say to those people, “Here’s my work.” The journals that were published at the time looked like newsletters, and still do, mostly. They don’t look like medical journals, they don’t look like science journals. The review process is two years long, much more akin to the philosophy or classics journal that many of us are associated with. So assistant professors were literally being denied tenure, not on rate of publication, but on a combination of the fact that they’re weird, I mean they don’t get NIH grants, etc., and that their journals are unheard of. My claim was as important as it is to reach the general audience, it’s important to reach the scientific and medical audience. I said I think that’s possible. So I said I don’t necessarily want to do it, but a way we could try to do that is to build a kind of system that would allow physicians, scientists, and lawyers and others to participate in not just peer reviewed article submission, but also in discussions of those articles and that the journals built around, and we’re not the first journal to do this, but journals that are built around that are going to turn out, I said, and I think I was pretty prescient in this regard, are going to turn out to be the journals that are most important. I mean, if you look at the Thomson ISI impact factor ratings today, among the journals that nobody would ever have guessed would be most influential or most cited are journals like Nature Reviews: Genetics. Nobody would have ever said, “Yeah, I want my faculty to publish in a reviews journal.” And yet the fact that our journal really does have a kind of comprehensive, multi-disciplinary approach with people talking to each other, and that it looks like a medical journal, and has a title that invokes the notion that we are being responsible to scientists and doctors. That was important. I don’t know why it’s been as successful as it’s been. I’d like to think that it’s because it’s so cited, and where we’re cited. Part of it probably has to do though with the fact that we have had just extraordinary luck with getting people who don’t like to write for anybody but New England Journal of Medicine, to write for AJOB, and to give us some of their best stuff. With a jump start like that you can really move ahead quite quickly.

Steve: Dr. McGee, given your expertise in ethics, I’d like to focus much of our interview on ethical issues surrounding journal publishing.

Dr. McGee: Sure.

Steve: To begin, could you sketch for our listeners some of the important ethical issues surrounding scientific publishing?

Dr. McGee: Well I wrote a piece in Science’s online subsection called “Science Next Wave” called “Does it Take a Village to Write an Article?” From the time that I started teaching, I spent my first 10 years of my career at the University of Pennsylvania. As anybody in the world of medicine knows, there’s a mandatory course for biomedical scientists in ethics. I call it the “pizza and blackberry” course. It takes about four hours, usually. The students read the newspaper and they’re told a kind of mantra, do not steal data, do not pretend that you’re an author or let anyone else pretend that they’re an author with your own knowledge, do not in any way fabricate data. So don’t be Hwang Woo-suk and say you’ve cloned something, or paint mice as Summerlin famously did. But I wrote a piece before the authorship piece, actually, in the Chronicle of Higher Education, saying this is ridiculous. We’ve got articles by National Institutes of Health and other places on being a scientist that are designed to fix that, but my quote that gets requoted all the time is, if someone comes to your ethics program out of their basic science lab and already believe that it would be okay to paint a mouse black, you’re not going to convince them otherwise in four hours with pizza. I think that fact has led to a broader conversation. With every new small ethics scandal comes increased attention to a broader problem that crosses medical journals. When you have editors-in-chief of New England Journal of Medicine and JAMA both resign, or are fired, right? When you have one them, Catherine DeAngelis, become an ethicist and go on a mission to crunch conflict of interest in journal publishing, then it’s time to focus on those issues. The one that I focused on first was authorship. I think it’s become clear that in the world of medical publishing it is almost impossible to know who’s an author. I mean, we just don’t know. I was trained as a philosopher. Very few articles in philosophy were co-authored until roughly 1985, and after that the co-authorship that exists exists for some very specific purpose. The people who are participating would never think, in general, of a junior or senior partnership. If they do, they would label it, and they’d write another paragraph about how much of a role one person played versus another. In a typical science piece by a big lab, the person who gets the money that makes the lab go will be what’s called senior author, or last author. Some people know what that means. For example, when I first arrived at Albany Medical College, I talked about how my plan was as a person who was moving into a department chair position for the first time, to move from first author, where I’d been on the first hundred publications I’d had or so, to last author, because that’s a good place to be, anchoring things, helping to set the compass, but not playing the primary role in writing the article. He said to me, why would it be better to be last? In some world that’s not recognized. They just don’t get it. In the world of biomedical science, if you don’t have five or ten publications as last author, then that means you’re not senior. By the same token, first author is how you build your career, second author can be just as important. Everybody else doesn’t count. And yet maybe they do. I was just on a paper in circulation about ethical issues in cardiac care, and where genetic testing is going in medicine. I was the ethicist of the group, and I was an important part of the group. I think I’m seventeenth author out of twenty-something. I don’t even know what that means, right? I mean, I reviewed a couple of paragraphs and worked on it. The questions that have been asked--and that I asked in “Does it Take a Village?”--are do you have to write, number one, as Mildred Cho asserted in a pretty prominent article in Science—authors write. Do you have to contribute if you didn’t write, in a special way? And what would that mean? In other words, does raising funding for a lab independent of anything else count? If you begin to kind of run through the list of things that count about authorship, a lot of them have less to do with who gets credit, than with who gets blame. So in the Korean stem cell scandal, when the University of Pittsburgh scientist who had essentially facilitated the publication of the most important paper, which was also the most fraudulent paper, about the purported cloning of human embryos, he wrote the editor of Science and said, “I want to be pulled off this paper.” He was senior author. I was involved in conversations with them. Ultimately I was second author on a three author paper in Science called “Ethical Lessons of the Korean Stem Cell Scandal” in which we said, among other things, what Science said, which is, you can’t pull a senior author. You’re responsible for the paper. Scandals also have a lot to do with this, and that’s important because if you’re a student or a junior faculty member, today publication is how you get grants, if you’re working in that world. Even if you’re not, increasingly publication through teams is incredibly important. I can tell you from my own experience as an author that it is incredibly difficult to know where you stand with other authors, that the different disciplines such incredibly different standards for what it means to have collaborated, or for everyone to agree. For example, in biomedical sciences, everybody on the team might sign on to a paper, but author number four might disagree completely with its conclusions, and that would not be viewed as inappropriate or wrong, even though many of the new signoff sheets for these journals have a paragraph in them that say something like “I hereby agree that I am a part of this, and agree with what the paper says.” Not the conclusions, necessarily, but this is not stuff that I disagree with. It is still not viewed as odd at all for one, two, three, four of those people to just agree with the work they did on the paper. In a law review article that I myself recently participated in, it was viewed as, and this is standard issue for a law review, no one ever writes a multiple author paper. It was viewed as unthinkable that a couple of the authors on the paper disagreed with the conclusions of the paper, and ultimately they pulled off. So here I am, a journal editor, and I myself had found myself in what I think of as the swamp of authorship today. We ourselves had to pull one of the papers about the Korean scandal because we ultimately said in our retraction article in the American Journal of Bioethics, we said the group that had promised that there was an ethics code that was followed in Korea, this is one of the most important papers we published. It was hugely prestigious, quoted in AP stories, appeared in every newspaper in the English speaking world that carries the AP. We had to retract this paper because we could not vouch for the fact that those people had actually any clue what had or hadn’t gone on in the laboratory. Thinking about that led us to have to write a paper about what we called “gee whiz” or “I was there” papers, a category that didn’t even exist a year ago. And that category means the kind of quick, bang it out, 600 word article for Nature or AJOB or whatever, where you say, “we don’t really know yet, but this is what we think we saw.”

Steve: Glenn, in volume 2 of AJOB, you and Kelly Carroll, the managing editor, co-authored a conflict of interest policy for the American Journal of Bioethics. Could you describe what the policy is, and why it was necessary?

Dr. McGee: We crafted the policy because no one else in bioethics had one. We thought it was important, as we said, that there be policies about this, because we have encountered situations in which the nondisclosure of a conflict of interest in submissions had been surfaced ranging from peer reviewers saying, “By the way, I work with this person” and or authors calling furious, and saying why didn’t find out that this person is really my department chair, even though the name of the department differed. More importantly, conflicts of interest in bioethics became a big deal after scandals about so-called ethics advisory boards, and I’ll admit that I started this problem. I resigned quite publicly from Advanced Cell Technologies, the largest stem cell corporation in the world. I resigned as chair of their ethics advisory board after the ethics advisory board was not told that the company was experimenting with making clones of zoo animals. Eessentially I said in my resignation letter, which was printed in the Washington Post in large part, and then on the front page of the New York Times in large part, I said this is, you know, the danger here is that ethics advisory boards in the world of stem cells, we as ethicists are beginning to play a role where we’re rubber stamps. That’s dangerous. Another bioethicist at the University of Minnesota said it in a more clever way. He said, “Bioethicists have gone from being guard dogs to being lap dogs.” I think he was right in saying that’s a real risk. That pointed to something that right wingers, as bioethics has become more and more political, and more and more of those who are Republican have said bioethics is mostly peopled by liberals. A number of those, for example the White House Domestic Policy Council actually started to say things like, “You guys are owned, you’re bought and sold.” At the same time, and this is really critical fact about bioethics scholarship—in the old days, when I was doing my post doctorate, there was what my boss Art Kaplan called the full employment act. If you wanted to study bioethics, there was so much money you had to beat it away because of the Human Genome Project, which gave five percent to ethics. In the world of stem cells, well, there’s no money. All the money is for venture capital, except in California. So if you wanted to study ethical issues in human embryonic stem cell research, you basically had one and only one choice, and that was to go work with one of the groups, because the stuff’s all under patent, it’s all totally secret. The biggest company, Advanced Cell, is not traded publicly, or wasn’t until very, very recently, if they are now. So there was this problem of conflict of interest that we felt like we had to deal with. So we created a policy, and we decided that as long as we were going to be first, we would try to go beyond the existing policies. We’d adhere to the other ones, but we would go beyond. And we went beyond in the following way. We said we will disclose everything about what we earn. So I’m invited to give talks and particularly was then during the Dolly era for drug companies. So I’ll disclose every dollar that I get from doing anything for anybody. We’ll essentially release our tax returns. My co-editors and those who work with me in the editorial group agreed to it, I won’t say reluctantly because I don’t really remember. But then we created this policy and nobody cared. I have to say that policy was received with a resounding nothingness. Until finally Carl Elliot, whom I mentioned earlier, wrote a piece I believe in the Atlantic Monthly, but I wouldn’t swear by it, it might have been New Republic, in which he hammered bioethicists. He’s written five or six times the same piece over and over again. In this piece he really focused on AJOB, and he said I want this thing, and I’ve been asking for this conflict of interest thing forever, and I’m not getting it. It proved, if nothing else, that there’s at least one guy out there who’d like to see a conflict of interest policy in bioethics not only be good, but lead the way.

Steve: I was particularly struck by the requirement that peer reviewers had to disclose the sources of research funding, and any other relationships relevant to the article that they’re reviewing. Has that requirement made it difficult to recruit reviewers?

Dr. McGee: No, not at all. The only thing that makes it hard to get peer reviewers is that nobody wants to be a peer reviewer.

Steve: So you don’t think it’s changed that.

Dr. McGee: No, I don’t. I think that actually first of all there’s almost no corporate money in bioethics. I give talks occasionally for pharmaceutical companies, and I’m happy to be able to do that when it happens. But the list of, I mean Carl Elliot’s complaints about corporate money going into bioethics, you can really only name two or three bioethics programs out of the four thousand that exist that receive any corporate money of any consequence. The list of people who have received more than $100 from anybody, from any group at all, that has any investment in anything, is probably less than a hundred. It’s not a big problem. Conflict of interest for peer reviewers occurs in, I mean that’s the sort of policy we hoped would spread to avoid things like peer review of an article about Vioxx in New England Journal of Medicine.

Steve: But it hasn’t caught on in medical journals.

Dr. McGee: I don’t think so, but when I talk for example to the people who are working with Catherine DeAngelis, or to my peers in various committees that I serve on, it wasn’t that people weren’t interested, it’s that they really do fear that that won’t work out. We published probably most controversial article ever—no, that’s not true, we’ve published a lot of crazy controversial articles. But the one that was most controversial within our field was an article by James Coyne that was about, essentially it was an argument that a particular psychiatrist working in Canada is bought and sold. That article, which dealt with conflict of interest, created what I would describe as the biggest flap in the history of bioethics. The argument that was made was, and this is really why we started this conflict of interest policy, as a thing that we thought was unavoidable, as opposed to what I’d argued before, which is we wanted to do it anyway. We had to do it quick in my view, because we were watching as other journals were having problems when they published papers by non-bioethicists. Hastings Center Report fairly famously published a paper by the psychiatrist who I’m talking about, in which that psychiatrist said that antidepressants cause suicide, and it’s a huge problem, and accused Lilly in particular of hiding data about that. He said that in a bioethics journal. He subsequently said that in American Journal of Bioethics, and when James Coyne wrote his article, which even though we published it, it’s a broadside attack on us, the American Journal of Bioethics. What he pointed out is, that this story about how American Journal of Bioethics and Hastings Center Report published these pieces by a psychiatrist, that psychiatrist went on to testify in a number of cases about suicides by children in which he cited as scientific data his publications in the ethics journals. Literally. Coyne’s right, that in fact happened. So is it a conflict of interest? Yes. But it’s bigger than that. It’s that we’re not equipped by peer review to do certain kinds of things. At least everybody I know in the publication world remembers the debacle, I’m blanking on the name of the guy, who published the postmodern physics article.

Steve: Andrew [correction: Alan] Sokol?

Dr. McGee: Yes, the Sokol affair. It stands out, but ultimately it was just a way in which people could argue about whether postmodern scholarship was real, whether or not it would be irresponsible to submit a fake article to a journal. In this case, for someone to publish purported scientific data in an ethics journal, and then it survives our peer review process, in our case it was a peer commentary. That’s a huge deal. I mean, these were testimony issues for life and death issues. The biggest problem was that the argument that the Hastings Center Report made was that as soon as the article that this psychiatrist published came out in the Hastings Center Report that Lilly, who had been a big sponsor of the Hastings Center, pulled its annual contribution to the Hastings Center. The Hastings Center bragged and bragged and bragged for years about how they weren’t influenced by companies, even though they had tons of money from companies, and I believe still do. Look, they took that standing up, they lost the thirty thousand dollars, that was too bad, but that’s just how it had to go.

Steve: Glenn, we have only five minutes left, so I wanted to ask you one last question that’s on a different topic. What’s your take on Open Access publishing, where the costs of running a journal are paid up front by an author pays model or grants or some other method, and then they’re made freely available to anyone with a web connection.

Dr. McGee: I think it’s unethical. It’s unethical in the guise of being ethical, which makes it worse. I think the idea, of course, of providing scholarship free of charge is one that the world of the internet is more than prepared to provide. I think that the day is going to come in the not too distant future when the publishing world will be split into scholarly journals and not-so-scholarly journals. Scholarly journal editors who still own their journals will be able to say look, this is just not right. Already we push for example our company [Taylor & Francis], and they agreed, to give access to any library in the developing world. But to put the burden of peer review etc. on a potential author, this is disproportionate. It’s unfair taxation. I mean, essentially it’s the taxing of the poor, because it’s assistant professors who are going to turn to those journals, and when those assistant professors do turn to the journals and fork over a huge amount of money, not only are they forking over that money for journals that don’t have high impact factors, but the appearance in almost every discipline, that those aren’t real publications isn’t something that those journals are disclosing. So I really do honestly, I think that it’s really insipid that although I don’t think anybody intended for it to be this way, but I think it’s insipid that the argument is being made, “Hey we’re making things free, isn’t that great, the libraries don’t have to pay.” Well these universities that are funded by grants from Duke, and Stanford, and Vanderbilt, and huge corporate grants and so on, who are cutting their library budgets. Those are the people who actually aren’t paying for the journal subscriptions. So saving money for them by charging their faculty seems a little bit strange.

Steve: So you would be against the little bit of legislation in a large bill that’s kind of in the works right now, the requirement would be that anybody that publishes something with NIH funding would then have to deposit their article on the web within a year.

Dr. McGee: Well that’s a different issue. Of course, I think there’s absolutely no question that authors should have a choice, but that’s a different issue. The issue as to whether or not people who work in government institutions even under the Bayh-Dole Act [University and Small Business Patent Procedures Act] should be providing their information because it’s federally funded for free is a very different question than whether or not Open Access journals should charge assistant professors a thousand dollars to submit an article. I think those are just completely different issues. If what it means is just that as physicists do, they’ll just stick that stuff on the web, on a NIH web site, who’s to object? I think ultimately the biggest issue is going to be, so I’m a journal editor in bioethics, and if someone at the NIH has to put their stuff on the NIH web site, at the end of the day what’s going to happen to them when they have to leave the NIH and want to go get a real job working in bioethics at a university, what’s going to happen to them? Their journal articles have no impact factor whatsoever. I think that’s going to hurt them and I think we should we be very careful about moving in that direction.

Steve: Dr. McGee, I could speak to you for much longer, but unfortunately our half hour is up.

Dr. McGee: Well, I appreciate very much your calling, and I think this is a fabulous idea, and I’m happy to help you.

Steve: You have been very helpful, thank you. To subscribe to the American Journal of Bioethics, or to read Dr. McGee’s blog, go online to http://bioethics.net. Thank you for listening to this installment of Periodical Radio. I’m your host, Steve Black.

Note: The audio file for this interview was edited for length, to fit our 30 minute time limit. This transcript includes brief passages edited from the audio.