Complaints and conundrums: an ombudsman–ethicist for CMAJ

Complaints: (1) A reviewer calls to say he will never review another paper for CMAJ because we accepted a paper he had urged us to reject in view of the authors' undisclosed and close relationship with a pharmaceutical company. (2) A letter writer complains that we edited her letter so severely that the main point was utterly lost. (3) An author complains that his paper was rejected even though it was “obvious [we] had not even read it.” Another complains that we misplaced his paper for 8 months, only to reject it when we found it.

Conundrums: (1) In their report on a trial of chemotherapy regimens in patients at a community hospital, the authors do not mention obtaining either patient consent or approval from a research ethics board. (2) Another paper, this time from a major university, describes a small study involving outpatients; the participants gave informed consent, but the authors neglected to obtain approval from a research ethics board. (3) An author who was asked during final editing of her paper to provide additional data simply fabricated the numbers; luckily, this was detected before the paper appeared in print. (4) An author calls to say that his institution has refused to allow him to submit a report on a series of deaths that occurred at his institution and which he believes might have been caused by the incorrect prescribing of a commonly used drug.

Each of the above situations has arisen at CMAJ in the past 2 years. In the first set of instances our responses were as follows. (1) We felt that including a disclosure of the competing interest with the published article was sufficient. (2) We were sorry, but we had had trouble finding the main point of the letter. (3) We regretted giving the impression of being inattentive, but we still felt that these articles were not suitable for publication in the journal.

In the second set we (1) rejected the paper on scientific grounds but did nothing else, (2) asked the authors to inform their ethics committee and refused publication of the paper (3) did nothing and (4) did some further investigation and asked the caller to send us the report. Saying he would be fired if he submitted the report, he declined.

Our responses to these complaints may or may not have been satisfactory. Journal editors are often viewed by authors as a lesser species of despot, and complaints may seem to fall on ears that, if not deaf, are also not impartial. But, other than complaining to editors, there is no other means to air a grievance. As Richard Horton wrote when he established an ombudsman at The Lancet, “there is no-one to whom [the editors] are accountable.”¹

The conundrums raised various issues that might be lumped under the heading “publication ethics,” a relatively new field in which there is a small but growing literature.² In collaboration with the Canadian Institutes of Health Research and others, CMAJ has recently established an ad hoc committee of Canadian health science journal editors in an attempt to cultivate awareness and agree on common standards for publication ethics in the health care disciplines.³ But, as specific problems arise and demand resolution, editors need the ready advice of an ethicist.

It is with this joint role in mind — ombudsman for CMAJ and resident consultant in publication ethics — that we are happy to announce the appointment of Dr. John Dossetor, who has agreed to take on both functions. Dr. Dossetor, emeritus professor in Medicine and Bioethics of the University of Alberta, Edmonton, has had a distinguished career as a nephrologist, researcher (he has published over 250 articles) and medical ethicist with a particular interest in organ transplant issues (see profile in this issue, page 1329). In 1985 he devoted a sabbatical year to studies in bioethics and the following year became director of the Division of Bioethics and of the Bioethics Centre at the University of Alberta. In 1996 he was appointed to the Chair of Bioethics. His outstanding contribution as a leader and mentor was acknowledged with the renaming of the University of Alberta's Bioethics Centre as the John Dossetor Health Ethics Centre in 1998. Dr. Dossetor now lives, in active retirement, in Ottawa.

In his role as ombudsman, Dr. Dossetor will investigate unresolved complaints about our editorial process — for example, a failure to follow the procedures outlined in our information for authors (www.cmaj.ca/misc/ifora.shtml) or prescribed by the International Committee of Medical Journal Editors (www.icmje.org); inappropriate editing; delays; and discourtesy. In his role as the journal's ethicist he will advise us on the questions of conduct we encounter from time to time. In carrying out both duties, he will have confidential access to all pertinent files and records and will be able to consult others (while preserving the anonymity of authors and reviewers). As ombudsman he will write an annual report of his findings with regard to complaints (again, preserving anonymity), his recommendations and the resultant changes made at CMAJ. The complete report will appear each year in CMAJ and on our Web site.

Readers, authors, peer reviewers and indeed anyone who feels that he or she has not been treated fairly by the journal should first correspond with the editors and outline the nature of the complaint. We will respond. If that response is judged unsatisfactory, the complaint (and our reply) should be sent to the ombudsman, c/o CMAJ, 1867 Alta Vista Dr., Ottawa ON K1G 3Y6; fax 613 565-5471; email ombudsman@cma.ca.

CMAJ is produced not just by editors and authors, but also by readers, peer reviewers, letter writers, journalists and the public. Dr. Dossetor's help as ombudsman and ethical consultant is a welcome addition to the journal's “constituent assembly.” ⁴