Responsibilities of Authorship

To the Editor:— Your article, “The Responsibilities of Authorship” ¹ is a laudable effort to maintain the journal's high standards. I would like to join the debate by questioning the assertion that “duplicative, or redundant, publication is both wasteful and misleading” and the journal's policy prohibiting prior publication.

I submit that, in the electronic age, it is time we re-examine some basic assumptions about career advancement through publication of journal articles; the economics of peer-reviewed publications; and the ethics of withholding or delaying the dissemination of information in favor of economic considerations or considerations of personal prestige.

This issue of the journal reports on “Guidelines for the clinical use of electronic mail with patients”² in a paper developed through the AMIA task force and board of directors. The guidelines were submitted to the board in January 1997, approved after revision in June, submitted to JAMIA in July, accepted after revision in September, and appear in print in January 1998. I am dismayed that the editorial policy prohibiting prior publication postpones release of information while it is in press. We must find a way to maintain the integrity of medical information while accelerating the process of distribution. I propose the following subjects for discussion and debate:

• New economic models of electronic publication of medical journals, facilitated by secure Internetable financial transactions, should permit publication of journal articles within three days of approval with no loss of revenue to the publication, which could, in effect, become more like a newspaper. Subscribers without electronic access may continue to pay for paper-based information in the usual fashion.

• Because of overwhelming amounts of medical information, redundant publication is not only not unethical, it is desirable and necessary for adequate penetration of new ideas, treatments, technologies, and policies. Duplicate sources on “mirrored” Internet sites could be engineered to transmit invoicing methods to, say, CORBA-based accounting objects to charge for information across web sites. In that way, if a paying NEMJ subscriber wanted an article from JAMIA, s/he could be charged via the NEMJ account number. Other subscriptions would be feasible on a pay-per-view basis.

• Professionals who hope to advance on the basis of precedence of publication would benefit most from publishing in online, peer-reviewed, high-quality journals with minimal lead time. When all publications have less than three-day lead time, redundancy will be the tool of the true pioneer, not the weapon of the intellectually dishonest. “Let historians judge whose work is important... based upon the rate at which work is built upon or reused by others.”¹

• A full discussion of paradigm shifts in calculation of professional and personal self-worth, while necessary, is beyond the scope of this letter.

• All letters to the editor should be included in the online version of medical journals. I am disappointed that only four of 19 JAMIA issues in my possession have letters (in each case, a single letter) to the editor. Surely we must encourage public dialogue among authors and their readers. The technology for threaded electronic discussions is especially appropriate for professional exchange. Ongoing threads could in fact extend the life of journal articles well past the usual single volley of letter-and-reply.

I hasten to add that the peer-review and editorial processes would not change. Standards of quality would be maintained under the new model.

Finally, like you, I would like to see these questions and trade offs discussed by the Association's Publications and Ethics Committees.”