Q: The internet has produced mass democratization of information provision and access with little quality control. You represented JAMA at the International Committee of Medical Journal Editors (ICMJE) for over 10 years. How important is the ICMJE in protecting quality and ethics?
A: Since 1978, when a group of high impact medical journal editors representing several countries first met, the ICMJE has played a major role in setting standards for the ethics, preparation, and formatting of biomedical manuscripts. The current membership consists of thirteen medical journal editors and representatives of selected related organizations including the National Library of Science and the World Association of Medical Editors (WAME). These individuals work together to improve the quality of medical science and the reporting of such science.
The ICMJE publishes recommendations for the conduct, reporting, editing and publication of scholarly work in medical journals. These guidelines, primarily for authors, reviewers and editors, are available on line for anyone. ICMJE developed these recommendations to review best practices and ethical standards for the conduct and reporting of research and other material published in medical journals. The recommendations also help authors, editors, and others involved in peer review and biomedical publishing create and distribute accurate, clear, reproducible, and unbiased medical journal articles. These guidelines have also provided useful insights into the medical editing and publishing process for the media, patients and their families, and general readers.
One example of the important role the ICMJE has played in helping to assure the ethical publication of sound research occurred in September 2004 when the editors published a joint editorial regarding the registration of randomized clinical trials. At that time the law in the United States required that all clinical trials be registered in clinicaltrials.gov as soon as the first patient was enrolled. Very few such trials were registered because no one enforced the law. This put editors in a quandary because they had no idea if the submission of a manuscript that described a trial accounted for other trials using the same intervention (often a drug or medical device). In addition, editors looking at a manuscript’s trial did not know the results of those other trials or if the other trials were performed in different populations.
The joint editorial by the ICMJE editors announced that they would not publish any unregistered trials. This essentially meant that they also would not even review such manuscripts. The editors gave investigators a year to enroll the ongoing trials, but after September 2005 no unregistered trial would be published. This caused a great kerfuffle especially among the pharmaceutical and medical device manufacturers. However, the ICMJE prevailed and since September 2005 essentially all published clinical trials have been registered.
The numerous journals that follow the ICMJE recommendations are listed online and allow authors, reviewers, the media and others to know if the journal to which they plan to submit a manuscript or to review a publication follows the ethical and scientific guidelines.
The ICMJE has no legal jurisdiction. However, the respect shown for its leadership and the influence it has had on medical journalism for the past thirty-eight years cannot be questioned. The importance of having guidelines to assure honest reporting is more important than ever with the expanding use of online and print, non peer-reviewed publications by foundations and other institutions.
Hopefully the influence of the ICMJE will continue for as long as medical publications in any form exist.