What WAME and ICMJE Can Do: Values Backed By Power

The WAME and ICMJE are excellent bodies for they embody what is right and proper in the world of biomedicine. However, as I see it today (especially in the wake of the CAMJ episode), they lack the teeth to implement their recommendations.

Just look at the others.

1. Medical Associations: Medical Associations have committed office bearers who have to cater to the constituency of their members. They have a finger on their pulse, and will go ahead and do what is in their welfare, oblivious of whether it is right or not. Members of such Associations too are very aware of their rights, and see to it they are well protected by their office bearers.

2. Pharmacists: Pharmacists have equally strong Associations, which will go to any extent to protect their members’ interests. Their economic power, ability to coerce drug manufacturers, and vantage position as medicine dispensers makes them formidable adversaries to have.

3. Manufacturers: Drug manufacturers exercise their considerable clout by the huge drug industry they run and the researches they support, for which most researchers and departments, even Medical Associations, are beholden to them.

4. Patients: Patients now have numerous advocacy bodies and activist groups to support them. With wide information available on the net, and legal advice ready to seize the opportunity, patients appear reasonably well protected today. The number of lawsuits being won by them in recent years should be ample proof of this.

What does this leave out? Only two. Editors and editorial board members, and medical researchers. Let us look at editors here, for WAME represents them.

Editors have at least two bodies which represent them. WAME and ICMJE. But where is the power to implement what they recommend? We may say their power is moral, of the Right, of the stature of their members who toil to lay down guidelines and procedures. But when it comes to the crunch, when it come to implementing what they recommend, what powers do they have to pull up erring parties aside from writing letters and petitions? If someone decides to ignore what they say, what power do they have to implement what they, and we all, know, is right?

I say this not to embarrass our office bearers. I am just voicing my anguish, which must be that of many others too, including, I guess, of the office bearers of WAME and ICMJE.

I think both these organizations have a larger role to play, apart from their role to refine research and offer guidelines for editors and researchers. This role they can decide to ignore, but will do so only at their own peril.

This is the activist role. When we know the forces against which we work are so strong and committed to their welfare, irrespective of what is right, how can we be content with only laying down guidelines and writing petitions?

Values, by themselves, are only words. If not backed by the power to implement them, they come to naught. And will be trampled upon in every crunch situation. As has happened with the present CMAJ episode, and happened earlier with JAMA and NEJM.

So what do we do?

What Can WAME and ICMJE do?

Both these bodies are the conscience of biomedical research. They must give clear-cut calls to their members. When they find their members being shortchanged, they must rise in their favour.

What do we mean by clear-cut calls?

1. First of all, take an unequivocal stand. If injustice is done, it must be clearly spelt out it is so. And ask for revoking wrong decisions. Also helping those who are at the receiving end of brash decisions by appropriate legal counsel and possible placements, ad hoc or permanent.

2. Call upon members to resist this injustice by expressing solidarity with the aggrieved. Members must be exhorted to write editorials and welcome other correspondence which sheds light on such episodes. Both sides need be represented of course, but a goal-directedness in such writing is necessary nevertheless.

3. Insist on members reporting transgressions of editorial independence to these bodies, and helping them resist it in their respective organizations. Otherwise, token espousal of editorial independence is all we will ever get. And its perpetual flouting by the unscrupulous is what we should perennially expect.

4. Adopt method of peaceful noncooperation with the aggressor. Associations fire upright editors when they become inconvenient. Pharmacists pressurize Associations to protect their interests. Manufacturers pressurize researchers and institutions by their money power. Why should not WAME and ICMJE pressurize unscrupulous employers by asking for peaceful noncooperation with their efforts by its members? How? By:

i. Not taking up editorial positions in such journals.
ii. Not reviewing papers for such journals.
iii. Not writing for such journals.
iv. Exhorting those who work for such journals, so to save them in the interim, not to do so. For their intentions are honourable, but misdirected at such times. And likely to blunt the offensive.
v. While we recognize the right of employers to hire or fire, they must recognize our right not to allow biomedical research to be directed by the whim and fancy of highhanded employers.

5. Lay down guidelines for editors and employers. Editors need to be on par with the Association Secretary, or Executive Vice-President, whatever, and report to the Executive Body of the Association, and finally to the Annual General Body, rather than to any individual. They can be impeached, even fired, but only after a statutory body of the Association gives them a full hearing.



Signing off, For Now

The promise such problems offer is tremendous. Provided we are ready to rise to them.

ICMJE and WAME have an excellent opportunity to prove they are not, and never will be, paper tigers.

It is only when they realize that the values they stand for can be backed by the power they have, but is still untapped: the strength of their members, and the clear-cut decisions of their office bearers.

I have great hope in the future of these organizations, and request its office bearers to help actualize this hope and the legitimate wish of its members.

Ajai
17 March 2006