ethical populist

As editor of the British Medical Journal, Richard Smith has become known for using his high profile position to put the cat among the medical pigeons. Already this year there have been two issues where he has created a stir: first by resigning in July as professor of medical journalism at the University of Nottingham, in protest over the acceptance of money from the tobacco industry.Then, in a recent debate on researchers declaring conflicts of interests and the responsibility of journals publishing their work (highlighted by Nature's new policy of openness published in August), he was an outspoken advocate for the need for transparency. These latest issues highlight Smith's long-held interest in ethics, in particular the effects of information technology on science and the ethical issues subsequently raised.Smith has watched with interest as the Internet and other technologies have revolutionized science and scientific research. Among these key issues is that of research misconduct. Smith feels that, while misconduct is something that has always been out there, the Internet can be a means for wayward researchers to steal information and to manipulate data. But it can also be a tool for the scientific community to use in order to maintain the integrity of researchers. "Although there is the possibility that the Web could make research misconduct more common and worse, I also think it means we can respond to it better… that we can do a better job than we did in the past." He advocates a system of peer review conducted on the Web. When a study is up for publication, it should be posted on the Internet, with access to the full text of all the references. Reviewers will then be more easily able to check for plagiarism and to insure the validity of premise of the research. Smith also sees a move towards publishing not only the full data set of a study but also the software that has been used to manipulate the data. With these controls, journals and others in the scientific community should be better able to handle research misconduct.The move to put peer review of studies on the Internet is part of a larger movement towards more scientific information online. "Some of these journals are $10–15,000 to subscribe to and I think it's a rip-off," says Smith. "What exactly do the publishers do? It's a hell of a business to do a big, randomised control trial. It's a hugely difficult, value-added activity. Peer review is usually done by other academics so that value is added by the academic community. A lot of journals are edited by full-time academics and then it is the academic community that ultimately buys these journals and stores them in libraries so what exactly do publishers do? Well, not a lot, one would argue… The drive is leading towards everything being available on the Web, rather than putting out journals and sending them all over the place."The Public Library of Science is an agreement that over 25,000 academics have signed, in which they state that they will not publish in, review for or edit any journal that will not allow its original research to be made available to everyone free of charge after six months. While Smith has not signed on to the agreement as a journal editor, he supports its aims. The ideals of the Public Library of Science, to grant access to current scientific information to all, raises the issue of the global digital divide. While it is fine to ensure that new studies are put on the Internet for anyone to see, people without access to computers and the Internet are still left out. Smith sees this as the biggest ethical issue facing us today.Similarly, while most disease and suffering takes place in the developing world, the majority of resources and new treatments are in the developed world. Smith finds this analogous to the current digital divide but sees the Internet as a way of destroying the disparity in knowledge. While it may seem to make things worse right now, as information is shared through the Internet almost exclusively by the developed world, eventually it will be a tool to bring information to the developing world. It will share that information in a way that shipping copies of medical journals never could. The Internet has already brought medical information to millions of people who previously had no easy access to it. Now patients often have just about the same access to medical information as doctors. They are able to research conditions that their doctors have diagnosed to learn about treatments and sometimes attempt to diagnose themselves, changing the face of the doctor/patient relationship.Smith believes this changing relationship can be beneficial to both patient and doctor. "If doctors and patients act in partnership, rather than with the doctor as the superior source of making most of the decisions… everything goes better," he says.But he does worry about some of the information out there that patients are finding. "Information people come across using Yahoo or Google or whatever, can be truly terrible, it's effectively misinformation….That worries a lot of people, they say that we must have a way of stamping what information is and what information isn't acceptable. But I think that is a very difficult thing to do." Smith is, at heart a populist and the BMJ is the most populist of the medical journals. "We have many competitors, but I say in a way we are competing with Manchester United, with Hollywood films, because we are competing for people's attention."His adversary at Nottingham University over the tobacco issue, vice chancellor Colin Campbell, accused Smith of conducting a media stunt in order to raise the BMJ's circulation. It's a charge he's happy to live with. "I don't mean that we should just have naked women and cartoons and quizzes, but I think we have to use devices to get people's attention."

ethical populist

discusses how he sees the future of electronic biomedical publishing.

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