The flexible focus of the recommendations merits special attention. In some areas the text reveals intentional ambiguities intended to leave room for editorial policies that allow specific publications enough autonomy to defend their own interests.
In the new version, the more technical aspects regarding manuscript preparation and submission (Section IV) make up a bit less than one third of the document. In contrast, these aspects accounted for almost the whole document in its 1991 version,2 whereas in 19974 they made up half of the recommendations that were proposed. Among the few technical novelties added to the current version are recommendations on the word count of the manuscript and on the use of electronic formats to submit figures. The document suggests that the abstract should be structured and that the International System of Units should be used, but leaves the decision open. The section on reference formats has been greatly reduced, and readers are now instructed to consult the guidelines of the National Library of Medicine (www.nlm.nih.gov/bsd/uniform_requirements.html) and the Index Medicus (for key words and journal listings) on their own. Undoubtedly the most interesting development in this area is the suggestion to use the CONSORT checklist (CONsolidated Standards Of Reporting Randomized Trials, www.consortstatement.org) to prepare reports of randomized clinicaltrials.
It is therefore obvious that the current Uniform Requirements were written with a focus on education, to draw attention to the importance of ethical considerations. The functions, rights and responsibilities of editors are now clearly delimited, and the concept of editorial freedom or independence is stressed. Basically, editorial freedom should be founded on the editors´ absolute authority to decide on the content of the publication, and to express their viewpoints on different aspects of medicine. At the same time, logically, the Uniform Requirements remind readers that the contents of the journal should be appropriate for the readers´ general interests. The ICMJE has adopted this definition of editorial freedom from that of the World Association of Medical Editors (WAME). It is worth noting here that WAME recently expanded the concept of editorial independence to explicitly include “geopolitical” considerations (www.wame.org/wamestmt.htm).
The process of peer review and a summary of reviewers´ functions and responsibilities have also meriteda separate section for the first time. Critical, unbiased judgment by independent experts is emphasized as an essential part of the scientific process. Although most manuscripts submitted should be assessed with this process, the decision to use reviewers and the eventual use that is made of their reviews are left at the editor´s discretion.
The document also reviews the requirements for deserving authorship.5 Authors should assume direct responsibility for the final manuscript, while the “guarantor” (a new term introduced in this update) should assume responsibility for the “overall scientific content.”
Aspects related to potential conflicts of interest, not only by authors´ but also by reviewers and editors, are dealt with in three long, separate subsections where the importance of the recommendations to protect the “credibility” of scientific information is stressed.6,7 The Uniform Requirements suggest that editorial policies that favor transparency should be adopted. Specifically, the document recommends using a standardized text to explicitly communicate conflicts of interest. Aspects such as “intellectual passion” and “academic competition” are also mentioned among the potential factors—aside from economic considerations—that can generate unwanted biases. Although the need to disclose possible conflicts of interest is clear, the decision regarding when possible conflicts should be mentioned explicitly in the final publication so that the scientific content and the possible implications of the potential conflict can be judged appropriately is left at the editor’s discretion. Particular mention is made of the role of sponsors, whose involvement should be noted, and whose role in the research and potential publication detailed.
The new text draws attention to aspects of privacy and confidentiality for patients, authors and reviewers, and to the requirement for informed consent and compliance with the Declaration of Helsinki.8 The document suggests that there are different opinions regarding whether reviewers should remain anonymous. In this connection it is pertinent to recall that successive editors at REVISTA ESPAÑOLA DE CARDIOLOGÍA have shown the utmost respect for preserving the anonymity of authors and reviewers.
Consideration is given to the retraction of published articles, or—to use a more euphemistic term—the “expression of concern” when scientific fraud is proved. Suggestions are also given for how to handle possible conflicts between authors regarding performance of a study, the results obtained, and even their analysis and interpretation. To conclude, there is a specific section that attempts to regulate the reporting of scientific information to the lay media (embargo policy).
Of particular interest are the considerations about redundant publication as opposed to “secondary publication.” Specific reference is made to the clinical practice guidelines published by many scientific societies. This topic has particular bearing on our work as editors of REVISTA ESPAÑOLA DE CARDIOLOGÍA since the Spanish Society of Cardiology subscribes to the guidelines published by the European Society of Cardiology.
The Uniform Requirements now regulate editorial policies for supplements and advertisements in both print and electronic publications, and even note how some design elements of the links to other web pages should be handled.9
These observations show that there has been a clear change in the orientation and emphasis of the suggestions offered by the ICMJE. The former emphasis on attention to technical and formal aspects so as to impart greater clarity, precision and ease of dissemination of biomedical studies has given way to deeper considerations of issues in editorial ethics that affect not only authors, but also reviewers, editors, and indeed the entire international scientific community. At REVISTA ESPAÑOLA DE CARDIOLOGÍA we wish to reflect upon these considerations and will make every effort to adapt as well as possible to the spirit of these new recommendations. Unquestionably, they will smooth the way toward our aims10 by enhancing the quality and credibility of the scientific content of our journal.
Correspondence: REVISTA ESPAÑOLA DE CARDIOLOGÍA.
Sociedad Española de Cardiología.
Nuestra Señora de Guadalupe, 5-7. 28028 Madrid. España.
E-mail: rec@revespcardiol.org