Keeping the Current Editorship Current

Some people were born to edit, others achieve editorships, and others have editorship thrust upon them.

From the time of my undergraduate, government summer internships in Washington, and on through a career in nutrition and biomedical research, my consciousness has always been about scientific papers. First, it was reading those papers published by others, and then writing and publishing those from my own research, and finally moving on to evaluating and commenting on the suitability of those by other authors not yet published; the latter was in the context of peer review. In relation to the paraphrased header quotation, however, I clearly am in the third (thrust-upon) category as an Editor-in-Chief (EIC). I was always gleefully in the bridesmaid—perhaps better groomsman—position with regard to Editorial Boards, having been on the inaugural mastheads of Nutrition Research (1981), Nutrition (1983), and the Asia Pacific Journal of Clinical Nutrition (1990), and then on—and sometimes off again—the EBs of up to a score of scientific journals, encyclopedias, or limited series. Never had it crossed my mind, however, to seek to contract nuptials at the EIC altar. If ever there was a Reluctant Dragon who would rather spend his time in the comfortable confines of his research cavern in Guatemala in analysis and writing than to enter the lists of an editorial office, it was yours truly.

The Nature of an FNB Editor—Sample Size of 3

Those following this FNB 40th Anniversary series will know that Nevin S. Scrimshaw and Irwin Rosenberg were the first 2 EICs. From my perspective of on the nature of the editors, there are elements of commonality and concordance, and even of possible fusion, whereas there are others of discordance and contrast. The 2 predecessors were Midwesterners born in Wisconsin, whereas I was a Bostonian cum Cantabrigian New Englander. We all wound up obtaining some of our formal education at Harvard: Nevin for a PhD, Irv for his MD, and I for my AB and MD; this feature does make us partners in Crim(son). Nevin got his medical doctor credentials as well, which unites us in the Hippocratic tribe of physicians, having taught medical students, cared for patients, and engaged in scholarly clinical and public health research. We each had a passion for sports (participatory and spectator) and seafood meals (only participatory). Perhaps the most important common experience in the lineage of EICs of the journal has been their experience with building institutional and human capacity in low-income societies: Nevin Scrimshaw founded the Institute of Nutrition of Central America and Panama in 1949; Irwin Rosenberg was clinical chief and codirector of the East Pakistan (Bangladesh) Survey of the Interdepartmental Commission on Nutrition in the National Defense in the late 1960s; and the present editor cofounded the Center for Studies of Sensory Impairment, Aging and Metabolism in Guatemala in 1985. Directly confronting the challenges, possibilities, and areas of public health relevance in developing countries provided us with perspectives on manuscript contributions emanating from low-resource settings.

Journal Editor as Cabin Attendant

There is a grave and somber side to the role of an Editor-in-Chief, one that the submitting and reading public is not so often aware of. It is analogous to a cabin attendant on a commercial airline, for whom the flying public perceives the role as bringing good things to their seats during the flight, but in who the underlying purpose is assuring the passenger safety on the aircraft. In this analogy, the reading public seeks new discovery and insights into the browsing of scientific journal pages; but there are elements of “safety” as the fundamental, core basis of an editor’s duty. In part for me they derive from the Hippocratic principle of primum non nocere (first do no harm). Three scenarios provide the greatest worry—or should—to a contemporary science editor: falsification of findings, bioethical transgressions, and erroneous reports. These are the cardinal sins of contributors, but without sufficient vigilance, they can leave their crimson stain on the reputation of the journal and its editorial corps.

Falsification of Findings

The highest priority on my radar of misconduct vigilance is for the fabrication or falsification of findings, that is, the results basis of a paper created without data. The international nutrition community is particularly associated with this phenomenon in the incidence by a pediatrician, Professor of Nutrition and Immunology at Memorial University in St. Johns, Newfoundland, Canada, and founding editor of the journal, Nutrition Research. The history has been widely cited and analyzed. ^{1 -3} In sum, it involved a clinical trial of a patented multinutrient formulation on nutritional status and immune and cognitive function of elderly Newfoundlanders, published in various facets across a number of journals. ^4,5 There was also a confirmatory study published in Nutrition Research by a “Dr Jain” identified with a post office box address in India.

The study was first called into question for statistical anomalies by members of the academic community at the University of California at Berkeley, and seconded by an internal statistician at the BMJ, to which a derivative manuscript had been submitted—but never published. An internal review by the Memorial University failed to identify the original data files, and no participants among members of the St. John’s community of the ages in question were ever identified. The respective publications have both been retracted by the journals. ^4,5

My policy since assuming the EIC post at FNB has been, perhaps unfairly, to question single-authored manuscripts of original research arriving in the editorial offices. They are flagged and given more scrutiny than a companion manuscript with multiple authorship. The “too good to be true” standard is applied across more than the usual cadre of peer reviewers. Fabrication is the most egregious and nefarious form of fraud in research. ⁶ In the present instance, it could have led to popular consumption of a formula with evidence neither for its efficacy nor safety and providing profits for the undisclosed patent holder. There is no way to imagine the range of havoc to the literature and to the public that unchecked fabrication of data out of whole cloth could wreak.

Bioethical Transgressions

Dating to 1959 and the original expression of the Declaration of Helsinki, the reduction in research risk and guarantee of the human rights of participants in investigation have been a growing concern internationally. If we consider the 4 essential principles of bioethics, transgressions would include deprivation of autonomy, absence of beneficence, expression of maleficence, and disregard for justice. Human studies committees, termed institutional review boards (IRBs) in US parlance, have been designed and designated to eliminate or minimize these transgressions. I have lived and worked for over 4 decades in Central America and have written on the issue of bioethics in the context of developing countries. ^7,8 As such, I have become, over the course of time, both sensitive to the unique damage that can be done to vulnerable sectors in unethical research and sympathetic to the difficulties in low-income societies of complying with the formalistic requirements derived in developed nations.

Active maleficence, intrinsically linked to weakness in the support of free-willed participation, is the most ominous antiethical situation to be seen in submissions to international journals. I have had the opportunity over the years to flag to editors a series of severe transgressions. One study from China looked at the dietary context of a degenerative condition of knee cartilage diagnosed by the biopsy histology. Tissue was available both from afflicted patients and unaffected controls. The ethics of performing such a biopsy without clinical indications seemed questionable, and a close look at the fine print revealed that the “controls” were military conscripts from the national army. The manuscript was never returned for further review.

On a more generic basis, any paper with the hypothesis that any of the planned interventions will leave one or another of the treatment groups in an inferior condition than without intervention must be recognized as the prescription for maleficence and suffer rejection. Children in research are classified as a population segment with increased vulnerability in ethical considerations. Developing countries have a higher proportion of their populations younger than 18 years, often 50%, and their health and nutritional challenges are major. Research in juveniles, therefore, is an imperative to reflect the relevance and realities in most low- and middle-income countries, but it requires insight and tact to avoid ubiquitous adverse bioethical consequences.

The actual patient and complete explanation of the nature, purpose, benefits, inconveniences, and risks for the participants is more important than any consent form approved by a committee removed from the actual population of study. My office is tolerant of the absence of formal institutional review if authors show the respect for the tenets of bioethics, especially autonomy, whereas we frown on the studies in which foreign investigators, armed only with an IRB approval from their home institution, seek the “informed” consent of participants from a society and culture on the other side of the globe without first acquiring prerequisite local knowledge and understanding of context.

Erroneous Reports

The gravest of the mortal sins to be avoided is that of erroneous and flawed reports, especially when there are immediate practice or policy implications, as these, in the extreme, can foment real mortality. The pitfalls to be avoided are manifold: a falsely positive report raises false expectations of efficacy, leaving users unprotected; a falsely negative report on efficacy deprives potential beneficiaries of real benefits; a falsely positive report on safety can leave users unsuspectingly vulnerable to adverse consequences; and a falsely negative report on safety once again deprives potential beneficiaries of real benefits. Although all configurations are recognized, the last is the most nefarious example of an erroneous report.

The FNB was a mere adolescent in 1992, when the United States had its last terrible outbreak of measles before 2019. This 40th year of the journal has seen 981 cases from January through May across half of the states. ⁹ This resurgence in transmission of the rubeola virus is directly attributable to the resistance to the application of the measles–mumps–rubella (MMR) vaccine as the result of an erroneous report, published in 1998 in The Lancet by the British gastroenterologist Andrew Wakefield and his coworkers. ¹⁰ Their data alleged an association between the MMR vaccine and the additional risk of Crohn inflammatory bowel disease and autism. The findings have been shown to be erroneous due to methodological problems in the analyses. Despite the numerous subsequent studies showing no adverse consequences from MMR vaccination, a large and influential antivaccination movement has arisen across the world. The journal, The Lancet, has retracted the study, and the lead author has been defrocked as both a physician and investigator, but the lasting effects of this Fake News about MMR has continuously ramifying consequences. ¹¹

In the history of vaccine research publications, there are immunizations that have proven to be efficacious in prevention of the infectious disease and released to general use; some have been found only later with follow-up surveillance to be unsafe and have been withdrawn from distribution and later replaced by much more secure varieties. ^12,13 This latter experience shines as a glowing example of transparent responsiveness to the evolution of evidence of harm and safety in an area in which risks and benefits are inherently at loggerheads.

Clearly, the global visibility of The Lancet magnifies the probability of findings passing into practice, as compared to FNB. However, to the extent that erroneous findings may dissuade other researchers from or encourage them into more profound investigation, they are inherently insidious for scientific progress.

Supply and Demand in FNB Publications

In any scientific journal, including the FNB, there is a supply-and-demand paradigm. The conundrum for the Editorial Office is analogous to the situation of tension raised in the New Testament of the Holy Bible in Matthew 6:24: “No one can serve two masters.” Upon assuming any editor position, it becomes immediately obvious that one is facing 2 constituencies: the readership, which consumes the literature, and the authorship, which contributes the offering for publication. Each constituency has a different set of interests, and it requires Solomonic wisdom to achieve the appropriate balance.

The Council of Science Editors (CSE) is a resource that provides some background orientation and guidance in this conundrum. In addition to logistical and practical points for journal management, the CSE provides a forum for discussion of protection of the interests of those who contribute manuscripts and of those of the reading public. Since the beginning of my tenure, I have been affiliated with the CSE and attended its annual meetings. Prominent in the agenda at the recent meeting in May of 2019 were divergent views on the value of the Impact Factor and on the gravity of plagiarism, especially of one’s own previously published words in a Methods section.

From the perspective of the supplier, that is, the journal process of review and publication, 2 years is not an interval of sufficient duration, when compared to the past editorships. If there are a couple of areas that seem to be budding or fully flowering in the selection of submissions over the past 36 months, it would be a trio. Mixed-method studies with a combination of quantitative variables and qualitative approaches with key informants and focus groups have been increasingly seen. Similarly, studies using dietary diversity scores applied to dietary survey data, surging across the literature, ^14,15 have arrived in the FNB inbox. Similarly, an important uptick in submissions using the technique of linear programming to simultaneously optimize characteristics of a diet, as originally pioneered in France. ¹⁶

A major theme clustering in the inbox of the SAGE Track submission portal is some form of the “double burden” of malnutrition. This is a direct descendent of the “Nutrition Transition” paradigm introduced by Popkin in 1994, ¹⁷ which called for the recognition and redress of the emergences of problems of nutritional excess, such as obesity and overweight, while maintaining a focus on undernutrition and micronutrient deficiency. This has led to a more ample spectrum of consideration of “malnutrition in all of its forms.” ¹⁸ The double burden has been analyzed at the community, national, and regional level with validity in the application, that is, targeting policies to over- and undernutrition, while avoiding exacerbation of one condition from measures aimed at the other ¹⁸ ; the FNB is seeing a growing number of manuscripts addressing this conundrum. We also receive submissions looking at the so-called “household double burden,” examining the simultaneous occurrence of an obese or overweight mother and an offspring with wasting or stunting, a supposed paradox. We are guided in our (skeptical) evaluation of this latter association by the seminal publication by Dieffenbach and Stein ¹⁹ ; they showed that the prevalence of this “phenomenon” of household double burden is generally the unbiased combination of the prevalence of excess weight at the maternal level and undernutrition in children.

From the point of view of demand, we can examine the consumption of our published material using some metrics that show how voraciously the content may be gobbled up, beyond the perusal of the regular subscribers. For this reader’s demand perspective, the online materials for this third issue of the anniversary volume includes the 10 publications most frequently cited in secondary publications since their appearance on the pages of FNB over the past 3 years and the 10 publications with the greatest cumulative frequency of download over the same time period.

One Thousand and One Arabian Nights Moments

From my early years, I was soothed by the melodious strains of Rimsky-Korsakov’s Scheherazade Suite, which is based on the mythology of the 1001 Arabian Nights. Assuming an EIC position is truly an adventure and harkens to Sinbad the Sailor, one can envision oneself being surrounded by monstrous creatures, tempest-tossed, shipwrecked, and isolated on an abandoned island. When I assumed charge of the FNB, what I would not have given for the Genie of Aladdin’s lamp to materialize out of spout, resolve all of the journal’s issues, and run the operations. In fact, the Managing Editor, Dr Corey O’Hara, represents a somewhat superhuman entity with the energy to see that the journal miraculously overcomes its challenges. Corey, in association with our editorial assistant, Anna Carr, moreover, has moved us into the social media communications age. The most imposing analogy to the myths, however, was that of Ali Baba and the 40 thieves, with its obvious numerology surrounding the FNB anniversary; as the anniversary series was looming within 2 years of my transition to EIC, commemoration of the 40-year history of the journal had me over a barrel, stealing additional amounts of my time from other pursuits.

The journey, however, is nearing its final point of call, and Bulletin not only has survived—but thrived—through the fourth decade, initially on the shoulders of giants in its sequence of EICs. ²⁰ The “Vision” theme for this commemoration, moreover, has served as a laudable banner; no one has a crystal ball to predict the future, but, in this anniversary year, we are assembling aspirations as how best to shape it for the FNB. Hold on tight for the fifth decade’s Magic Carpet Ride.