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Last week’s post introduced “neo-culturalism“. This post might add to the sense of what’s at stake and why there is a need for Samizdat – and your input to help us all work out how to grapple with what is going wrong.
Two decades ago, the editors of journals were people with what was once – way back in the 1960s – called bottom. Maybe this was a British thing. It applied to men who had reached middle years and whose bottoms had begun to spread and with this spread came what was viewed as a certain maturity of judgment – a time when men didn’t feel compelled to become Mamils (middle-aged med in Lycra, on bikes or in gyms).
Figures like Robin Fox, the editor the Journal of the Royal Society of Medicine (JRSM). There were whippersnappers like Richards Horton (Lancet) and Smith (BMJ) coming up behind him, figures of some substance but perhaps not quite the same.
Early in the crisis about children and antidepressants, I sent a paper about SSRIs and children to Robin Fox, who replied:
Nearly six weeks have passed since you sent me the paper on SSRIs in children. I spent two of them in contemplation, two of them taking outside advice, and the last two wondering how to proceed. The difficulty lies in the mixture of review and polemic. For clinicians in search of good advice, the accusatory element will be off-putting. In reviews of published work, many commentators nowadays warn about commercial influences, which have been demonstrated statistically by the likes of J.V.; but questions of greed and cynical disregard for human life need to be discussed in a different context. I suspect that you could write a brilliant article about ghost writing and kindred behaviour, but this is not it. In my editorial career I have always been suspicious of the pharmaceutical industry – and the question of ghost writing was raised during my editorship of the Lancet – but I have found that medical readers do not relish the fire and brimstone approach. My external reviewer, an academic child psychiatrist, took a similar view. He reckoned that the review should be rewritten, with evidence for and against throughout and minus the direct accusations of immoral behaviour. Whatever you do, I think that you should describe and leave to others to judge.
I fished out this 2003 article to check out just how shrill this young man had been – Here. It was worth the dig.
A few years before I had liaised at length with Richards Smith and Horton attempting to get articles published outlining the development of the SSRI and suicide crisis. Smith was blunter than Fox – ultimately saying we will never publish anything you send us.
Journal editors are essentially part of the establishment – the culture. Fox had a friendlier tone and was more judicious in his choice of words. Perhaps he had a less guilty conscience than Smith, who had approved and supported the Beasley article exonerating Prozac from charges of suicide.
Whatever you think is going on, a smelly figure (breaking bad) with warts and a personality was making the call at the other end of the correspondence. If you were disgusted, you knew what face to put on the voodoo doll as you prepared the pins.
A decade later, big-name journals with less high-profile editors, supported by an editorial team, might ask for a review of an article but now after submitting a review, if I’d raised any concerns, I’d find the article coming back to me for re-review. It was (and is) only when the reviewers signed off on the article that it would be published. There was a vacuum where the editor had been.
Asking if there is anyone at home, draws a response that its not the editor’s job to make decisions – it’s the reviewers.
Journals began to get online review systems with automatic dropdowns offering reject, accept with major revision, accept with minor revision, accept as is – but no “editor to decide” option. Previously you knew you were dealing with a great editor if in the face of three negative reviews of the article, he still decided to publish.
In the case of the BMJ, a review team now sits where Richard Smith once sat. Chances are there is someone on the team dead set against publication of an article on antidepressants and children, whatever the reviews, but you’ll never find out whose face to put on the voodoo doll. If the reviewers haven’t killed the article, authors get told about the boxes that have just not been ticked.
We now have platforms, where we once had bottoms. A topic gets picked by a company like Frontiers who own a platform. They look around for editors to help put together an issue on the now sure-fire topic like antidepressants in children.
The editors approach academics they know to write articles on some aspect of the topic. An exciting portfolio of articles and authors takes shape on an important topic. Deadlines are set for submission of articles and final publication etc.
Then things begin to go wrong.
Some background information is needed here to make sense of what begins to go wrong.
The peer review process is distinctly last millennium. Reviewers don’t get paid. Sometimes they do the job out of love, sometimes out of hate and the chance to pay back some grudge.
Authors don’t get paid when their article gets published. They get their kicks out of someone citing their article and it may help them in the academic pecking order.
Old-style editors like Robin Fox used to get paid a pittance. If you were running something like the BMJ business, you had a fulltime job.
The rhythm of twentieth century academic life involved keeping several balls in the air and focusing on one of them, like a review, only when necessary. Into this rhythm a Frontier’s algorithm now comes asking for a review of a submitted article – right now. Maybe you ignore it for a bit – reviews are never urgent. The requests keep coming to both editors and reviewers and multiply if the editor is responsible for several articles.
Its not possible to feed the beast without dropping something else because it’s not just a matter of clicking a proforma note to be sent to some anonymous reviewer, or as a reviewer it’s not just a quick skim of an article, there are all sorts of administrative issues that now go with reviewing – boxes to be ticked at every step, regular requests to reconfirm your inside leg measurement. Think automated call centres that loop back to some automatic question you’ve already answered and then cut you off without explanation.
This is fast forward to Lyon in 1840. Machines had begun to appear that could do a quicker job than the hand-weavers of cotton, wool or silk. The machine garments did not have the same variety and were not tailor made, but they could be produced at speed and in bulk, so machine owners could undercut the price traditional weavers were offering. Low wages or no wages became the only options.
The weavers protested. The new way of working meant moving out of their homes, breaking up family life, being crowded into factory settings, chained to a timetable and ending up with less money.
In 1840 Louis Villerme mapped out the health effects of the new factory working and depressed wages on the workers – they were getting new diseases, and injuries but also suffering because they could no longer afford decent food. Villerme and other doctors at the time sided with the workers and their research on occupational health led to the formation of a communist party in Lyon in 1840.
The brewing discontent led to a Revolution in France in 1848. Spotting a bandwagon to jump on, Marx thought communism was the coming thing and rushed out his Communist Manifesto. But the Revolution failed. The communists emigrated to Illinois – south west of where Chicago would later be.
Fifty years later, Chicago’s meatpacking industry repeated the trick pioneered by the silk factory owners, putting butchers and the local processing of meat out of business across the United States. In response to a growing labor unrest, in 1906 the US government put a Food and Drugs Act in place as part of an effort to placate the workers and a new class – consumers.
Now the platform has arrived in the middle of medical publishing. After the editors and authors do tons of work, any of the authors who wants to get published, (including the editors if they happen to have written something), gets charged $3000 to have their article published. For some academics, this will be paid for by their university (you the public in the case of most universities) but for others it won’t. There can be waivers which will drop the price to something closer to $1000 but the bottom line is that publication makes someone who has done no work, has no idea what the content of the articles means and probably no interest, a lot of money.
Someone whose only interest is in the ticked boxes that show they are producing a quality product.
One or two people who know nothing about medicine can make the system turn a profit for the organisation. Telling the platformers this is enslavement doesn’t compute. There is nobody at home to engage with the idea of slavery.
In the course of a decade the Frontiers Operation claims to have grown to be the 5th most cited academic publisher in the world.
Samizdat is anti-Frontiers, anti-platforms and anti-metrics. It embraces smells, messiness and a human touch. Its about not leaving you dead in your car while the parking ticket boxes get ticked.
But it is not about going back to the twentieth century and being co-opted by an establishment. The establishment is now or soon will be a platform, an algorithm. We have to find a way to make things happen within relationships such that to adapt an old saying “A Friend supported by a Friend has the strength of a Walled City”.
As Challenging Health Totalitarianism put it Samizdat is about finding something more complex than a Middle Ground.
Some of the good guys trying to roll back whatever it is that is going wrong, talk about conflicts of interest – abolish these and all will be okay. This is not wrong, anymore than platforms are inherently wrong, but in their efforts to become odour-free campaigns against conflicting interests risk becoming just like platforms – sterile.
The key thing is how do we get to objectivity. Removing all conflicting interests isn’t the way anymore than using platforms is. Objectivity comes when conflicting interests are invited into a room and let engage – we need more not less conflict of interest. But at the moment only one set of interests get heard.