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What is the role of a medical journal? Should it stick narrowly to the daily work of doctors and only discuss diagnosis and treatment or should it range more widely, adopting a broader perspective on the role of medicine in society? Some readers are angered when a medical journal strays beyond a narrow definition of medicine, while others believe that medicine and health are related to the political and social affairs of our world in the same way that it can be argued that economics is.
You can judge where I stand in this debate with the publication of this month's essay by David Owen, the UK's former foreign secretary (pp. 548-551). Owen's analysis of the intoxication of power, with particular reference to George Bush and Tony Blair, calls on his experiences as a politician and as a neurologist, though admittedly not as a psychiatrist. The intoxication of power is not a malaise confined to political leaders, of course; it can be found in leaders of trusts, hospitals, and clinical teams. Some might suggest that it is a particular problem with journal editors—although I don't believe that for a moment.
Owen's verdict is an unfavourable one for Bush and Blair. He sees a link between hubris and incompetence, and his view is that both leaders are hubristic. That hubris, he says, has affected their decision making. You might not agree, but another attribute of a medical journal in that it is a forum for debate, and that debate rarely ends with any article that is published. Indeed, we continue that particular debate in this very issue with Simon Wessely's commentary (pp. 552-553). ‘Owen the doctor gives us some insight into the characters and the motivations of the powerful, but it is Owen the politician who delivers the most compelling verdicts.’
The debate on authorship might not be as old as the debate about the intoxication of power in political leaders but it is old enough. Authorship disputes are common, but they are probably hindered rather than helped by the guidance of the International Committee of Medical Journal Editors, the guidance that most people know as the Vancouver Group guidelines.
The central problem is that this guidance makes it hard to meet the criteria for authorship. While nobody endorses gift authorship, it is important and fair that genuine contributions to work are acknowledged. Some journals, led by the BMJ and the Lancet, have adopted contributorship in addition to traditional authorship. Contributorship is more akin to film credits, with each contribution being recognized for exactly what it is. Liz Wager sets out the arguments that lead to contributorship in greater detail (pp. 542-543). It is a system that the JRSM will now be adopting in parallel with retaining more traditional authorship. We already ask authors to name a guarantor for their work, somebody who takes responsibility for the integrity of the research and its presentation. Contributorship is a more transparent concept than authorship, and it is a shame that few journals have adopted it so far. You might, then, cite this as an example of the hubris of journal editors.