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Can you imagine a tobacco company publishing health journals? Probably not. The journals would be suspect. The hypocrisy would be too brazen for all but the most cynical of investors. And surely the company's business mission would be impossibly confused: would the company be in the business of killing people or keeping them alive? But if you can't imagine that absurdity, can you imagine a company that simultaneously promotes arms sales and publishes health journals? Well, you don't have to imagine such a company—because it exists. Indeed, it is Reed Elsevier, the world's largest publisher of scientific and medical journals. And the finest of Reed Elsevier's journals is The Lancet, the leading global health journal, which has been receiving much attention from the Pentagon for its important articles showing that death rates in Iraq are far above those admitted by the United States government.1,2 This is the absurd world of Ionesco. How did it happen, and how should the company and the editors, authors and readers of its journals respond?
There are nearly 650 million guns and light weapons in the world, and each year some eight million more are added.3 Every year about half a million people are killed by armed violence. Most of those who die are civilians, particularly women and children. Since the Second World War, 85% of armed conflicts have been in the poor world.4 By 2020, deaths and injuries from war and violence will overtake deaths from infectious disease.5 It was The Lancet that published the study which told us that war and armed conflicts are the main barriers to development in poor countries, and expenditure on arms diverts resources from education and health. Yet last year's United Nation's conference on small arms collapsed without agreement, as MacDonald's article in The Lancet told us.3
Through its subsidiary, Reed Exhibitions, Reed Elsevier runs arms fairs in Britain, the United States, the Middle East, Brazil, Germany and Taiwan. The same subsidiary runs Lancet conferences, including the forthcoming one in Asia. The Lancet told us how the fairs have in the past included cluster bombs, which are especially dangerous to civilians because they fail to explode and thus create minefields.6 The Lancet has consistently spoken out against cluster bombs. Last year's fair in the US included torture equipment sold by Security Equipment Corporation, who use the grotesque slogan ‘Making grown men cry since 1975.’ The Lancet has long been a leader in condemning torture.
You will be able to predict the response of Reed Elsevier, which disturbingly boasts regularly of the impact of The Lancet on global health—using it as a moral fig leaf.7 The company says that it is legal to sell arms, that the trade is tightly regulated, and that arms are clearly needed in a dangerous world. Unfortunately, the scale of sales is clearly excessive—and the harm that results is experienced mostly by women and children in the poorest countries, the very people for whom The Lancet speaks. The easy availability of guns also contributes to the gunning down of teenagers in South London.
The Lancet has acknowledged its discomfort.6 In 2005 it published a letter from 16 readers calling on Reed Elsevier to stop its involvement in the arms trade.8 That involvement, wrote the readers, was ‘incompatible with The Lancet's guiding principles, Reed's subscription to the UN Global Compact, and the ethics of many of its contributors, readers, editors, and reviewers.’ In the same issue the editors and international advisory board of The Lancet bravely and ‘respectfully’ asked ‘Reed Elsevier to divest itself of all business interests that threaten human, and especially civilian, health and well-being.’6
Unfortunately, Reed Elsevier didn't. So what now? The Joseph Rowntree Charitable Trust has spent three years trying to persuade the company to rethink its engagement with arms sales, but has failed—so it has sold its shares in the company. But what might be the actions of the editors, authors and readers of not only The Lancet but also the other 2000 medical and scientific journals published by Reed Elsevier? Alone they might achieve little, but together they might force the company to change, not by appealing to its non-existent conscience but through threatening its business.
It is the scientific and medical part of Reed Elsevier's business that is the most profitable: in 2005 its sales totalled £1436 million, or 28% of total Reed Elsevier sales, and its profits were £449 million, or 37% of the company's total profits. Indeed, Reed Elsevier plans to sell its education division, which is not nearly so profitable. The scientific and medical part of the business is so profitable because of the extraordinary value of the science it publishes. But the value in that research is created not by Reed Elsevier but by the scientists and academics who produce the research, peer review it, and edit most of the journals. This is where Reed Elsevier is vulnerable—were those researchers to go elsewhere, the company would promptly pull out of arms exhibitions. And, of course, those researchers might leave and never return.
It is essential, however, to act together. Somebody needs to orchestrate a campaign. The people in the strongest position to do so are the authors and readers of The Lancet and the 2000 other journals. Who will take the lead?
Competing interests RS is a member of the board of the Public Library of Science and a critic of journals and journal publishers. Before writing this piece he was invited by the leaders of Elsevier to speak to them at a meeting in Bavaria.