'Truth' in Medical Journal Publishing (From the Editor) (Editorial‪)‬

The meaning of 'truth' as a concept has exercised the minds of philosophers and ordinary mortals alike, perhaps since the emergence of Homo sapiens. Richard Smith, when he was editor of the British Medical Journal, once astounded his audience of leading fellow medical editors by declaring that 'The BMJ is not in the business of publishing "the truth".' He had a point. In the realm of human endeavour, be it science or religion, 'truth' invariably evolves and changes over time so that what is accepted as true today is shown to be untrue tomorrow. To paraphrase Harry Emerson Fosdick, the renowned US Baptist theologian of the early 20th century: 'The fact that astronomies change while the stars abide is a true analogy of every realm of human life and thought, religion not least of all. No existent [theory] can be a final formulation of [scientific] truth.' Furthermore, research findings published even in the most prestigious journals are often refuted by subsequent evidence right across the range of research designs, from clinical trials and traditional epidemiological studies to the most modern molecular research. (1) The fundamental function of medical journals therefore is to publish not the 'truth' per se, but rather the current state of knowledge derived from good research conducted and reported with the utmost integrity. 'Such publishing', a PLoS Medicine editorial admonishes, 'is predicated, above all, on trust. Authors need to trust that a journal's reviewers and editors provide a fair review process of their papers. And of course journals need to trust authors to provide a fair, honest, and complete account of their work. Only then can readers have trust in the articles that are published.' (2) Reviewing their experience during 2009, the editors observe--alarmingly--that 'it would be hard to conclude that this trusting relationship has not been shaken rather profoundly at times. Editors have sometimes been taken unawares by ghost and guest authors, manipulation of figures, lack of authors' willingness to share data, failure to register trials, and salami-slicing of data ...'