Quixotian attack on Bioethics journals leads to retraction

I have blogged a few weeks ago on this website about a Quixotian attempt by a team of authors aimed at blaming leading mainstream subscription based bioethics journals for their alleged imperialist nature and what not else. A version of this blog entry has since been published here. I pointed out that the analysis of said article rested essentially on a questionable letter by the same team of authors that manipulated categories of the Human Development Index in order to generate a particular result plus false empirical claims about the availability of these journals through access schemes administered by the World Health Organisation.

I am pleased to report that the journal that published said article as a peer reviewed output has since retracted said content. There is no shame in retracting content found significantly wanting.

Fighting Imaginary Enemies in Bioethics Publishing

The Australia based Journal of Bioethical Inquiry has recently published two papers[1],[2] by the same group of authors. One of these papers was a Letter to the Editor, hence it is not entirely clear whether or not it was peer reviewed. Let’s call this paper Paper One. It was published in 2013. Another paper was published in 2015, the journal mentions that this paper was externally peer reviewed. Let’s call this paper Paper Two. Each of these papers targets editorial and commercial practices of major English language bioethics journals or their publishers. Both papers are Open Access at the time of writing, I encourage you to take the time to read them for context. 

This blog entry responds to both papers. My primary objective is to show that each paper fails in each mission.

Let us start with Paper One. The authors aimed here to investigate whether bioethics journals are variously ‘institutionally racist’ or ‘editorially biased’. They tried to achieve this by using the following method. They investigated the composition of major journals’ Editorial Boards – no content analysis was undertaken as part of this research project. The authors of this paper then grouped Editorial Board members into various categories according to where they live in terms of their countries’ rankings in the Human Development Index.  Surprisingly – and evidently unjustifiably so - this paper then proceeded to grouping the Editorial Board members into three categories (the HDI offers four[3]). It grouped Editorial Board members into Very High and High HDI, Medium HDI and Low HDI. The paper then notes indignantly that the vast majority of Editorial Board members belong into the first group of HDI countries. It turns out, by grouping Very High and High HDI countries into one category, these authors created arguably artificially the result required for their scathing critique. Unsurprisingly they found that the vast majority of Editorial Board member hail from countries that are either Very High or High HDI. However, a closer look into these categories reveals that the following countries can be found in their amalgamated first category: Germany and Libya, Mexico and Switzerland, Iran and the United States, Sri Lanka and Liechtenstein, and so on and so forth. Quite clearly, many countries belonging to the global south were unjustifiably folded into the global north category to achieve the desired outcome, namely blameworthy bioethics journals having an insufficient number of Editorial Board members hailing from the global south.

As mentioned already, Paper One also failed to undertake an actual content analysis. Bioethics established some 15 years ago its own specialised developing world focused companion journal called Developing World Bioethics. In case you wonder whether that meant shunting articles aside into a global south niche category, nothing could be further from the truth.  Developing World Bioethics has currently the second highest Impact Factor of bona fide bioethics journals, as measured by the Institute for Scientific Information. All of this escaped the authors of this paper, because they were primarily concerned with the composition of the Editorial Board of Developing World Bioethics, an Editorial Board they happily castigated for having insufficient representation from the global south, because by these authors’ definition, for instance the journal's Mexican and Sri Lankan Editorial Board members don’t quite count as representatives of countries of the global south.

Paper Two proceeds in this methodological vein. The focus is on purportedly greedy publishers and general bioethical imperialism. Like in the first paper, hyperbole remains a strong selling point of these authors. The target this time are paywalls. Most journals in our field are subscription based journals, which is partly a function of the fact that most authors publishing in bioethics journals do not have access to the funds required to publish in pay-for-play Open Access journals. That also means that access to the content we publish is restricted to subscribers, typically subscribing university libraries. Individual articles are available for sale to people interested in purchasing them. Paper Two then proceeds to investigate the question of whether mainstream or leading bioethics journals are available to academics working in the global south. This actually is an important issue and as an Editor of Bioethics and Developing World Bioethics I have always cared passionately about affordable or complimentary access for academics working in the global south. Leading academic publishers, including Wiley-Blackwell, the publisher of Bioethics, are founding members of myriad access schemes aimed at ensuring that academics in the global south have access to the content we publish. Knowledge is power after all. Among these schemes is HINARI, a scheme administered by the World Health Organisation. There are other schemes, AGORA and OARE among them.  

The authors of Paper Two apparently investigated whether leading English language bioethics journals are available via HINARI. That is a fair enough approach, HINARI covers health related research outputs, so Bioethics and Developing World Bioethics should be available thru HINARI, if at all. Paper Two reports erroneously that neither Bioethics nor Developing World Bioethics are available via HINARI. The authors make the same erroneous claim about other major journals in the field, including but not limited to ajob – American Journal of Bioethics, jme – Journal of Medical Ethics, Journal of Clinical Ethics, Cambridge Quarterly of Healthcare Ethics, Journal of Law, Medicine and Ethics, Journal of Medicine and Philosophy, Journal of Bioethical Inquiry.

It is worth noting here that the authors of Paper Two did not bother confirming with me or my fellow editors, or with our publishers, whether these journals are really not made available free of charge or at very low cost to academic institutions in LMIC countries. Apparently, confirming with the editors of these journals, or their publishers, that these bioethics journals really are not available free of charge to authors in the global south was too onerous for the campaigning authors of Paper Two.  It turns out, not only are Bioethics and Developing World Bioethics available via HINARI, but so are our esteemed competitors, namely all of the journals I mentioned above.[4] There is some irony in the fact that the current Editors of the Journal of Bioethical Inquiry were unaware of the availability of their very own journal via HINARI. It is doubtful that they meant to stand idle by while authors slander their journal in the pages of their own publication.

In light of these facts, I strongly encourage you to read Paper Two again. The anti-imperialist emperors look pretty naked to me. It’s a good example for the view that good intentions are not good enough. This research output reportedly underwent peer review, which goes to show that while peer review might be the best quality control mechanism there is, it is far from perfect. Paper Two goes on at great length about the purported profit motives of greedy publishers and how that impacts access to scientific information for researchers in the global south, alas its starting premise turns out to be false.

One would hope the Editors of the Journal of Bioethical Inquiry retract this particular peer reviewed output at their earliest possible convenience.

UDO SCHUKLENK

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[1] Subrata Chattopadhyay , Catherine Myser and Raymond De Vries. 2013. Bioethics and Its Gatekeepers: Does Institutional Racism Exist in Leading Bioethics Journals? Journal of Bioethical Inquiry DOI: 10.1007/s11673-012-9424-5 [Paper One]

[2] Subrata Chattopadhyay, Catherine Myser, and Raymond De Vries. 2015. Imperialism in Bioethics: How Policies of Profit Negate Engagement of Developing World Bioethicists and Undermine Global Bioethics. Journal of Bioethical Inquiry DOI: 10.1007/s11673-015-9654-4 [Paper Two]

 [3] UNDP. 2014. Human Development Report 2014.  http://hdr.undp.org/en/content/human-development-report-2014 - The interested reader might find these graphics displayed at Wikipedia informative. https://en.wikipedia.org/wiki/List_of_countries_by_Human_Development_Index [Accessed August 11, 2015]

[4] A complete list of accessible journals can be found here, http://extranet.who.int/hinari/en/journalList_print.php?all=true . [Accessed August 11, 2015] Consider saving the large file as a CSV file (follow the link offering that option). You will then download a MS Excel file that can easily be searched for journal titles that you are interested in.

Are Bioethics and Developing World Bioethics institutionally racist?

The answer appears to be 'yes' if you believe a Letter to the Editor published recently by our colleagues at the Journal of Bioethical Inquiry. Three authors (one from India the other two from the USA and the Netherlands respectively -  ie two thirds from the global north, I'll get back to that!) decided one way to ascertain whether there's institutional bias toward the rich world's problems in bioethics journals would be to investigate the country location provided for the journals' editors as well as their editorial board members. They picked 14 journals, looked at their overall number of editorial board members and divided them into groups based on the Human Development Index into Very High and High, Medium and Low. To no one's surprise they discovered that the vast majority of Editorial Board members hail from Very High and High HDI countries. You might wish to note that High HDI includes countries such as Jamaica, Malaysia, Grenada, Brazil, Iran and so on and so forth. The current list is here. So, by lumping countries such as Germany and Jamaica into one category (ie by lumping together Very High and High HDI) the authors of the letter have arguably created the particular outcome they needed to mount their criticism, namely the underrepresentation of bioethicists from developing countries on bioethics journals editorial boards. They discovered that 95% of editorial board members hail from these countries. These countries, of course, include countries as far apart in terms of development as are Germany and Libya.

Surprisingly this question begging bean counting activity must have passed peer review at the Journal of Bioethics Inquiry. Well, or it passed the editorial judgment of whoever is currently in charge at that journal. 

Now, fair enough, it is reasonable to be concerned about bioethics focus on the - often times decadent - problems of folks in the global north while ignoring more serious issues confronting people in the global south. I certainly feel passionately about this and have done my best during my years as one of the Editors of Bioethics and as one of the Founding Editors of Developing World Bioethics to remedy this situation. Let me show you how this pans out in the Letter writers analysis. I mentioned already that they're lumping - unreasonably - together folks from Germany and Jamaica or Australia and Dominica to generate the scandal they are keen on exposing. Bioethics is listed here as a journal with zero representatives from medium and low HDI. Brilliant insight. Here is the context the Letter writers ignored - were too busy investigating. 

On my initiative, more than a decade ago, while I was working full-time as an academic in South Africa, we made a considered decision to 'sacrifice' some of the Bioethics print real estate (ie the number of print issues we could produce in a given year) by starting a companion journal dedicated exclusively to developing world issues, and so Developing World Bioethics was born. Its distribution is identical to that of Bioethics, so wherever Bioethics is available in a personal or institutional subscription, there is also Developing World Bioethics. You could argue now that that surely was just a means to shunt aside issues affecting the global south, but incidentally the success of Developing World Bioethics in competitive journal impact rankings (where it does better than many mainstream bioethics journals) suggests otherwise. Criticizing Bioethics then for not having editorial board members from medium to low-income HDI countries completely misses the point of this arrangement. It constitutes unfair and uninformed criticism. Incidentally, 2/3rds of the Letter's authors hail from countries of the global north. Their own logic applied to their own letter would suggest that that somehow isn't a good thing. 

A more serious omission by the authors is their decision not to undertake actual serious qualitative research.  After all, the Letter writers have not even bothered to undertake an actual content analysis to investigate (and demonstrate) that the problem they are concerned about exists. Instead they say this, 'Scanning 4,029 research articles in nine bioethics journals, Borry, Schotsmans, and Dierickx (2005) found that developing country scholars contributed fewer than 4 percent of publications (the other 96 percent coming from authors working in developed countries). It is no surprise, then, that bioethics pays more attention to esoteric ethical problems facing wealthy nations than it does to issues such as poverty, hunger, and health inequities that are global in nature.'

You might wish to note that the study they cite ignored Developing World Bioethics. There's something amusing about scholars trying really hard to show how badly the global south is done by by mainstream bioethics, yet they have to resort to unnecessary acts of omissions, such as ignoring journals dedicated exclusively to this issue. They also ignore something else: many journals focusing strongly on these issues (in China, in Brazil, in Iran and so on and so fourth) do not feature on their list.  Why should non-English speaking academics working in the global south submit content to English language journals that are not widely read in their home countries? Are they doing wrong, in the eyes of our Letter writers, when they focus on journals in their mother tongue that are actually locally read by their fellow country men and women? 

My bone of contention with the authors of this Letter (and the Editors of the journal that published it) is that the research that it is based on is shoddy at best; that even if it wasn't as shoddy as it is it would still not have been able to show what needs to be shown, namely that the absence of editorial board members from the countries in question is the cause of bioethics lack of focus on issues the Letter writers are rightly concerned about.

Arguably today more content than ever before is produced by bioethicists on these issues. Perhaps not enough, but since Developing World Bioethics has come into being a lot has changed for the better. Journals such as the Journal of Global Ethics, Metaphilosophy, Public Health Ethics and others continue to produce high-quality outputs on the issues the Letter writers are concerned about. 

Dignity's 'wooly uplift'

I have been sufficiently concerned for awhile about the more or less random deployment of terms such as 'human dignity' for and against any and all kinds of normative positions that I have done a bit of research on it while I was a Distinguished Visiting Fellow at Queen Mary, University of London's Graduate School last term. Here's a pre-print of an Editorial I jointly wrote with Anna Pacholczyk, a graduate student at Manchester University for the journal BIOETHICS (2010; 24(2): ii. There's also a longer article forthcoming in the first issue of the JOURNAL OF BIOETHICAL INQUIRY in 2010 that I wrote on my own. Check it out and let me know what you think about it.

DIGNITY'S WOOLY UPLIFT

A. J. Ayer was famously and predictably dismissive of terms such as 'human dignity', referring to them as a kind of 'wooly uplift'.¹ Despite the pervasive presence of appeals to dignity in medical ethics and the common use of this term in professional codes, constitutional texts and various human rights instruments², both the moral basis as well as the meaning of this term continue to remain nebulous at best. Ruth Macklin suggested that we can do without dignity.³ Christian anti-choice campaigners, worried that a term as hegemonic as 'dignity' might be used by their opponents in the context of arguments about assisted dying, are staking their claims as to the true meanings of the term.⁴

Recent empirical research focuses on the importance and meaning of dignity to terminally ill patients. Dignity here, however is little other than an umbrella term for various patient needs being satisfied.⁵ This place-holder function offers us nothing by way of addressing the crucial normative questions that usually give rise to the deployment of 'dignity' in bioethics and biopolicy, such as for instance the moral permissibility or otherwise of assisted dying.

Given that the concept of dignity is not a primitive term of ethics, despite vague noises to the contrary⁶, invoking dignity without clarifying its basis and reach is mere sloganism – an ethical conversation stopper of a kind.⁷

Ethics is commonly and quite rightly so understood as having two primary functions: to guide our actions as moral agents and to provide us with justifications for the guidance provided. Can a hydra-like notion of dignity serve this purpose? In the context of assisted dying, appeals to dignity are used on the both sides of the fence. For instance, the Roman Catholic Church considers euthanasia to be a 'violation of the divine law, an offence against the dignity of the human person.’⁸ On the other hand, organizations campaigning in favour of the decriminalization of assisted dying in its varying forms do not hesitate to campaign in the name of 'human dignity', too.⁹ The situation in the legal context is not much better. When in September 1993 the Canadian Supreme Court issued a ruling on the terminally ill Sue Rodriguez's petition to declare invalid s 241 (b) of the Criminal Code¹⁰ - which criminalizes assisting people to commit suicide – both the majority and minority opinions employed the argument from ‘human dignity’ to support their views. ¹¹

Some scholars accept that we cannot reasonably 'expect dignity to have only one, clearly delineated meaning.'¹² Doris Schroeder argues that this is no reason to get rid of the concept altogether. She maintains that 'dignity is a slippery idea, but also a very powerful one and the demand to purge it from ethical discourse amounts to whispering in the wind.'¹³ A recent defense of the UNESCO Declaration on Bioethics and Human Rights against its critics, asserts that 'human dignity' and other such principles could 'function as guidelines for reviewing or reorganising research practices'.¹⁴ That is a troubling proposition.

The current state of affairs seems to be that, notwithstanding the dubious normative merits of 'human dignity', the fact that it is commonly used is sufficient reason to continue using it. This proposition is evidently flawed. We surely can do better than this.

1 A. J. Ayer. (1947) Language, Truth and Logic. London: Victor Gollancz.

2 C. McCrudden. Human dignity and judicial interpretation of human rights. European Journal of International Law 2008; 19: 655-724.

3 R. Macklin. Dignity is a useless concept. BMJ 2003; 327: 1419-1420.

4M. Somerville, “Defining human dignity”, 22 November 2009, The Gazette (Montreal), online: . Accessed 29 November 2009.

5 H.M. Chochinov. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ 2007; 335: 184-187.

6R. Goddin, “The political theories of choice and dignity” (1981) 18:2 American Philosophical Quarterly 96.

7 R. Van Der Graaf & J.J.M. van Delden, “Clarifying Appeals to Dignity in Medical Ethics from an Historical Perspective” (2009) 23:3 Bioethics 151.

8 F. Cardinal Seper. Declaration on Euthanasia. Acta Apostolicae Sedis 1980; 72: 542. Available at: Congregation for the Doctrine of the Faith http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html [Accessed 29 Nov 2009].

9 D. Hillyard & J. Dombrink. 2001. Dying Right: The Death With Dignity Movement. New York: Routledge.

10 R.S.C., 1985, c. C-46.

11 Rodriguez v. British Columbia (Attorney General), [1993] 3 S.C.R. 519.

12 D. Schroeder. Dignity: Two riddles and four concepts. Camb Q Healthc Ethics 2008; 17: 230-238: 237.

13Ibid: 237.

14 M. Levitt & H. Zwart. Bioethics: An export product? Reflections on hands-on involvement in exploring the “external” validity of international bioethical declarations. J Bioeth Inq 2009; 6: 367–377:370.