The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Medical Journal Editing: Who Shall Pay?

Harold C. Sox, MD, Editor
[+] Article, Author, and Disclosure Information

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Harold C. Sox, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Ann Intern Med. 2009;151(1):68-69. doi:10.7326/0003-4819-151-1-200907070-00013
Text Size: A A A

This issue of Annals is my last as Editor and an occasion to describe some lessons learned. Here are 3: Spotless research is a rare exception; editors and statisticians who labor to improve reports of clinical research are a national treasure; and clinical journals can provide a unique public service if they ensure that research methods are correct, reporting is accurate and complete, and conclusions are appropriately cautious. These lessons will emerge as I discuss the question that haunts me as I leave Annals: Who will pay for this public good that clinical journals provide?

First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Medical Journal Editing: Who Shall Pay?
Posted on July 16, 2009
Chang-Qing Gao
The Research Center for Medical Sciences, The 3rd XiangYa Hospital
Conflict of Interest: None Declared

To the Editor,

The editorial paper "Medical journal editing: who shall pay? (1)" by Dr. Sox, revealed the exact processes a manuscript goes through during editing at the Journal. The Journal has a responsibility to the readers, and thus their patients as well. As the readers, we admire you for your efforts to make the articles published in the Journal as precise and accurate as possible by incorporating statisticians in the editing team and for the positive outlook when it comes to working closely with authors.

By integrating statisticians into the decision making team, you guaranteed the high scientific value for the papers published in the Journal. In fact, the incidence of the statistical errors in some other medical journals may be up to 88%, with some errors resulting from lack of statistical knowledge and some introduced intentionally to obtain desired outcomes (2).

By clarifying the statistic issues and working closely with the authors, the editors potentially saved many research papers that have important significance, which may have been simply rejected by other journals. Your efforts to be responsible to the authors and readers have also been clearly demonstrated by the rejection letter as well as the published papers. In the past we have always received specific comments from the Journal to explain the rational for the decision not to publish a manuscript in the Journal, while other journals send the same rejecting letter repeatedly for more than ten years. In addition, in the author center of the website of the Journal, when an article was rejected for publication, it is noted as "not accepted for publication", whereas many other journals simply inform us with one word "rejected", generating a completely different feeling when we see them. These kinds of differences in the details of treating authors can not be simply attributed to lack of time of the editors of the other journals, but rather a reflection of the editors' attitude to the authors. Obviously, the editors of the Journal are the true champions of research.

In summery, the readers of the Journal and accordingly their patients, the public, as well as the researchers themselves have benefited from the work of the editors of the Journal. It is thus clear who should pay for the editing. We suggest the Journal keep an account open to the public as well as the authors for donation. There must, of course, be a ceiling for each donation to prevent some individuals from donating an extreme amount of money in an effort to influence the decision of the editors.


1. Sox HC. Medical Journal Editing: Who Shall Pay? Ann Intern Med 2009;151 68-69.

2. He J, Jin Z, Yu D. Statistical reporting in Chinese biomedical journals. Lancet. 2009;373:2091-3.

Conflict of Interest:

None declared

Why is public good a private concern?
Posted on July 17, 2009
Marvin E Gozum
Jefferson Medical College
Conflict of Interest: None Declared

A key issue that could be raised for funding journal editing is why a private organization provides a public service, if indeed, journal articles are released for the public good? Are journals a form of philanthropy for the ACP if information is inevitably put into the public domain for free, and as mandated by US law? I am sure the Annals has exhaustively explored alternative funding models that could include annual monetary grants and endowments from charitable organizations. However, the amount of philanthropy varies with the economy, yet the output of studies remain at least constant. Its clear a funding strategy must exist proportionate to the volume of studies themselves, as it is a problem affecting all the journals.

I have not seen universality in embedding the cost of publication within a grant writing proposal nor a standard cost that could be entered into a grant proposal, the model proposed by open access publications. Maybe its time publication charges be standardized and made proportionate to the complexity of study design so it can be properly justified, especially to the NIH. This does not solve the editorial requirements of letters, reports, and unfunded studies all made with limited resources, but its very likely such reports are equally less complex to review, compared to large studies.

While accessing websites appear free, it is the server owner's responsibility for maintaining the servers and network, which are not free (1, 2). The publication charges would also subsidize resources to make information available for free.


1. Davis PM, Lewenstein BV, Simon DH, Booth JG, Connolly MJ. Open access publishing, article downloads, and citations: randomised controlled trial. BMJ. 2008 Jul 31;337:a568.

2. Gozum ME. Internet Access. Science. 1996 Apr 19;272(5260):335c.

Conflict of Interest:

None declared

In Response
Posted on August 31, 2009
Zhe Tang
Xuan Wu Hospital
Conflict of Interest: None Declared

We were surprised by the financial situation of the Journal, as in our mind medical journals can be highly profitable (1). There are numerous ways for a medical journal to generate revenues. For example, promoting drugs and charging authors by the pages they publish in the journal. For well- known journals the former method is very effective, whereas for the under-known journals the latter is attractive. One of the expected outcomes is that medical journals are too close to drug companies (2). The other is that, in order to make the greatest profit, some journals print their papers in extra large fonts with unusually wide margins and charge astonishing prices. The Journal has done nothing like this, and even does not charge anything for articles published in it. By doing this, the Journal maintains its independence, integrity and reliability and has long been admired by the medical community. However, in order to keep its high quality, it is essential to retain the editing staff. To solve the financial problem of the Journal, we suggest that the Journal charge authors at a reasonable price for articles published in it. We believe that it is not only acceptable but also welcome.


1. Angell M. A farewell. N Engl J Med. 2000;342:1989.

2. Smith R. The trouble with medical journals. J R Soc Med. 2006;99:115-9.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.