ISSN 0303-5212

Publication, subscription and Editorial office

PMA House G/220-B Liaquat Road, Rawalpindi. Phone: 051-555-9812, Fax: 051-553-7088 Email: Website: All correspondence should be addressed to Dr Nasir Khokhar, Editor-in-Chief.


Annual Rs.2000.00 (US$ 100.00), single copy Rs. 500.00 (US$ 25.00).

 Content Authenticity

The editorial Board makes every effort to ensure accuracy and authenticity of the material published in the journal. However, the statements and conclusions made are those of the authors and do not necessarily reflect the opinions of the editorial board or the PMA. Publishing of the advertising material does not imply an endorsement by the PMA.

Policy Statements

Peer-Review process

Peer review is fundamental to the scientific publication process and the dissemination of sound science. Peer reviewers are experts chosen by editors to provide written assessment of the strengths and weaknesses of written research, with the aim of improving the reporting of research and identifying the most appropriate and highest quality material for the journal. Regular reviewers selected for the journal are required to meet minimum standards regarding their background in original research, publication of articles, formal training, and previous critical appraisal of manuscripts.

Peer reviewers are experts in the scientific topic addressed in the articles they review, and are selected for their objectivity and scientific knowledge. Individuals who do not have such expertise are not be reviewers, and there is no role for review of articles by individuals who have a major competing interest in the subject of the article (e.g. those working for a company whose product was tested, its competitors, those with special political or ideological agendas, etc.)

Reviews will be expected to be professional, honest, courteous, prompt, and constructive. The desired major elements of a high-quality review should be as follows:

  • The reviewer should have identified and commented on major strengths and weaknesses of study design and methodology
  • The reviewer should comment accurately and constructively upon the quality of the author's interpretation of the data, including acknowledgment of its limitations.
  • The reviewer should comment on major strengths and weaknesses of the manuscript as a written communication, independent of the design, methodology, results, and interpretation of the study.
  • The reviewer should comment on any ethical concerns raised by the study, or any possible evidence of low standards of scientific conduct.
  • The reviewer should provide the author with useful suggestions for improvement of the manuscript.
  • The reviewer's comments to the author should be constructive and professional
  • The review should provide the editor the proper context and perspective to make a decision on acceptance (and/or revision) of the manuscript. (Some journals may wish a recommendation on whether the article should be published; others will not, as such decisions are usually made on priorities different than the reviewer's).

All reviewers are informed of the journal's expectations and editors make an effort to educate them and suggest educational materials (such as articles on how to peer review).

The editors routinely assess all reviews for quality; they may also edit reviews before sending them to authors, or simply not send them if they feel they are not constructive or appropriate. Ratings of review quality and other performance characteristics of reviewers is periodically assessed to assure optimal journal performance, and must contribute to decisions on reappointment or ongoing review requests. Individual performance data is kept confidential. Performance measures such as review completion time is used to assess changes in process that might improve journal performance.

The submitted manuscript is a privileged communication; reviewers must treat it as confidential. It should not be retained or copied. Also, reviewers must not share the manuscript with any colleagues without the explicit permission of the editor. Reviewers and editors must not make any personal or professional use of the data, arguments, or interpretations (other than those directly involved in its peer review) prior to publication unless they have the authors' specific permission or are writing an editorial or commentary to accompany the article.

If reviewers suspect misconduct, they should notify the editor in confidence, and should not share their concerns with other parties unless officially notified by the journal that they may do so.

High-quality review is important, but equally important is that readers be able to readily determine which contents of the journal are peer reviewed. Editors strongly consider having a statistician review reports of original research that are being considered for publication, if this feasible, since studies have shown that typical nonstatistician reviewers do not identify many major errors in research.

Review materials and original submitted manuscripts may sometimes be useful for educational purposes, for review by other parties in the peer review process (other than the decision editor or other reviewers of the same manuscript) or in educational products. No reviews or manuscripts should be so used without the express written permission of the reviewer or authors, respectively. (One procedure may be to have a blanket permission for autonomous internal quality assurance use included in the submission requirements for the manuscript, and the reviewer's assignment agreement).

Editorial Decisions

Decisions about a manuscript should be based only on its importance, originality, clarity, and relevance to the journal's scope and content. Studies with negative results despite adequate power, or those challenging previously published work, should receive equal consideration.

If a published paper is subsequently found to have errors or major flaws, the Editor takes responsibility for promptly correcting the written record in the journal. The specific content of the correction may address whether the errors originated with the author or the journal. The correction should be listed in the table of contents.

Ratings of review quality and other performance characteristics of editors is periodically assessed to assure optimal journal performance, and must contribute to decisions on reappointment. Individual performance data must be confidential. These performance measures should also be used to assess changes in process that might improve journal performance.

The handling of manuscripts that may represent a conflict of interest for editors is described under the section on conflict of interest.

A peer-reviewed biomedical journal is one that regularly obtains advice on individual manuscripts from reviewers who are not part of the journal’s editorial staff. Peer review is intended to improve the accuracy, clarity, and completeness of published manuscripts and to help editors decide which manuscripts to publish. Peer review does not guarantee manuscript quality and does not reliably detect scientific misconduct.

Peer reviewers are experts in the manuscript’s content area, research methods, or both; a critique of writing style alone is not sufficient. Peer reviewers are selected based on their expertise and ability to provide high quality, constructive, and fair reviews. For research manuscripts, editors may, in addition, seek the opinion of a statistical reviewer.

Peer reviewers advise editors on how a manuscript might be improved and on its priority for publication in the journal. Editors decide whether and under which conditions manuscripts are accepted for publication, assisted by reviewers’ advice.

Peer reviewers provide their opinions free of charge, as a service to their profession. Editors require all peer reviewers to disclose any conflicts of interest, financial or otherwise, related to a particular manuscript and take this information into account when deciding how to use their review. Generally speaking, people with a direct financial interest in the results of the manuscripts are not assigned as reviewers.

We obtain external reviews for all manuscripts, including all original research, review articles, opinion pieces (commentaries/editorials) and correspondence. To have been peer reviewed, a manuscript should have been reviewed by at least one external reviewer; it is typical to have two reviewers and sometimes more opinions are sought.

Editors need not send all submitted manuscripts out for external review. Manuscripts that seem unlikely to be published in the journal may be returned to authors without external review, to allow authors to submit the manuscript to another journal without delay and to make efficient use of reviewers’ and editors’ time.


Authorship is a way of making explicit both credit and responsibility for the contents of published articles. Credit and responsibility are inseparable. The guiding principle for authorship decisions is to present an honest account of what took place. Criteria for authorship apply to all intellectual products, including print and electronic publications of words, data, and images.

Criteria for Authorship. Everyone who has made substantial intellectual contributions to the study on which the article is based (for example, to the research question, design, analysis, interpretation, and written description) should be an author.
Only an individual who has made substantial intellectual contributions should be an author. Performing technical services, translating text, identifying patients for study, supplying materials, and providing funding or administrative oversight over facilities where the work was done are not, in themselves, sufficient for authorship, although these contributions may be acknowledged in the manuscript. It is dishonest to include authors only because of their reputation, position of authority, or friendship (“guest authorship”). Every submission must provide the following information at the time of submission.

Author Contributions: (Who did what?)

Conception and design: 

Collection and assembly of data:

Analysis and interpretation of the data:

Drafting of the article:

Critical revision of the article for important intellectual content: 

Statistical expertise:

Final approval and guarantor of the article:

It is preferable that all authors be familiar with all aspects of the work. However, modern research is often done in teams with complementary expertise so that every author may not be equally familiar with all aspects of the work. For example, a biostatistician may have greater mastery of statistical aspects of the manuscript than other authors, but have somewhat less understanding of clinical variables or laboratory measurements. Therefore, some authors’ contributions may be limited to specific aspects of the work as a whole.

Number of Authors. Editors do not arbitrarily limit the number of authors. There are legitimate reasons for multiple authors in some kinds of research, such as multi-center, randomized controlled trials. In these situations, a subset of authors may be listed with the title, with the notation that they have prepared the manuscript on behalf of all contributors, who are then listed in an appendix to the published article. Alternatively, a “corporate” author (e.g., a “Group” name) representing all authors in a named study may be listed, as long as one investigator takes responsibility for the work as a whole. In either case, all individuals listed as authors should meet criteria for authorship whether or not they are listed explicitly on the byline. If editors believe the number of authors is unusually large, relative to the scope and complexity of the work, they can ask for a detailed description of each author’s contributions to the work. If some do not meet criteria for authorship, editors can require that their names be removed as a condition of publication.

Order of Authorship. The authors themselves should decide the order in which authors are listed in an article. No one else knows as well as they do their respective contributions and the agreements they have made among themselves. Authors may want to include with their manuscript a description of how order was decided. If so, editors welcome this information and publish it with the manuscript.

Authorship Disputes. Disputes about authorship are best settled at the local level, before journals review the manuscript. However, at their discretion editors may become involved in resolving authorship disputes. Changes in authorship at any stage of manuscript review, revision, or acceptance should be accompanied by a written request and explanation from all of the original authors.

The Registration of Clinical Trials

The effectiveness of medical interventions should be based on the results of all properly conducted clinical trials, whether or not the trials have been published. The results of unpublished trials are systematically different from those that are published; they tend to be "negative" (find no effect or harm) or fail to support the interests of the funding agency. Therefore, relying on published trials alone can provide a biased view of effectiveness and safety.

Registration of clinical trials at their inception, in widely available registries, makes it possible for all stakeholders to take unpublished trials into account when summarizing the evidence for an intervention's effects. Information in registries can also prompt efforts to discover the original objectives and results of unpublished trials and the reasons why they were not published.

Journal editors support the development of registries by participating in efforts to develop a consensus on requirements for registry contents, responsibility, access, search ability, and comprehensiveness and by promoting their implementation. When suitable registries are available, editors require prior registration of all trials published in their journals.

Ghost Writing Initiated by Commercial Companies

The integrity of the published record of scientific research depends not only on the validity of the science but also on honesty in authorship. Editors and readers need to be confident that authors have undertaken the work described and have ensured that the manuscript accurately reflects their work, irrespective of whether they took the lead in writing or sought assistance from a medical writer. The scientific record is distorted if the primary purpose of an article is to persuade readers in favor of a special interest, rather than to inform and educate, and this purpose is concealed.

 Ghost authorship exists when someone has made substantial contributions to writing a manuscript and this role is not mentioned in the manuscript itself. WAME considers ghost authorship dishonest and unacceptable. Ghost authors generally work on behalf of companies, or agents acting for those companies, with a commercial interest in the topic, and this compounds the problem. For example, a writer employed by a commercial company may prepare an article, then invite an expert in the field to submit the work, perhaps with minor revisions, under his or her own name. The submitting author may be paid, directly or indirectly, for this service. In other circumstances, investigators may pay a professional writer to help them prepare their article but not mention this assistance, gaining credit for writing they have not done. Although editors seek to avoid publication of ghost written articles, these articles are often very difficult to detect.

Submitting authors bear primary responsibility for naming all contributors to manuscripts and describing their contributions. Ghost authorship would be avoided if corresponding authors listed everyone else who participated in the work, including those who contributed only to the writing, along with their individual contributions and institutional affiliations; stated explicitly how the work was paid for; and fully disclosed any further potential competing interests.

To prevent some instances of ghost authorship, editors make clear in their journal's information for authors that medical writers can be legitimate contributors and that their roles and affiliations should be described in the manuscript. When editors detect ghost written manuscripts, their actions involve both the submitting authors and commercial participants if they are involved. Several actions are possible:

  1. publish a notice that a manuscript has been ghost written, along with the names of the responsible companies and the submitting author;
  2. alert the authors' academic institutions, identifying the commercial companies;
  3. provide specific names if contacted by the popular media or government organizations; and
  4. share their experiences on the WAME Listserve and within other forums.

Together, these actions would increase transparency and public accountability about ghost writing and its manipulation of the scientific record and deter others from this practice.

Geopolitical Intrusion on Editorial Decisions

Decisions to edit and publish manuscripts submitted to biomedical journals are based on characteristics of the manuscripts themselves and how they relate to the journal's purposes and readers. Among these characteristics are importance of the topic, originality, scientific strength, clarity and completeness of written expression, and potential interest to readers. Editors also take into account whether studies are ethical and whether their publication might cause harm to readers or to the public interest.

Editorial decisions are not affected by the origins of the manuscript, including the nationality, ethnicity, political beliefs, race, or religion of the authors. Decisions to edit and publish is not be determined by the policies of governments or other agencies outside of the journal itself.

Editors defend this principle, as they do other principles of sound editorial practice, and enlist their colleagues' support in this effort if necessary.

The Responsibilities of Medical Editors

The following statement was drafted at a meeting of the World Association of Medical Editors (WAME) during a meeting at the Rockefeller Foundation Study and Conference Center in Bellagio, Italy, January 22-26, 2001. It has been revised by the Editorial Policy Committee and reviewed by the Executive Committee of the WAME Board before being posted on the WAME website.

Editors should:

  1. Respect their journal’s constituents (readers, authors, reviewers, and the human subjects of research) by:
    • Making the journal’s processes (e.g., governance, editorial staff members, number of reviewers, review times, acceptance rate) transparent;
    • Thanking reviewers for their work;
    • Protecting the confidentiality of human subjects.
  2. Promote self-correction in science and participate in efforts to improve the practice of scientific investigation by:
    • Publishing corrections, retractions, and critiques of published articles;
    • Take responsibility for improving the level of scientific investigation and medical writing in the larger community of potential authors and readers.
  3. Assure honesty and integrity of the content of their journal and minimize bias by:
    • Managing conflicts of interest;
    • Maintaining confidentiality of information;
    • Separating the editorial and business functions of the journal.
  4. Improve the quality of their journal by:
    • Becoming familiar with the best practice in editing, peer review, research ethics, methods of investigation, and the rationale and evidence base supporting them;
    • Establishing appropriate programs to monitor journals’ performance;
    • Soliciting external evaluations of the journal’s effectiveness.

The Relationship Between Journal Editors-in-Chief and Owners (formerly titled Editorial Independence)

Editors-in-Chief and the owners of their journals both want the journals to succeed but they have different roles. The editors-in-chief’s primary responsibilities are to inform and educate readers, with attention to the accuracy and importance of journal articles, and to protect and strengthen the integrity and quality of the journal and its processes. Owner of this journal, Pakistan Medical Association, Rawalpindi Islamabad Branch  supports the core values and policies of their organization and are ultimately responsible for all aspects of publishing the journal, including its staff, budget, and business policies. The relationship between owner and editors-in-chief is based on mutual respect and trust, and recognition of each other’s authority and responsibilities.

The following are guidelines for protecting the responsibility and authority of both editors-in-chief and owner:

  1. The conditions of the editors-in-chief's employment, including authority, responsibilities, term of appointment, reporting relationships, and mechanisms for resolving conflict, are explicitly stated in writing and approved by both editor and owner before the editor is appointed. Those conditions bearing on editorial freedom are shared with readers by publication in the journal or on its website.
  1. Editor-in-chief has full authority over the editorial content of the journal, generally referred to as “editorial independence.” Editorial content includes original research, opinion articles and news reports, both in print or electronic format, and how and when information is published. Owner does not interfere in the evaluation, selection or editing of individual articles, either directly or by creating an environment in which editorial decisions are strongly influenced.
  1. Editorial decisions are based mainly on the validity of the work and its importance to readers, not the policies or commercial success of the owner. Editors are free to publish critical but responsible views about all aspects of medicine without fear of retribution, even if these views might conflict with the policies or commercial goals of the owner. To maintain this position, editors seek input from a broad array of advisors such as reviewers, editorial staff, an editorial board, and readers.
  1. Editors-in-chief establish procedures that guard against the influence of commercial, organizational, and personal self-interest on editorial decisions and should make these procedures clear and transparent to all interested parties.
  1. Owner has the right to hire and fire editors-in-chief but they should dismiss them only for substantial reasons such as a pattern of bad editorial decisions, disagreement with the long-term editorial direction of the journal, or personal behavior (such as criminal acts) that are incompatible with a position of trust. It may also be appropriate to end the editor’s service if, for whatever reason, owner and editors find they are unable to work together in a spirit of mutual trust and collaboration. Termination of an editor’s appointment should be a deliberate process, involving open discussion at the highest level of the organization, and should not be precipitous, except for egregious wrongdoing.
  1. The limits of editorial freedom are difficult to define in the general case. Editors are receptive to articles representing all legitimate points of view and should be free to publish any responsible positions. However, owner cannot be expected to retain editors who take strong, consistent, one-sided positions against the core values and policies of their parent organization.
  1. Editors-in-chief report to the highest governing body of the owning organization, not its administrative officers. Major decisions regarding the editor’s employment are made by this body with open discussion and time to hear from all interested parties. Both owner and editors have a meaningful role in appointment of members, since both are stake-holders in the committee’s effectiveness. The work of such committees is be transparent and publicly available.
  1. Editors resist any actions that might compromise these principles in their journals, even if it places their own position at risk. If major transgressions do occur, all editors can participate in drawing them to the attention of the international medical, academic, and lay communities.


                                                        Publication Ethics Policy

Adapted from the WAME Publication Ethics Committee

The purpose of a policy on ethical principles

A comprehensive policy on publication ethics is summarized in this document, which addresses all the major areas of ethics we believe contemporary science journals should consider.

Study Design and Ethics

Good research should be well justified, well planned, and appropriately designed, so that it can properly address the research question. Statistical issues, including power calculations, should be considered early in study design, to avoid futile studies that produce subject risk without enrollment sufficient to answer the research question. Outcomes should be specified at the start of the study. Research should be conducted to high standards of quality control and data analysis. Data and records must be retained and produced for review upon request. Fabrication, falsification, concealment, deceptive reporting, or misrepresentation of data constitute scientific misconduct.

Documented review and approval from a formally constituted review board (Institutional Review Board or Ethics committee) is required for all studies involving people, medical records, and human tissues. For those investigators who do not have access to formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed. If the study is judged exempt from review, a statement from the committee should be required. Informed consent by participants is always sought. If not possible, an institutional review board must decide if this is ethically acceptable. Journal requires these review board approvals documented by the authors, or simply attested to in their cover letter, and how they should be described in the manuscript itself.

An informed consent must be obtained by all participants of study.

Animal experiments should require full compliance with local, national, ethical, and regulatory principles, and local licensing arrangements.


We follow the universally agreed definition of authorship; contributors are made aware of the guidelines developed by the International Committee of Medical Journal Editors (available at

Authorship implies a significant intellectual contribution to the work, some role in writing the manuscript and reviewing the final draft of the manuscript, but authorship roles can vary. Who will be an author, and in what sequence, should be determined by the participants early in the research process, to avoid disputes and misunderstandings which can delay or prevent publication of a paper.

Originality, Prior Publication, and Media Relations

Journal generally seeks original work that has not been previously published. Web and other electronic publication should be considered the same as print publication for this purpose. Redundant publication occurs when multiple papers, without full cross reference in the text, share the same data, or results. Republication of a paper in another language, or simultaneously in multiple journals with different audiences, may be acceptable, provided that there is full and prominent disclosure of its original source at the time of submission of the manuscript. At the time of submission, authors should disclose details of related papers they have authored, even if in a different language, similar papers in press, and any closely related papers previously published or currently under review at another journal.

Previous publication of an abstract during the proceedings of meetings (in print or electronically) does not preclude subsequent submission for publication, but full disclosure should be made at the time of submission.

Responding to Allegations of Possible Misconduct

Journals do not have the resources or authority to conduct a formal judicial inquiry or arrive at a formal conclusion regarding misconduct. That process is the role of the individual's employer, university, granting agency, or regulatory body. However, journals do have a responsibility to help protect the integrity of the public scientific record by sharing reasonable concerns with authorities who can conduct such an investigation.

Deception may be deliberate, by reckless disregard of possible consequences, or by ignorance. Since the underlying goal of misconduct is to deliberately deceive others as to the truth, the journal's preliminary investigation of potential misconduct must take into account not only the particular act or omission, but also the apparent intention (as best it can be determined) of the person involved. Misconduct does not include unintentional error. The most common forms of scientific misconduct include the following:

Falsification of data: ranges from fabrication to deceptive selective reporting of findings and omission of conflicting data, or willful suppression and/or distortion of data.

  • Plagiarism: The appropriation of the language, ideas, or thoughts of another without crediting their true source, and representation of them as one's own original work.
  • Improprieties of authorship: Improper assignment of credit, such as excluding others, misrepresentation of the same material as original in more than one publication, inclusion of individuals as authors who have not made a definite contribution to the work published; or submission of multi-authored publications without the concurrence of all authors.
  • Misappropriation of the ideas of others: an important aspect of scholarly activity is the exchange of ideas among colleagues. Scholars can acquire novel ideas from others during the process of reviewing grant applications and manuscripts. However, improper use of such information can constitute fraud. Wholesale appropriation of such material constitutes misconduct.
  • Violation of generally accepted research practices: Serious deviation from accepted practices in proposing or carrying out research, improper manipulation of experiments to obtain biased results, deceptive statistical or analytical manipulations, or improper reporting of results.
  • Material failure to comply with legislative and regulatory requirements affecting research: Including but not limited to serious or substantial, repeated, willful violations of applicable local regulations and law involving the use of funds, care of animals, human subjects, investigational drugs, recombinant products, new devices, or radioactive, biologic, or chemical materials.
  • Inappropriate behavior in relation to misconduct: this includes unfounded or knowingly false accusations of misconduct, failure to report known or suspected misconduct, withholding or destruction of information relevant to a claim of misconduct and retaliation against persons involved in the allegation or investigation.

Deliberate misrepresentation of qualifications, experience, or research accomplishments to advance the research program, to obtain external funding, or for other professional advancement.

Responses to possible misconduct

We follow the guidance provided to editors by a publication of the US Office of Research Integrity may be useful (, accessed 12/2/03). The process described in the following 2 paragraphs is an example of a policy for an individual journal:

All allegations of misconduct will be referred to the Editor-In-Chief, who will review the circumstances in consultation with the deputy editors. Initial fact-finding will usually include a request to all the involved parties to state their case, and explain the circumstances, in writing. In questions of research misconduct centering on methods or technical issues, the Editor-In-Chief may confidentially consult experts who are blinded to the identity of the individuals, or if the allegation is against an editor, an outside editor expert. The Editor-In-Chief and deputy editors will arrive at a conclusion as to whether there is enough evidence to lead a reasonable person to believe there is a possibility of misconduct. Their goal is not to determine if actual misconduct occurred, or the precise details of that misconduct.

When allegations concern authors, the peer review and publication process for the manuscript in question will be halted while the process above is carried out. The investigation described above will be completed even if the authors withdraw their paper, and the responses below will still be considered. In the case of allegations against reviewers or editors, they will be replaced in the review process while the matter is investigated.

All such allegations are kept confidential; the number of inquiries and those involved are kept to the minimum necessary to achieve this end. Whenever possible, references to the case in writing is kept anonymous.

Journals have an obligation to readers and patients to ensure that their published research is both accurate and adheres to the highest ethical standard. Therefore, if the inquiry concludes there is a reasonable possibility of misconduct, responses should be undertaken, chosen in accordance with the apparent magnitude of the misconduct. Responses may be applied separately or combined, and their implementation should depend on the circumstances of the case as well as the responses of the participating parties and institutions. The following options are ranked in approximate order of severity:

  • A letter of explanation (and education) sent only to the person against whom the complaint is made, where there appears to be a genuine and innocent misunderstanding of principles or procedure.
  • A letter of reprimand to the same party, warning of the consequences of future such instances, where the misunderstanding appears to be not entirely innocent.
  • A formal letter as above, including a written request to the supervising institution that a investigation be carried out and the findings of that inquiry reported in writing to the journal.
  • Publication of a notice of redundant or duplicate publication or plagiarism, if appropriate (and unequivocally documented). Such publication will not require approval of authors, and should be reported to their institution.
  • Formal withdrawal or retraction of the paper from the scientific literature, published in the journal, informing readers and the indexing authorities (National Library of Medicine, etc), if there is a formal finding of misconduct by an institution. Such publication will not require approval of authors, should be reported to their institution, and should be readily visible and identifiable in the journal. It should also meet other requirements established by the International Committee of Journal Editors(, accessed 12/2/03). It is recommended that editors inform readers and authors of their reservation of the right to publish a retraction if it meets these conditions, thereby helping decrease arguments with authors.

Editors or reviewers who are found to have engaged in scientific misconduct should be removed from further association with the journal, and this fact reported to their institution.

                                       Relation of the Journal to the Sponsoring Society

Editors-in-chief and the owner both want the journals to succeed, but they have different roles. The primary responsibilities of the editors-in-chief are to inform and educate readers, with attention to the accuracy and importance of journal articles, and to protect and strengthen the integrity and quality of the journal and its processes. Owners are ultimately responsible for all aspects of publishing the journal, including its staff, budget, and business policies. The relationship between owners and editors-in-chief should be based on mutual respect and trust, and recognition of each other's authority and responsibilities, because conflicts can damage the intellectual integrity and reputation of the journal and its financial success.

The following are guidelines for protecting the responsibility and authority of editors-in-chief and owners:

  • The conditions of the editors-in-chief's employment, including authority, responsibilities, term of appointment, and mechanisms for resolving conflict, should be explicitly stated and approved by both editor and owners before the editor is appointed.
  • Editors-in-chief should have full authority over the editorial content of the journal, generally referred to as "editorial independence." Owners should not interfere in the evaluation, selection, or editing of individual articles, either directly or by creating an environment in which editorial decisions are strongly influenced.
  • Editorial decisions should be based mainly on the validity of the work and its importance to readers, not the commercial success of the journal. Editors should be free to express critical but responsible views about all aspects of medicine without fear of retribution, even if these views might conflict with the commercial goals of the publisher. To maintain this position, editors should seek input from a broad array of advisors, such as reviewers, editorial staff, an editorial board, and readers.
  • Editors-in-chief should establish procedures that guard against the influence of commercial and personal self-interest on editorial decisions.
  • Owners have the right to hire and fire editors-in-chief, but they should dismiss them only for substantial reasons, such as a pattern of irresponsible editorial decisions, scientific misconduct, disagreement with the long-term editorial direction of the journal, or personal behavior (such as criminal acts), that are incompatible with a position of trust. Furthermore it is preferable that any evaluation on which hiring or firing is based should be performed by a panel of independent experts, rather than a small number of executives of the owning organization.
  • Editors-in-chief should report to the highest governing body of the owning organization, not its administrative officers. Major decisions regarding the editor's employment should be made by this body with open discussion and time to hear from all interested parties. Some owners have found it useful to appoint an independent board to advise them on major decisions regarding their editor and journal.
  • Editors should resist any actions that might compromise these principles in their journals, even if it places their own position at stake. If major transgressions do occur, editors should participate in drawing them to the attention of the international medical community.

Acknowledgments: This document was drafted with the assistance of the Ethics Committee of WAME, and is based on similar documents developed by Annals of Emergency Medicine and COPE, among others. We thank all the experts and editors who have helped develop it.


Plagiarism Policy

Plagiarism is the use of others' published and unpublished ideas or words (or other intellectual property) without attribution or permission, and presenting them as new and original rather than derived from an existing source. The intent and effect of plagiarism is to mislead the reader as to the contributions of the plagiarizer. This applies whether the ideas or words are taken from abstracts, research grant applications, Institutional Review Board applications, or unpublished or published manuscripts in any publication format (print or electronic).

Self-plagiarism refers to the practice of an author using portions of their previous writings on the same topic in another of their publications, without specifically citing it formally in quotes. This practice is widespread and sometimes unintentional, as there are only so many ways to say the same thing on many occasions, particularly when writing the Methods section of an article. Although this usually violates the copyright that has been assigned to the publisher, there is no consensus as to whether this is a form of scientific misconduct, or how many of one's own words one can use before it is truly "plagiarism." Probably for this reason self-plagiarism is not regarded in the same light as plagiarism of the ideas and words of other individuals. If journals have developed a policy on this matter, it should be clearly stated for authors.

All submitted manuscripts are scanned with “turnitin” and those falling outside journal guidelines are returned to author(s).

Any disputes are considered on merit and editorial Board decides the issue after looking at all the pertinent facts.


Conflict of Interest Policy

Adapted from the WAME Editorial Policy and Publication Ethics Committees. 2009.

Conflict of interest (COI) exists when there is a divergence between an individual’s private interests (competing interests) and his or her responsibilities to scientific and publishing activities such that a reasonable observer might wonder if the individual’s behavior or judgment was motivated by considerations of his or her competing interests. COI in medical publishing affects everyone with a stake in research integrity including journals, research/academic institutions, funding agencies, the popular media, and the public.

Definition and Scope

COI exists when a participant in the publication process (author, peer reviewer, or editor) has a competing interest that could unduly influence (or be reasonably seen to do so) his or her responsibilities in the publication process. Among those responsibilities are academic honesty, unbiased conduct and reporting of research, and integrity of decisions or judgments. The publication process includes the submission of manuscripts, peer review, editorial decisions, and communication between authors, reviewers and editors.

Types of Competing Interests

Financial ties. This conflict is present when a participant in the publication process has received or expects to receive money (or other financial benefits such as patents or stocks), gifts, or services that may influence work related to a specific publication. Commercial sources of funding, by companies that sell drugs and medical devices, are generally seen as the most concerning, perhaps because of many well-publicized examples of bias related to ties to industry. Examples of financial ties to industry include payment for research, ownership of stock and stock options, as well as honoraria for advice or public speaking, consultation, service on advisory boards or medical education companies, and receipt of patents or patents pending. Also included are having a research or clinical position that is funded by companies that sell drugs or devices. Competing interests can be associated with other sources of research funding including government agencies, charities (not-for-profit organizations), and professional and civic organizations, which also have agendas that may be congruent or at odds with research findings. Clinicians have a financial competing interest if they are paid for clinical services related to their research —for example, if they write, review, or edit an article about the comparative advantage of a procedure that they themselves provide for income. Financial competing interests may exist not just on the basis of past activities but also on the expectation of future rewards, such as a pending grant or patent application. “Insider trading,” which is the use for one’s financial gain of information obtained through participation in research, review or editing before it is available to the general public, is a special kind of financial COI that has both legal and ethical implications.

Academic commitments. Participants in the publications process may have strong beliefs (“intellectual passion”) that commit them to a particular explanation, method, or idea. They may, as a result, be biased in conducting research that tests the commitment or in reviewing the work of others that is in favor or at odds with their beliefs. For example, if research challenging conventional wisdom is reviewed by someone who has made his or her reputation by establishing the existing paradigm, that person might judge the new research results harshly. Investigators in the same field might make extra-efforts to find fault with manuscripts from competing teams, to delay publication or relegate the work to a lesser journal. While such commitments are not generally part of author’s disclosures, editors should be aware of them and their potential influence on author(s), reviewer(s), and themselves.

Personal relationships. Personal relationships with family, friends, enemies, competitors, or colleagues can pose COIs. For example, a reviewer may have difficulty providing an unbiased review of articles by investigators who have been working colleagues. Similarly, he or she may find it difficult to be unbiased when reviewing the work of competitors. Bonds to family members may be strong enough that their competing interests should be treated as if they are also present for those directly involved with a manuscript.

Political or religious beliefs. Strong commitment to a particular political view (e.g., political position, agenda, or party) or having a strong religious conviction may pose a COI for a given publication if those political or religious issues are affirmed or challenged in the publication.

Institutional affiliations. A COI exists when a participant in the publication process is directly affiliated with an institution that on the face of it may have a position or an interest in a publication. An obvious concern is being affiliated with or employed by a company that manufactures the drug or device (or a competing one) described in the publication. However, apparently neutral institutions such as universities, hospitals, and research institutes (alone or in partnership with industry) may also have an interest (or the appearance of one) in the results of research. For example, investigators may have a COI when conducting research from a laboratory funded by private donors who could have (or appear to have) an interest in the results of the study, on a device for which the participant’s institution holds the patent, when the institution is the legal sponsor of the drug or device trial, or if the institution is in litigation in an area related to the study. Professional or civic organizations may also have competing interests because of their special interests or advocacy positions.

Declaring and Managing COIs

Journal takes the following into consideration:

All conflicts of interest must be declared at the time of submission. For this purpose “Author certificate” must be completed and uploaded during submission process. It should also be clear that we may ask additional questions or seek clarification about declarations. For example, the journal may ask for details about future monetary gains or ask an author who works in a laboratory funded by a particular organization for written details about how their independence and research integrity was maintained.

All declarations about COI are a condition of reviewing a manuscript.

The consequences for failing to declare COI: The journal journal may investigate allegations of COI and action may be taken if found to be true. Such investigations are to be completed as quickly as reasonably possible. If a manuscript has been published and COI surfaces later, the journal may publish the results of the investigation as a correction to the article and ask the author to explain, in a published letter, why the COI was not revealed earlier.

We publish all relevant COI disclosures with the publication. We try to increase understanding of the concept is and ask investigators and reviewers “if my competing interest becomes known to others later, would I feel defensive or would others in the publication process, readers or the public think I was hiding my other interests or could they feel I misled or deceived them?”

Responsibilities of Participants

Authors. All authors are asked to report their financial COI related to the research and written presentation of their work and any other relevant competing interests. We publish all COI (or their absence) reported by authors that are relevant to the manuscript being considered. In additional to financial COI, policies for authors should be extended to other types of competing interests that might affect (or be seen to affect) the conduct or reporting of the work. Declarations require authors to explicitly state funding sources and whether the organization that funded the research participated in the collection and analyses of data and interpretation and reporting of results.

Reviewers. Reviewers are asked if they have a COI with the content or authors of a manuscript. If they do, they are removed from the review process. We avoid reviewers from the same institution as the authors, unless the institution is so large that authors and reviewers are not working colleagues.

Editors. Editors do not make any editorial decisions or are involved in the editorial process if they have or a close family member has a COI (financial or otherwise) in a particular manuscript submitted to their journal. For example, if editors have political/religious COI or personal COI with respect to the authors or their work, the editors remove themselves from the decision-making process. An editor may also be in a COI if a manuscript is submitted from their own academic department or from their institution (if it is small); in such situations, they should have explicit policies, made in advance, for how to manage it. When editors submit their own work to their journal, a colleague in the editorial office manages the manuscript and the editor/author recuse himself or herself from discussion and decisions about it.


Advertising Policy

Editorial decision is not be influenced by advertising revenue or reprint potential. Editorial and advertising functions at the journal are independent. Advertisers and donors have no control over editorial material under any circumstances.

We require all advertisements to clearly identify the advertiser and the product or service being offered. In the case of drug advertisements, the full generic name of each active ingredient should appear. Commercial advertisements is be placed adjacent to any editorial matter that discusses the product being advertised, nor adjacent to any article reporting research on the advertised product, nor should they refer to an article in the same issue in which they appear. Ads have a different appearance from editorial material so there is no confusion between the two. Similar limitations (for the regular journal as well as supplements) may include placement of ads for related products on the front, rear, or inside cover pages of an issue that carries an editorial or original article on that topic.

Advertisements may not be deceptive or misleading. Exaggerated or extravagantly worded copy  are not be allowed. Advertisements are not be accepted if they appear to be indecent or offensive in either text or artwork, or contain negative content of a personal, racial, ethnic, sexual orientation, or religious character.

We have the right to refuse any advertisement for any reason. The decision as to acceptance (and any questions about eligibility raised by readers or others) is made in consultation with the journal's editorial content team and the editorial team is regularly informed about the evaluation of advertising, especially those that are refused due to non-compliance with the journal's guidelines.