ISSN 0303-5212

Editorial Policies

Rawal Medical Journal

Policy Statements

Peer-Review process

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 obtaine 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.

Regional Workshops for Medical Editors

Pakistan Association of Medical Editors (PAME) strongly encourages regional or local initiatives to provide workshops or conferences, etc, for editors of peer-reviewed medical journals, to encourage the highest standards of reporting medical science. With limited funds, PAME is assisting in the planning of workshops or conferences, to help in finding appropriate faculty, and to help negotiate some assistance to facilitate clearly planned projects that rely primarily on local or regional resources.




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.