Open letter from academics, practitioners, students and members of the public to the British Medical Association, the British Medical Journal publishing group, and the British Association of Sports and Exercise Medicine regarding editorial governance of the British Journal of Sports Medicine
***PLEASE SCROLL TO THE BOTTOM OF THE PAGE TO SIGN THE LETTER***
Dear Ms Phipps, Dr Nagpaul, Dr Godlee, and Mr Holloway,

As academics (scientists, lecturers, researchers), practitioners and students in the fields of sport and exercise science and medicine, evidence-based medicine/health care, nutrition and dietetics, public health, general practice/family medicine, as well as patients and members of the public, we wish to express our concern about the editorial governance of the British Journal of Sports Medicine (BJSM).

We are specifically concerned about actions and consequences that are in direct opposition to the collective mission, values, and vision of not just the BJSM, but also each of your organisations.

We wish to highlight editorial bias at the BJSM evidenced by a lack of robust and transparent governance of the decision-making processes of the Editor in Chief (EIC). There appears to be an absence of systems to prevent personal views held or supported by the EIC from generating irrelevant and/or imbalanced narratives. If there are such systems, they are not being sufficiently enacted.

Evidence of editorial bias is provided in the form of the following:
1. A post on Pubpeer from signatories of this letter providing complete details of actions by the EIC and ensuing discussions with the EIC that indicate a lack of appropriate governing systems (or at least unwillingness by the EIC to share information on such systems should they exist) and illustrates the impact of personal bias leading to imbalanced dissemination and promotion of a particular narrative by the BJSM: https://pubpeer.com/publications/0C1B5A45793038A959D0ADAA168ADA

2. A blog that briefly outlines the details of the Pubpeer post here: http://www.weightymatters.ca/2018/10/guest-post-does-bmj-publishing-group.html

We provide a summary of the evidence in an Appendix at the bottom of this letter.

WHY WE ARE WRITING THIS LETTER:
It is important in the spirit of this debate that we too are transparent; the purpose of this letter is not to query the narratives being promoted per se (this is done anyway in the paywall rebuttals), but to highlight the lack of editorial processes and policies that should be in place (or their misapplication if they are) to prevent bias in outputs and their dissemination by the BJSM. Furthermore, we believe that the publication of these irrelevant and/or imbalanced narratives is in direct opposition and/or falls short of the aims and objectives of the journal (https://bjsm.bmj.com/pages/about/):

** British Journal of Sports Medicine (BJSM) is a multi-media portal that provides original research, reviews and debate relating to clinically-relevant aspects of sport and exercise medicine, including physiotherapy, physical therapy and rehabilitation. We contribute to innovation (research), education (teaching and learning) and knowledge translation (implementing research into practice and policy). Our web, print, video and audio material, combined with active social media, serves the international community of clinicians who treat active people.**

The BMA (https://www.bma.org.uk/about-us/mission-vision-and-values):

** We are an indispensable source of credible information, guidance and support throughout doctors' professional lives.
- The BMA welcomes open debate and free exchange of ideas.**

The BMJ Publishing group (https://www.bmj.com/company/who-we-are/values/):

** Our mission is to advance healthcare worldwide by sharing knowledge and expertise to improve experiences and outcomes. [values include]:
- Improving health care requires independent and unbiased information, even if this means challenging perceived wisdom.
- The best decisions depend on the best evidence.
- We create trust by being transparent and open.**

And BASEM (https://www.basem.co.uk/about-us/):

** The British Association of Sport and Exercise Medicine (BASEM) was founded in 1952 and is the largest multidisciplinary sports medicine organisation in the UK, offering full membership to medical practitioners and associate membership to allied professionals such as physiotherapists and sports scientists.
BASEM has its own internationally recognised journal, The British Journal of Sports Medicine and is dedicated to the promotion of good health through physical activity and the provision of sports medicine expertise to optimise athletic performance at all levels.
The Association aims to provide support and education to all healthcare professionals involved in the care of athletes and individuals undertaking, or aspiring to undertake, regular physical activity at all levels.
- 3.6 To promote the adoption of evidenced-based practice in all areas of Sport and Exercise Medicine;**

WHAT WE WOULD LIKE TO HAPPEN:
Our aim is to improve the systems in place at the BJSM to prevent editorial bias resulting in imbalanced outputs and their dissemination.
We also want better systems to ensure appropriate inclusion of topics and discussions which are relevant to the journal's aims and readership.

Given the above, we welcome your individual responses to the following:
1. Do you intend to investigate these charges? If so, we should be grateful if you would detail, step-by-step, how you will go about this and the anticipated timelines. If you do not intend to investigate, please could you outline your reasons?
2. If your investigation confirms that editorial governance at the BJSM is currently lacking systems that prevent avoidable biases as we have described, we should be grateful if you would detail in a transparent manner the procedures you will undertake to develop such robust systems and how these will be adopted, monitored, and enacted (where necessary).
3. If your investigation confirms that editorial governance at the BJSM already includes sufficient systems in place to prevent avoidable biases as described, please detail in a transparent manner why these appear not to have been enacted in the examples highlighted in this letter and why the EIC is unwilling to share details of these systems.
4. Will you provide a written, public statement outlining the reasons and nature of any investigations you will undertake and the resultant outcomes of any such investigations? Equally, if you do not intend to conduct an investigation, will you provide a written public statement outlining the nature of the call for an investigation and your reasons for not conducting one?
5. We would welcome declaration of any and all relevant conflicts of interest relevant to the nature of this request, the related topics and/or any individuals it concerns. The lead signatories of this letter have provided their DOIs at the bottom of the page.


Yours faithfully,

***************************

NOTES FOR SIGNATORIES

1. This letter is coordinated by the authors of the most recent relevant rebuttal in the BJSM. Please direct any queries to Ian Lahart (i.lahart@wlv.ac.uk) or David Nunan (david.nunan@phc.ox.ac.uk)

2. The BJSM's Editorial Board remit:
(1) The BJSM and IPHP Editorial Boards work hand in hand to deliver quality clinically relevant material for the sports medicine community. We use the Blog, Podcasts, Web and Print resources to share cutting-edge material. The IPHP group focuses particularly, but not exclusively, on the four issues of BJSM that are supported by the International Olympic Committee.
(2) The Senior Associate Editors are responsible for journal direction. They provide diverse input representing the various disciplines in our field, geographic perspectives and areas of specialisation.
(3) Associate Editors support the Senior Associate Editors in relation to journal strategy and play a major role in reviewing and in suggesting appropriate reviewers.
(4) The Editorial Board serves in various roles including connecting BJSM with various end-user groups, suggesting emerging themes and providing peer review more frequently than do “occasional” reviewers.

3. A list of signatories will be pasted beneath these notes and updated at regular intervals.

4. Some people who would like to sign the letter have expressed concern at potential ramifications for their current/future career prospects if they did so. Whilst this is a sad, but nonetheless telling, reflection of the current status quo, we respect this decision. With their permission, we have compiled a google sheet of such emails with individuals' details redacted: https://docs.google.com/spreadsheets/d/10uAj48ne7rR3YYYTi3727jsqqJtlDjGpXO0Ehh_kX0o/edit?usp=sharing

5. We are collecting email addresses to verify responses. You will only receive one email confirming receipt and one follow-up email notifying all signatories when the letter is sent to the BMA, the BMJ, and BASEM.

6. We are posting responses from the BMA, BMJ and BASEM if and when we receive them here:
https://docs.google.com/spreadsheets/d/1mNUotdIlSqtqz7hnRnnI_0BsOTLWBkVIMswExbtYetk/edit?usp=sharing

***************************

SIGNATORIES

Dr Ian Lahart, University of Wolverhampton, UK
Dr David Nunan, University of Oxford, UK
Dr Nicola Guess, King's College London, UK
Dr Duane Mellor, University of Coventry, UK
Dr Yoni Freedhoff, University of Ottawa, Canada
Mel Gannon,
Campbell Glover, Victoria University, New Zealand
David Hargreaves,
Dr Denise Robertson, University of Surrey, UK
Dr Simon Wheeler,
Dr Katherine Killoran, Midcoast Medicine, USA
Dr Stephen Gilbert, University of Sydney, Australia
Dr Matthew Tenan, U.S. Army Research Laboratory, USA
Dr Sean Owens, UCD, Ireland
Eileen O'Sullivan, Patient, Ireland
Dr David Robert Grimes, University of Oxford/Queen's University Belfast, UK
Dr Andrew Hills, Stanley Medical Group, UK
Joseph J Matthews, Birmingham City University, UK
Dr Dylan MacKay, University of Manitoba, Canada
Vincent Ng, Public Health Unit, Canada
Steven Trotter, Ireland
Mitchell Naughton, University of New England, Australia
Paulina Araujo, Trillium Health Partners, Canada
Colby Vorland, USA
Dr Maarten Van Smeden, Leiden university medical center, Netherlands
Nick Creelman, Northern Alberta Institute of Technology, Canada
Professor Samuele Marcora University of Kent,, UK
Jacques Rosseau, University of Cape Town, South Africa
Dr Robert O'Connor, Irish Cancer Society, Ireland
Professor Ulf Ekelund, Norwegian School of Sport Sciences, Norway
Professor Chad Hancock, Brigham Young University, USA
Theresa Bonfiglio, Mercy Health, USA
Sheila Kealey, Canada
Lorrie Chow, BC Children's Hospital, Canada
Karyn Rasmussen, Interior Health Authority, Canada
Dr Ross Tucker, University of Cape Town, South Africa
Michael Hull, McGill, USA
Own Marples, NHS Homerton, UK
Dr Alastair McAlpine, University of British Columbia, Canada
Professor Norma Lake Castillo, McGill University Faculty of Medicine (formerly), Canada
Tammy Beaudry, Metabolic & Endocrine Diabetes Education Center, Canada
Professor Boye, University of Oslo, Norway
Dr Brennan Smith, Canada
Russel Best, Waikato Institute of Technology, New Zealand
Richie Goulding, Liverpool Hope University, UK
Claire Julsing Strydom, PPD, South Africa
Helen West, UK
Caroline Lambert, Canada
Jane Jensen, Alberta Health Services, Canada
Dr Garry Tew, Northumbria University, UK
Dr Ash Routen, Loughborough University, UK
Dr Stuart Gray, University of Glasgow, UK
Dr Brendon Stubbs, King’s College London & South London & Maudsley NHS foundation trust, UK
Regan, Boden, University of Cape Town, South Africa
Vibhuti Mistry, Homerton University NHS Trust, UK
Dr Enzo Di Battista, University of South Wales, UK
Dr Evan Allen, Allen Wellness and Medical Center, USA
Professor Alan St Clair Gibson, University of Essex, UK
Dr Chris Ball, SCNQ, Australia
Arelis Rodriguez-Farradas, NHS Barnsley CCG, UK
Dr Paddy Dempsey, University of Cambridge, UK
Dr Brian Power, University College London, UK
Andre Quinn, UK
Kevin Bass Texas Tech University Health Sciences Center, USA
Professor Kevin Davy, Virginia Tech, USA
Douglas Crichton Liverpool John Moores University, UK
Professor Fergal Grace Federation University, Australia
Dorothy Balhatchet, London Metropolitan University, UK
Nick Allen, University of Technology Sydney, Australia
Dr Shuaib Manjra, UCT, South Africa
Dr Jatin Joshi, University College London, UK
Daniel Thomson, Wangaratta Private Hospital, Australia
James James Fern, University of bath, UK
Dr James Brown, Aston University, UK
Catherine Collins RD FBDA, Surrey and Sussex NHS Healthcare Trust, UK
Dr Conor Kerley, Dublin Institute of Technology, Ireland
Maureen Lees, NHS Lanarkshire, UK
Elaine Hibbert-Jones, Aneurin Bevan University Health Board, UK
Dr Thom Phillips, Cardiff Metropolitan University, UK
Simon Cummings, Exercise Physiologist in private practice, Australia
Dr Abdul Abdul Wali, Bacha Khan University Charsadda KP, Pakistan
Lianne Mc Aree Murphy, University of Chester, Ireland
Liz Nelson, University of Queensland, Australia
Dr Judy Swift, The University of Nottingham, UK
Adrian Day, Australia
Steve Blackburn, University of Plymouth, UK
Dr Marc Wells, Liverpool Hope University, UK
Jay Adam, Interlake Eastern RHA, Canada
Dr Michael Mindrum, Dalhousie University, Canada
Zoe Connor, Coventry University, UK
Adrienne Baltadjian, Durham Region Healthy Department, Canada
Dr Richard Rosenkranz, Kansas State University, USA
Helena Scully, University College Dublin, Ireland
Clare Padfield BSc MSc RD, Great Western Hospitals NHS Foundation Trust, UK
Professor Marius Henriksen, University of Copenhagen, Denmark
Eduardo Patino, Oregon State University, USA
Dr Fergus Guppy, University of Brighton, UK
Professor Jeff Vallance, Athabasca University, Canada
Faye Harrison, UK
Dr Katherine Heath, UCL, UK
Cheryl Meyer, South Africa
Dr Brian Carson, University of Limerick, Ireland
Brett Chrest, Brandon University, Canada
Alex Swan, Not Affiliated, UK
Sophie Cremen, SVPH, Ireland
Dr David Scott, Monash University, Australia
Dr Brendan Gabriel, Karolinska Institutet, Sweden
Dr Suzanne Barr, Imperial College London, UK
Sarah Dempster, UK
Gideon Meyerowitz-Katz, University of Wollongong, Australia
Alex Ruani, University College London, UK
Claire Pettitt, Imperial College London, UK
Nick Trott, Sheffield Teaching NHS hospitals, UK
Dr Sinead Clancy, UCD, UK
Dr Kathryn Bradbury, University of Auckland, New Zealand
Dr Terry Boyle, University of South Australia, Australia
Professor Anoop Balachandran, Queens College, USA
Dr Stephen Norris, University of Calgary / Mount Royal University, Canada
Professor Michael Gibney, University College Dublin, Ireland
Jan Schimpchen, Germany
Professor Jerome Hoffman, UCLA, USA
Amanda Weimar, Region Östergötland, Sweden
Viktor Nordvall, Luleå Technical University, Sweden
Dr André Nelson, Victoria University, Melbourne, Australia
Daniel Plotkin, Queens College, USA
Dr Jean Haining, NHS, UK
Jane Spivey, Aneurin Bevan University Health Board, UK
Dr Simon Williams, University of Wales Trinity St David, UK
Elizabeth McKenzie, NHS, UK
Dr Eric Harvey, University of Washington, USA
Don Comrie, Neurolabs, Inc., USA
Jacob Gudiol, Sweden
Mary O'Kane, Leeds Teaching Hospitals NHS Trust, UK
Dr Andrew Coggan, Indiana University Purdue University Indianapolis, USA
Dr Clement Gwe Kungeh, University of Kwazulu Natal, Cameroon
Peter Aldiss, University of Nottingham, UK
Lara Wessels, South Africa
Dara Morgan, Freelance Dietitian, Ireland
Anthony Warner, UK
Niamh O'Connor, Ireland
Maggie Seixas-Pickup, UK
Nanci Guest, University of Toronto, Canada
Dr Yorgi Mavros, University of Sydney, Australia
Daniel Garrido, UK
Orlaith McCarthy, Sheffield Teaching Hospitals NHS FT, UK
Dr Aric Sudicky, Canada
Nigel Kinbrum, UK
Debaj Zentuti, University of Nottingham, UK
Eric Williamson. University of Toronto, Canada
Professor Bernie Garrett, University of British Columbia, Canada
Paul McArdle, University of Birmingham, UK
Raffaele Mazzolari. University of the Basque Country (UPV/EHU), Spain
Professor George Metsios, University of Wolverhampton, UK
Dr Lisa Te Morenga, Victoria University of Wellington, New Zealand
Professor Cliona Ni Mhurchu, University of Auckland, New Zealand
Professor Martijn Katan, VU University Amsterdam, Netherlands
Professor John D Potter, Massey University, Wellington, New Zealand
Brett Graham, UK
Dr Suzanne Doyle, Dublin Institute Technology, Ireland
Dr Andrew Govus, La Trobe University, Australia
Professor Rod Jackson, University of Auckland, New Zealand
George Henderson, New Zealand
Dr Katerina Vasilaki, UK
Dr Tom Cullen, Coventry University, UK
Professor Saptarshi Purkayastha, Indiana University Purdue University Indianapolis, USA
Monika Urbanski, Dietitian
Winston Martin, Registered Dietitian, Canada
Dr Jane Willcox, La Trobe University, Australia

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APPENDIX - Summary of evidence of editorial bias at the BJSM:

At the time of conducting our investigation (July 2018), the BJSM has published 10 editorials and opinion pieces, as well as reviews, on the topic of dietary guidelines, statins, and saturated fat and health in the past 3 years. All 10 were given open access status when first published, they all had narratives that denigrated current dietary guidelines and/or statins and promoted an exclusively low-carb dietary approach. All of the articles were authored by known supporters of these narratives, some writing two or more articles. The EIC, via the BJSM twitter account, has regularly promoted these articles and narratives on social media.

Apart from questions as to how well these topics meet the remit of the journal's mission and readership, it also appears that these topics are personally favoured by the current EIC of the BJSM, Professor Karim Khan. A key point here is that decisions to make articles such as these open access are made entirely by the EIC of the BJSM.

Four rebuttals/counter-arguments to these 10 articles have been published (including the most recent one from signatories of this letter) – none of these was made available as open access by the EIC. There has also been next to no promotion of any of these rebuttals via social media from the BJSM twitter account. Of course, we have no knowledge of how many rebuttals for any of the 10 articles have been dismissed for consideration for publication.

Furthermore, during the two-month period when authors of the most recent rebuttal were communicating with the BJSM editors for the rebuttal to be published open access (the request was denied), the BJSM produced two podcasts from authors of two of the 10 open access articles, releasing one of them (along with social media promotion) on the same day as the most recent rebuttal.

We suggest that the EIC at the BJSM should facilitate debate in an unbiased manner and ensure that systems are in place to prevent biases skewing scientific discourse. Promoting articles of certain narratives through open access and hiding every rebuttal (highlighting alternative, nuanced, and evidence-based narratives) quietly behind a paywall suggests bias.


DECLARATIONS OF INTEREST:
Dr Ian Lahart is a senior lecturer in exercise physiology and researcher at Institute of Human Sciences, University of Wolverhampton. He completed his PhD in the role of exercise in breast cancer. Through his PhD work, he conducted an exercise randomised controlled trial in women with breast cancer. Ian is also the lead author of a recent Cochrane collaboration review on the effects of exercise in women with breast cancer post-adjuvant therapy. Through his role as a research fellow at Russells Hall hospital, Dudley, UK, he helped set up and manage a MacMillan funded exercise-based cancer rehabilitation service. Although his research focus is on the role of exercise in breast cancer rehabilitation and survivorship, he has additionally worked with patients with other cancers, arthritis, cardiovascular disease, and diabetes and related metabolic conditions. He is also interested in the communication of science and meta-research—a field of research that investigates research practices and quality.

Dr David Nunan is a member of the Royal College of General Practitioners (RCGP) steering committee to support the new Physical Activity and Lifestyle clinical priority. He has received funding for research from the NHS National Institute for Health Research School for Primary Care Research (NIHR SPCR) and the RCGP for independent research projects related to physical activity and dietary interventions. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the RCGP or the Department of Health.

Dr. Duane Mellor has worked clinically as a dietitian, mainly in diabetes management and education and then as a researcher in clinical trials. However, reflecting back on the first 2 decades of his career he has begun to question a number of aspects of nutrition and dietetic practice. He is now interested in looking at evidence in nutrition, both in terms of causality and quality along with how this is communicated to the public by the media. Looking to challenge thinking in this area, to consider aspects of benefit and the risks of harm, ultimately looking at how the public can be best supported to eat food they enjoy that also supports good health.

Dr Nicola Guess has received grant funding from Diabetes UK, the Medical Research Council, and the National Obesity
Forum, as well as fellowship funding from Diabetes UK, the Winston Churchill Memorial Trust, American Overseas Dietetics Association and the Chronic Disease Research Foundation. NG has also received payment by Ways of Eating, for input into the Fixing Dad app on the management and prevention of type 2 diabetes. and from Oviva for an evaluation of a remote diabetes management programme. NG has published on the role of fibre, low-carbohydrate diets, high-protein diets, intermittent fasting, the Mediterranean diet and fat class in the management and/or prevention of type 2 diabetes.


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