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.
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 (email@example.com) or David Nunan (firstname.lastname@example.org)
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
Dr Ian Lahart, University of Wolverhampton, UKDr David Nunan, University of Oxford, UKDr Nicola Guess, King's College London, UKDr Duane Mellor, University of Coventry, UKDr Yoni Freedhoff, University of Ottawa, CanadaMel Gannon,Campbell Glover, Victoria University, New ZealandDavid Hargreaves, Dr Denise Robertson, University of Surrey, UKDr Simon Wheeler, Dr Katherine Killoran, Midcoast Medicine, USADr Stephen Gilbert, University of Sydney, AustraliaDr Matthew Tenan, U.S. Army Research Laboratory, USADr Sean Owens, UCD, IrelandEileen O'Sullivan, Patient, IrelandDr David Robert Grimes, University of Oxford/Queen's University Belfast, UKDr Andrew Hills, Stanley Medical Group, UKJoseph J Matthews, Birmingham City University, UKDr Dylan MacKay, University of Manitoba, CanadaVincent Ng, Public Health Unit, CanadaSteven Trotter, IrelandMitchell Naughton, University of New England, AustraliaPaulina Araujo, Trillium Health Partners, CanadaColby Vorland, USADr Maarten Van Smeden, Leiden university medical center, NetherlandsNick Creelman, Northern Alberta Institute of Technology, CanadaProfessor Samuele Marcora University of Kent,, UKJacques Rosseau, University of Cape Town, South AfricaDr Robert O'Connor, Irish Cancer Society, IrelandProfessor Ulf Ekelund, Norwegian School of Sport Sciences, NorwayProfessor Chad Hancock, Brigham Young University, USATheresa Bonfiglio, Mercy Health, USASheila Kealey, CanadaLorrie Chow, BC Children's Hospital, CanadaKaryn Rasmussen, Interior Health Authority, CanadaDr Ross Tucker, University of Cape Town, South AfricaMichael Hull, McGill, USAOwn Marples, NHS Homerton, UKDr Alastair McAlpine, University of British Columbia, CanadaProfessor Norma Lake Castillo, McGill University Faculty of Medicine (formerly), CanadaTammy Beaudry, Metabolic & Endocrine Diabetes Education Center, CanadaProfessor Boye, University of Oslo, NorwayDr Brennan Smith, CanadaRussel Best, Waikato Institute of Technology, New ZealandRichie Goulding, Liverpool Hope University, UKClaire Julsing Strydom, PPD, South AfricaHelen West, UKCaroline Lambert, CanadaJane Jensen, Alberta Health Services, CanadaDr Garry Tew, Northumbria University, UKDr Ash Routen, Loughborough University, UKDr Stuart Gray, University of Glasgow, UKDr Brendon Stubbs, King’s College London & South London & Maudsley NHS foundation trust, UKRegan, Boden, University of Cape Town, South AfricaVibhuti Mistry, Homerton University NHS Trust, UKDr Enzo Di Battista, University of South Wales, UKDr Evan Allen, Allen Wellness and Medical Center, USAProfessor Alan St Clair Gibson, University of Essex, UKDr Chris Ball, SCNQ, AustraliaArelis Rodriguez-Farradas, NHS Barnsley CCG, UKDr Paddy Dempsey, University of Cambridge, UKDr Brian Power, University College London, UKAndre Quinn, UKKevin Bass Texas Tech University Health Sciences Center, USAProfessor Kevin Davy, Virginia Tech, USADouglas Crichton Liverpool John Moores University, UKProfessor Fergal Grace Federation University, AustraliaDorothy Balhatchet, London Metropolitan University, UKNick Allen, University of Technology Sydney, AustraliaDr Shuaib Manjra, UCT, South AfricaDr Jatin Joshi, University College London, UKDaniel Thomson, Wangaratta Private Hospital, AustraliaJames James Fern, University of bath, UKDr James Brown, Aston University, UKCatherine Collins RD FBDA, Surrey and Sussex NHS Healthcare Trust, UKDr Conor Kerley, Dublin Institute of Technology, IrelandMaureen Lees, NHS Lanarkshire, UKElaine Hibbert-Jones, Aneurin Bevan University Health Board, UKDr Thom Phillips, Cardiff Metropolitan University, UKSimon Cummings, Exercise Physiologist in private practice, AustraliaDr Abdul Abdul Wali, Bacha Khan University Charsadda KP, PakistanLianne Mc Aree Murphy, University of Chester, IrelandLiz Nelson, University of Queensland, AustraliaDr Judy Swift, The University of Nottingham, UKAdrian Day, AustraliaSteve Blackburn, University of Plymouth, UKDr Marc Wells, Liverpool Hope University, UKJay Adam, Interlake Eastern RHA, CanadaDr Michael Mindrum, Dalhousie University, CanadaZoe Connor, Coventry University, UKAdrienne Baltadjian, Durham Region Healthy Department, CanadaDr Richard Rosenkranz, Kansas State University, USAHelena Scully, University College Dublin, IrelandClare Padfield BSc MSc RD, Great Western Hospitals NHS Foundation Trust, UKProfessor Marius Henriksen, University of Copenhagen, DenmarkEduardo Patino, Oregon State University, USADr Fergus Guppy, University of Brighton, UKProfessor Jeff Vallance, Athabasca University, CanadaFaye Harrison, UKDr Katherine Heath, UCL, UKCheryl Meyer, South AfricaDr Brian Carson, University of Limerick, IrelandBrett Chrest, Brandon University, CanadaAlex Swan, Not Affiliated, UKSophie Cremen, SVPH, IrelandDr David Scott, Monash University, AustraliaDr Brendan Gabriel, Karolinska Institutet, SwedenDr Suzanne Barr, Imperial College London, UKSarah Dempster, UKGideon Meyerowitz-Katz, University of Wollongong, AustraliaAlex Ruani, University College London, UKClaire Pettitt, Imperial College London, UKNick Trott, Sheffield Teaching NHS hospitals, UKDr Sinead Clancy, UCD, UKDr Kathryn Bradbury, University of Auckland, New ZealandDr Terry Boyle, University of South Australia, AustraliaProfessor Anoop Balachandran, Queens College, USADr Stephen Norris, University of Calgary / Mount Royal University, CanadaProfessor Michael Gibney, University College Dublin, IrelandJan Schimpchen, GermanyProfessor Jerome Hoffman, UCLA, USAAmanda Weimar, Region Östergötland, SwedenViktor Nordvall, Luleå Technical University, SwedenDr André Nelson, Victoria University, Melbourne, AustraliaDaniel Plotkin, Queens College, USADr Jean Haining, NHS, UKJane Spivey, Aneurin Bevan University Health Board, UKDr Simon Williams, University of Wales Trinity St David, UKElizabeth McKenzie, NHS, UKDr Eric Harvey, University of Washington, USADon Comrie, Neurolabs, Inc., USAJacob Gudiol, SwedenMary O'Kane, Leeds Teaching Hospitals NHS Trust, UKDr Andrew Coggan, Indiana University Purdue University Indianapolis, USADr Clement Gwe Kungeh, University of Kwazulu Natal, CameroonPeter Aldiss, University of Nottingham, UKLara Wessels, South AfricaDara Morgan, Freelance Dietitian, IrelandAnthony Warner, UKNiamh O'Connor, IrelandMaggie Seixas-Pickup, UKNanci Guest, University of Toronto, CanadaDr Yorgi Mavros, University of Sydney, AustraliaDaniel Garrido, UKOrlaith McCarthy, Sheffield Teaching Hospitals NHS FT, UKDr Aric Sudicky, CanadaNigel Kinbrum, UKDebaj Zentuti, University of Nottingham, UKEric Williamson. University of Toronto, CanadaProfessor Bernie Garrett, University of British Columbia, CanadaPaul McArdle, University of Birmingham, UKRaffaele Mazzolari. University of the Basque Country (UPV/EHU), SpainProfessor George Metsios, University of Wolverhampton, UKDr Lisa Te Morenga, Victoria University of Wellington, New ZealandProfessor Cliona Ni Mhurchu, University of Auckland, New ZealandProfessor Martijn Katan, VU University Amsterdam, NetherlandsProfessor John D Potter, Massey University, Wellington, New ZealandBrett Graham, UKDr Suzanne Doyle, Dublin Institute Technology, IrelandDr Andrew Govus, La Trobe University, AustraliaProfessor Rod Jackson, University of Auckland, New ZealandGeorge Henderson, New ZealandDr Katerina Vasilaki, UK Dr Tom Cullen, Coventry University, UKProfessor Saptarshi Purkayastha, Indiana University Purdue University Indianapolis, USAMonika Urbanski, DietitianWinston Martin, Registered Dietitian, CanadaDr Jane Willcox, La Trobe University, Australia
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 ObesityForum, 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.