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Ted Shotter's founding of the London Medical Group (LMG) 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics (JME) in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship (after which 5-year appointments extendable for up to 2 further years were instituted!). Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities (MH), was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.
From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric (one Anglican, the other Presbyterian), were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.
Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who (‘up to the elbows in blood’) could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. Two of the senior doctors on the appointing committee, Charles Fletcher and Archie Duncan, were familiar with the book and saw it as making medical sense, so were willing to take the risk of appointing a non-medic. Medical ‘street-cred’ was achieved by having Fletcher and Duncan as consulting editors and Roger Higgs as case commentary editor. A major challenge for Campbell was finding papers of a high enough quality, since the field at that time had no academic presence at all in medical schools or in any other university departments. Here the conferences organised by the LMG proved invaluable, with an iconoclastic paper by Ivan Illich providing a particularly memorable and provocative contribution (Illich, a renowned opponent of the medical establishment, told Campbell he should rename the journal ‘the Journal of Medical Masturbation’—this remark was not printed!). By 1980 there was a reasonable flow of good material.
Any apparent link with a religious perspective was severed with the appointment in 1980 of Raanan Gillon as editor. Originally appointed as an assistant director of the LMG, Gillon had told Shotter that he doubted that as an atheist Jew—albeit one educated at a Church of England boarding school—he would be of much use to ‘the Outfit’. Shotter had replied ‘If I may say so, I think you're a Godsend’. Godsend or not, Gillon, a part-time practising NHS general medical practitioner who at the time was completing a degree in philosophy, spent 20 fulfilling years combining editorship of the JME with part-time general practice and part-time academic medical ethics posts at King's College London and then Imperial College London. By the end of his editorship, the now bimonthly JME had achieved the highest impact factor in its field.
In 1998, medical humanities was becoming established in the UK as a serious field of research and postgraduate study, but, lacking an academic association or scholarly journal, researchers worked in relative isolation and published in disparate journals, including the JME.
With the aim of offering a workable introduction to regular journal publishing to a field that had not yet reached critical mass, Raanan Gillon encouraged Martyn Evans and David Greaves to develop their proposal for a twice yearly special issue of the JME. Despite the obvious financial risks, their proposal was accepted by the Institute of Medical Ethics (IME) and BMJ, co-owners of the JME. Evans and Greaves assembled an editorial board and obtained high-quality papers from prominent authors, and the first issue of MH appeared in June 2000.
During its infancy, the challenge was to maintain the supply of high-quality research papers, beyond medical humanities’ ancestral territory of medical education and ‘getting doctors to read books’. In particular, Evans and Greaves aimed to leaven literature with philosophy and history of medicine. In 2003 Jane Macnaughton succeeded David Greaves as co-editor with Evans. Over the following 5 years, MH's range of disciplinary contributors and its international reach steadily grew, and research papers increasingly predominated over pedagogical reports. In 2008, when Deborah Kirklin was appointed their successor, one of her first priorities was to publicly signal the editorial independence of MH by formally establishing it as a journal, rather than a special issue of JME. Another priority was to enhance the quality of submissions by obtaining MedLine indexing, clarifying the aims and scopes of the journal, and refreshing the editorial board, to reflect the disciplinary and geographical scope of MH's publication ambitions. In 2013 Deborah was succeeded by Sue Eckstein.
So separate sister journals, but with aims and ambitions based on shared familial values that Ted Shotter would, we hope, approve: commitment to the highest standards of publication ethics; an intellectually rigorous and open-minded approach to ensuring wide dissemination of relevant scholarship; and an appreciation of the power for both good and bad of this thing we call medicine.
John Harris and Søren Holm became joint editors-in-chief of the JME in 2004. During their 7 years at its helm, the number of good-quality submissions increased steadily and the journal moved from bimonthly to monthly publication. As part of this process, the editorial office moved to the BMJ offices in London. The three main challenges facing the journal in this period were, first, the ever changing situation in relation to electronic publication and Open Access, second, the increasing number of competitor journals and the need to maintain the JMEs ‘brand recognition’ and status, and, third, the need to convince especially US authors that, despite its publication in London, the JME is not ‘an English journal’ but has truly international scope. As in previous periods, the editors also had some interesting conversations with the BMJ's libel lawyers concerning certain articles whose authors had expressed themselves in the forthright style that is typical of much of the best medical ethics. In most cases, the lawyers managed to find words that allowed the same proposition to be expressed, but with a much reduced risk of a libel suit. Some new substantive issues emerged (eg, human enhancement), but many of the old stalwarts continued—and continue—to be explored.
Julian Savulescu's first period as editor (2001–2004) saw several important changes, including a redesign and introduction of thematic sections. Submissions greatly increased, and a new system of managing papers—Benchpress—was introduced. Highlights of that period were themed symposia and themed issues, as well as high-impact articles. By the start of Savulescu's second and current period of editorship, from 2011, much had changed. The journal was now published monthly, another management system—ScholarOne—was being introduced, and the balance of article type had moved from the philosophical to the empirical. Savulescu and colleagues introduced ‘Feature Articles’ to provide a forum for longer philosophical articles with associated commentaries. In 2013 the journal achieved the distinction of being the highest ranked journal in bioethics by Google Scholar, with an H index (a measure combining academic productivity and impact) higher than any philosophy journal. It was also ranked as the highest-impact journal by Eisenfactor. This of course reflected the earlier work of Holm and Harris as well—and was a welcome return to the heady days at the end of Gillon's editorship when the JME had the highest impact factor in the field.
On a more gloomy note, despite the journal's significant scholarly impact, prospects for bioethics publication are in certain ways bleaker. The democratisation of the internet has ensured not only widespread readership by the general public, ‘interest’ groups, search engines and the media, but also opportunities for misleadingly selective quotations to be pumped around the world instantly, distorting, miscontextualising and generally misleading and inflaming many people, with encouragement and amplification from the media. This has led to death threats, calls for sackings, and a consequent danger of a silent censorship of controversial articles being encouraged by ever growing managerial requirements for legal approval that stifle outspoken debate.
Savulescu warns that ‘we live in a kind of 1984 with scholars under pressure to be less challenging, adventurous and open and with editors under pressure to be constantly looking over their shoulder for Big Brother, and for others who will tweet, circulate, misrepresent or otherwise distort content for their own ends. The old days are past in which editors could think “Wow, that's exciting, or challenging or a new development” and go ahead and publish. They now have to ask “What will the fanatics say on the internet?” The need for that question has dulled the formerly stimulating, open, lively, rational and often highly controversial debate of medical ethics’.
Despite these worries—which reflect more general concerns about the development of the internet—the JME and MH are flourishing, sometimes contentiously so. From modest beginnings, the JME is now a leading international academic monthly journal that continues to focus primarily on healthcare ethics, but which also addresses the ever widening field of bioethics. In addition, twice a year it also brings with it an excellent journal that complements medical ethics and bioethics with the broader scope of issues covered by MH. The sale of a half share of the journal to BMJ in the 1980s not only solved a delicate immediate financial problem for the IME, but also proved an inspired publishing decision, bringing as it did BMJ's unparalleled expertise and vision in medically related publishing (including its agreement to launch MH). The publishing success of both journals and of BMJ as a whole has brought in its train substantial funding to support the charitable activities of the IME—itself a registered charity. All of this stemmed from Ted Shotter's invention of the LMG, the IME and the JME. Our thanks and congratulations.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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