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Twenty-five years ago
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  1. Ivan Barry Pless1,
  2. Richard Smith2,
  3. Alex Williamson2,
  4. Mike Hayes3,
  5. Sue Baker4,
  6. Frederick P Rivara5,
  7. Ian Scott6,
  8. Terry Nolan7
  1. 1 Retired, Westmount, Québec, Canada
  2. 2 Retired, London, UK
  3. 3 Child Accident Prevention Trust, London, UK
  4. 4 Baltimore, Maryland, USA
  5. 5 Harborview Injury Prevention and Research Center, University of Washington and Seattle Children’s Hospital, Seattle, Washington, USA
  6. 6 The Alliance for Safe Children, Da Nang, Viet Nam
  7. 7 University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Ivan Barry Pless, Retired, Westmount, QC H3Y2V2, Canada; barry.pless{at}mcgill.ca

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The first issue of Injury Prevention appeared in March 1995. Its birth followed a tough gestation, but with the support of Alex Williamson and the blessings of Richard Smith, the BMJ Publishing group brought it to life. With much pride, we now celebrate the Journal’s 25th anniversary.

The decision to proceed was made in 1994. The following year was a mixture of nightmares, excitement and much hard work. We needed to assemble an editorial board. I was determined to recruit every ‘big name’ I could think of and I was determined that it would have international representation. No one we invited declined. This acceptance persisted through the many changes in board membership that followed. Although my initial list of potential subscribers was wildly off target as were my financial projections, with strong support we were able to launch the following year.

An editorial in the first issue, ‘Giving Birth and Thanks’, summarised how it came about. Other details are described by the contributors to this editorial. It only remains for me to look back at how the field of injury prevention appeared a quarter of a century ago. I do so with the help of a lovingly preserved copy of the first issue as shown above, with the two other covers that followed years later.

In that issue, another editorial ‘Logo and Logic’ described one of my several injuries. I was hit by a car in London when I looked the wrong way. This prompted me to thank many people—notably Sue Heels and my wife, Ann Arnold. I noted the gamble authors took when they decided to submit papers to this new, untested journal. The list of lead authors in that issue included Eleni Petridou, Polly Bijur, Ian Roberts, Robyn Norton, Cheryl Alexander, Guy Grimard, Terry Nolan, Karen Zwi, Samuel Forjoh, Bernie Guyer, Rosa Gofin and Liz Towner. Some of these names are familiar; others less so or have been forgotten. The issue included a Classic—William Haddon’s 10 Countermeasure paper from 1973; a methodology paper by Ian Roberts, a Featured Programme the Child Accident Prevention Trust (CAPT), several fillers, a calendar and an exhaustive list of journal citations. Fred Rivara authored a column on the decision to make this the official journal of ISCAIP - the International Society for Child and Adolescent Injury Prevention. Today’s readers may not know that for several years the journal only addressed unintentional injuries to children. It was not until 1999 that we included violence and suicide. Later, we expanded to include all age groups. A guest editorial written by the late Hugh Jackson, described the history of child injury prevention in England and its relation to CAPT, which he had founded. There were several annotations by other luminaries. Polly Bijur wrote a prophetic Opinion piece on the contentious use of the word ‘accident’ versus ‘injury’. I introduced a photo quiz contest by reproducing a 14th century painting of a child using a scooter wearing a halo but no helmet.

Over the next 13 years of my tenure as editor, there were a few triumphs (our first impact factor) and several anxious episodes. At one point, we were on the verge of bankruptcy but Alex, Richard and two US government agencies rescued us. Along the way, we moved from 4 to 6 issues a year (this meant more editorials, a mixed blessing). Later came the inevitable move to electronic publishing—a blessing for readers but a curse for the financial bottom line. Over the years, we published seven (perhaps more) supplements and appeared at all the world conferences. At these the editorial board met and was given a good meal.

When the BMJ was deciding whether to create this journal, I was asked to speculate on its role in the development of an academic specialty. Although some academics, mostly in public health, were already focusing on injuries, I believed we needed to solidify the place of prevention in the broader world of medicine and public health. I was convinced that to do so, a journal was an essential step. Obviously we succeeded but it is evident we have a long way to go to achieve that goal or, more importantly, the real goal - a sharp and sustained reduction in all preventable injuries.

Injury Prevention, with the unflagging support of the BMJ, and the work of my successors—Brian Johnston and Rod McClure—has become a major contributor to the legitimacy of the field. As do most (but not all) journals, it adds to the fundamental knowledge base on which the academic discipline is built. Equally important, it has helped lay the foundation for many programmes and policies worldwide. We may still need a social revolution to persuade the public to view injuries as they do other diseases. Until then, however, I trust that Injury Prevention will continue to play its part in sustaining the prevention movement.

What follows is a series of contributions from some of the pioneers, each written at short notice. Notably, as I noted earlier, everyone I asked responded, as was true of the original editorial board. That they all did so is a source of immense pride. To assist readers who may not know who these contributors are I have added. a brief introduction. In 1995 this would not have been necessary, but fame is so fleeting.

Richard Smith

Smith (CBE) was editor of the BMJ from 1993–2004 and was CEO of the BMJ Publishing Group. He was Director of Ovations; Patients Know Best; and CEO of United Health Group. Notably, Smith was an early advocate of Open Access publishing. His support for the Journal was crucial.

Publishers have noble and less noble (even ignoble) reasons for starting new journals. The noble reason is that the journal will bring together people from many disciplines to tackle an important but neglected issue. This was certainly true of Injury Prevention, where this major cause of mortality and morbidity received nothing like the attention it deserved. It needed many disciplines to tackle the problem. I am delighted to see that the journal has survived and flourished for 25 years.

The less noble reason was to grow the stable of journals of the BMJ Publishing Group (as it was called then) with the aim of making a profit. When I became the editor of the BMJ and chief executive of the BMJ Publishing Group in 1991, the group was budgeted to make a loss. As it happened, we did not make a loss, but we did need to grow the business. We launched new journals, developed a book programme, and eventually started BMJ Knowledge and other enterprises.

Journals can be very profitable (as the 30% profit margin of Elsevier shows), but in the paper world when you launched a journal you immediately had the costs of producing, printing, marketing and circulating the journal—and no income until you persuaded libraries to subscribe to the journal (personal subscribers produce little or no profit). This inevitably took time and sometimes failed. At best, it tended to take 5 years to get a return on your initial investment.

The survival of Injury Prevention shows that it meets an important need and must be profitable—although I have no access to the accounts now. However, this is a journal where the noble aim for starting it has been amply achieved. In contrast, the aim of making a profit may not have been achieved. Even if it did, I very much doubt that the profits are anything comparable to those of some single-specialty blockbuster journals.

Alex Williamson

Williamson was managing director of the BMJ Publishing Group and publishing director of its specialist journals division. It was in this capacity that she became the midwife when the journal was born and served as its den motherduring the early years. She is now retired.

As the specialty journals publisher at the BMJ, I was always hunting for new journal ideas and this one seemed a likely candidate. I met with Mike Hayes who was very supportive and inspired me with his enthusiasm. He told me that Barry Pless was interested in editing it!

I had to ascertain if there was enough good research to sustain a quality publication and if there was a market for it. I had many meetings with interested parties to ascertain the viability of such a publication. I also canvassed several key people in the field; Jo Sibert, Hugh Jackson and Fred Rivara, among others. All were supportive and encouraged me to proceed.

Later I attended the World Conference in Atlanta. It was an exciting visit—the ISCAIP was born and its interest in associating with our putative journal was confirmed. The visit to Atlanta also gave me the opportunity to meet the great Barry Pless. I was somewhat in awe of this famous person but was soon put at ease. Needless to say, we got on famously and have been friends ever since.

Back in London, I met with my boss, Richard Smith, then editor of the BMJ and CEO of the Publishing Group. The journal proposal met with his approval and it is fair to say that he became even more enthusiastic when I told him that Barry Pless wanted to edit it. The journal then got the approval of the powers that be. Then, the hard work really started. The financial modelling indicated that a quarterly journal might be financially viable, though it would never be very profitable. This was one of the benefits of the BMJ Publishing Group; while needing to be financially secure, profit was not its primary motive. If a venture was intellectually sound, potentially influential and not sustaining huge losses, it would be supported. And so it was. The rest is history.

Mike Hayes: when planets align

Hayes was trained as an engineer. When we first met he was the Project Director at CAPT and served in this capacity for many years. As the Journal’s Associate Editor he was, responsible for the News and Notes section. He remains active with product safety in the European Union.

In August 1992, I happened to sit in on a meeting discussing ideas for new books between Professor Jo Sibert and the BMJ’s books editor, Mary Banks. I was casually asked whether I had any ideas for new publications, and I mentioned that it would be interesting to have a channel of communication between researchers and the expanding international community of injury prevention practitioners. The need for better communication was first floated when Barry Pless and I sat down together in Montreal earlier in 1992.

The day after my meeting with Banks, I had a phone call from Alex Williamson, the BMJ’s specialty journals director, inviting me to meet her. Working for a small UK charity, this was not the sort of invitation I often received. The following day, she and I sat down together and started conversations that led to the birth of Injury Prevention 3 years later.

In his editorial in the first issue, Barry suggests that it was the intercourse between Alex Williamson and me that led to the birth. This is an oversimplification because the idea had been floating around the elegant portals of BMA House well before Alex and I first met. By all accounts, an increasing number of papers on injury prevention were being submitted to the BMJ itself.

Early in the gestation period, Alex asked for my suggestion of who should be the editor. Having spent an inspiring, instructive and occasionally argumentative year when Barry Pless based himself at the UK’s Child Accident Prevention Trust, his name immediately came to mind. He had contributed to the BMJ on a number of occasions, so my suggestion was not immediately rejected.

The commitment of the BMJ Publishing Group to the journal was demonstrated when Alex attended the World Injury Prevention and Control Conference in Atlanta in May 1993 to take the temperature of the injury prevention community for there being a dedicated journal and to meet Barry Pless. The journal was launched at a conference at Church House, London, on 9 March 1995—and the rest is history.

Sue Baker

Baker was a world renown epidemiologist when she agreed to serve as one of four Honorary Editors. She was, and still is, grand old lady of injury prevention and has been much honoured and awarded. Baker was the first director of the Johns Hopkins Center for Injury Research and Policy. She developed the Injury Severity Score and edited the Injury Fact Book.

Reminiscing about the past 25 years of progress in injury prevention—the growth in knowledge, the changes in attitudes about injuries, the scores of new investigators, the excitement of witnessing contributions of our trainees and those they have influenced, the encouraging declines in many injury rates—brings smiles to my face. The journal has impelled all of this.

Ahead lie many challenges to keep us all from slowing down. To name a few:

  • Research on access to and use of firearms and activism to change that.

  • Research on effective ways to influence laws and regulations.

  • New knowledge about how to effect changes in behaviours that are dear to our hearts.

  • A movement towards safer designs of products, buildings and all man-made environments, so that safety becomes an initial consideration at the beginning of any design process.

No one said that injury prevention would be easy, nor did they mention that our efforts would be exciting and rewarding!

Fred Rivara

Rivara was and perhaps still is, the most widely published injury researcher worldwide. He is now Professor of paediatrics and epidemiology at U Washington and was the founder, Harborview Injury and Research Center and the ISCAIP. Rivara is the Editor-in-chief, JAMA Pediatrics. He has pioneered gun control, bike helmet, and intimate partner violence research.

The idea for Injury Prevention began at a conference sponsored by the CDC. It was the precursor to the World Injury conferences held regularly over the last two decades. A related meeting discussed injuries to children and adolescents and out of this grew the ISCAIP. A discussion led by Mike Hayes and Barry Pless, followed regarding the idea of creating a new journal dedicated injury prevention.

I fondly remember the inauguration of the journal in London. There were meetings at the BMJ headquarters, a kickoff conference near Westminster Abbey, and a wonderful dinner at the ‘In and Out Club’, to which Richard Smith arrived by bicycle.

The importance of the journal cannot be underestimated. Twenty-five years ago, there were far fewer people in the field, funding for research was scarce and publication on the topic was not easy. Key for any field is to establish it as a distinct scientific endeavour, with rigorous methods, careful research, critical peer review and a journal that brings it all together. Injury Prevention has done all that. It provides a platform for our work and underscores the science determining what works and what does not. From its inception, Injury Prevention has been an international journal, showcasing the work of colleagues from low-income, middle-income and high-income countries.

None of this would have been possible without the efforts of the founding editor-in-chief, Barry Pless, the journal’s guiding force for the first 13 years of its existence. One of the best talks I ever heard was given by him in 1988 when he received the George Armstrong Award from the Ambulatory Pediatric Association. In it, he discussed 8 ‘Ps’ in relation to research training. Later, they guided his approach to editing the journal. Patience with authors, reviewers and his associate editors; Parsimony in the presentation of results in an article; fidelity to the Principles of the broad concepts of injury prevention and control; Perspicacity in seeing the important work among the many manuscripts received each week; Persistence in getting the journal started and seeing it through some rough times; insisting on good Prose—that articles be written clearly; choosing articles that would influence Policy or Practice to advance the field of injury control; and following the Philosophy of science.

Ian Scott: The more things change…

Scott is an Australian health economist who served the Journal as books review editor. When the Journal began he was the Founder and head of Kidsafe. Recently he has worked on product safety issues for the Australian government and for WHO in Geneva and Vietnam.

As Fred Rivara notes, when Injury Prevention began publication the field of child and adolescent injury prevention had fewer people, scarce research funds, and publication was difficult. Barry Pless and colleagues were prescient on the need for and the value of a journal.

Recognition of the burden of injury was growing and early journal papers gave detail and spread the word. Research built on pioneering work such as that of the US National Committee for Injury Prevention and Control’s Injury Prevention: meeting the challenge and reinforced the need for wider research, for review and refinement.

Effective change was gathering pace. Twenty-five years after world-first laws requiring seat belt use in motor vehicles were enacted in Victoria, we were all benefiting from injury prevention being put into practice on the road and in other places.

A major issue remained applying and refining effective measures of prevention. US research showed child injury deaths would have been 31% lower if evaluated injury prevention interventions were fully used. An illustration that this sadly is still true is the issue of unsafe consumer products in Australia. Since 1987, the UK has forbidden producers and sellers from supplying products that they know or should know are unsafe. The provision has been revised and strengthened a number of times, adopted across Europe from 1994 and adopted in other countries such as Canada. Despite at least three attempts, 33 years later it is still not illegal to knowingly or recklessly supply unsafe products in Australia and they cause an estimated 780 deaths and 52 000 injuries each year.

The twenty-five years of Injury Prevention have flown by and the answer to the former editor’s question ‘Is this journal really needed?’ is still an emphatic yes!

Terry Nolan: ‘It’s a dirty job, but somebody has to do it’

Nolan is a distinguished paediatrician, epidemiologist, and recipient of the Order of Australia. He was Head of Melbourne School of Population Health, Chair of Australian Technical Advisory Group on Immunisation, the Redmond Barry Distinguished Professor, and Associate Dean. He now leads Vaccine and Immunisation Research Group.

In 2000, I wrote an editorial for the journal entitled ‘Injury Prevention is Growing Up’. This celebrated the decision to include injury research and policy papers for all ages, Barry’s recognition that such a step was necessary characterised his ambitious agenda to shake the global community awake by recognising the importance of injury prevention for everyone. I cited new evidence from Murray and Lopez’s Global Burden of Disease that starkly identified the global injury burden in terms of DALYs: years of life lost, and years of life spent with consequent disability. This included the often neglected developing world. I was optimistic then about growing government recognition of the importance of injury and of research needed to assist its control, at least in some areas, notably on the back of significant gains arising from road injury prevention (vehicle design, road engineering, seat belts and airbags, red light and vehicle speed cameras, including cyclist injury reduction, and random testing for alcohol and then other drugs), playground and domestic injuries, burns and drowning, and many others.

However, in an accompanying editorial, Leon Robertson, former Yale epidemiologist and IP Editorial Board member, was less sanguine, and his call to arms resonates strongly even today:

Too much death and disability occurs because what we know is not applied. We must be willing to confront governments and corporations whose policies and products fail to incorporate the science that we have developed. And those of us on consensus committees, funding review boards, or editorial boards, must confront colleagues and friends working in injury prevention who are ignorant of prior research on what works and what does not. We also need to confront those who put disciplinary loyalty above concern for the injured. It’s a dirty job, but somebody has to do it.

Over the journey of Injury Prevention’s first 25 years, its inception and initial steerage were motivated by Barry Pless’ social activism. As its editor and editorialist, as a researcher himself and advocate, he personified the sometimes outspoken voice of reason and science, driven by an abundance of strong principles and commitment to equity. It was indeed at time as dirty job, and he did do it superbly!

Barry Pless: I get the last word

In the 20th anniversary volume, Brian Johnston asked me—as the founding editor—to write something about the origins of the journal. I agreed providing Mike Hayes and Alex Williamson would coauthor. The contribution above from Alex was excerpted from that discussion. Mike and Alex played pivotal roles in the journal’s creation and with that came the start of enduring precious friendships alongside those I have with each of the other contributors to this editorial and most of the many editorial board members and authors. I trust most share my pride in what may well prove to be this important accomplishment.

Mike and Alex did far more than is described here. Mike placed a steady hand on the helm throughout all the difficult years, and without Alex’s unflagging support the journal would certainly have folded. It is not easy to introduce a new journal, especially in a field that at the time was struggling for identity. Perhaps it still is. It was even more challenging to keep it alive during financially lean years. Alex made certain we had support from all the right people, especially our boss, Richard Smith, the BMJ editor.

My devotion to this precious child is illustrated below: one whole bookshelf in my home office is devoted to each and every print copy ever published.

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data availability statement No data are available.

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