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To paraphrase Gilbert and Sullivan, “An editor's lot is not an easy one”. In truth, it is usually stimulating but at times, it can be challenging. One such occasion arises when faced with situations that may appear to present a conflict of interest. In this issue, I am the second author of two papers.
Clearly, this is open to question. To help allay concerns and set my conscience at rest, I want to explain to readers how we handle any circumstance like this. The problem arises, of course, because the senior (corresponding) author usually has the final word about the journal to which a paper is sent. Naturally, any sensible author with a good paper in the injury prevention field would first consider sending it to this journal. It would be wrong to deny them the opportunity to do so.
It would be foolish to pretend coauthors are not influenced by my role as editor, although (as I will explain) I make a point of warning my colleagues that I will not be involved in any way. I also alert them to the fact that with me (or others like me as a coauthor) the review process may actually be tougher. It would not be too surprising to discover that reviewers set higher standards for papers in which a well established investigator is a coauthor, and perhaps higher still for those in which editors are foolish enough to expose themselves to scrutiny.
Thus, in any instance where I am involved in any capacity in a paper submitted to the journal, I assign the entire review process to one of the associate editors chosen independently by the assistant editor. The associate then chooses reviewers, responds to their comments, makes the final decision, and informs the corresponding author of the decision. If there is a request for revisions, the associate editor alone decides if a resubmission has met the criticisms adequately. In short, I play no part whatsoever until after all judgment calls are made.
With respect to the two papers in this issue, however, I faced another dilemma. I had to decide whether to include them in the same issue. Normally, I try to avoid having more than one paper from the same group in one issue. In this instance, however, the topics were so intimately related that there seemed to be a compelling reason for publishing them side by side. The difficulty was somewhat mitigated by the fact that they come from different institutions.
Therefore, my conscience is clear. But to further protect it, I invited Drs Stone, Morrison, and Smith to write a commentary on the topic addressed by the papers in question—surveillance (see 166). In spite of my having helped create the Canadian system described in the papers by Mackenzie and Macarthur, CHIRPP, I now have mixed feelings about the benefits of surveillance systems. After hearing Stone and Smith express some of those reservations at a recent meeting, especially with respect to surveillance based exclusively in emergency departments, it seemed essential to include their comments.
When I began my efforts to have the CHIRPP surveillance system established in Canada I did so because I thought we needed more data to raise the profile of the injury problem. It is hard to tell how well CHIRPP served this purpose. It provided new and better information about causal factors, which, in turn, should lead to better preventive measures. So I think a system like CHIRPP, that includes open text fields for a description of “what happened”, is appealing.
Nevertheless, the points raised by Stone et al about whether we need to include every hospital attendance to achieve our goals deserves consideration. Similarly the concerns about the bias of hospital data are probably justified but may be correctable. In short, surveillance systems can and probably should be improved and those that don't have them probably should. But there are other caveats.
Quite apart from the important methodological issues raised in the commentary, we also need to assess whether surveillance systems serve their ultimate goals. Most assume that the more data we can collect and the better their quality, the more quickly we will achieve the goal of preventing injuries. However, if these data are not often used, or not used well, this assumption does not hold. Certainly, if the sponsors of the surveillance systems use all or most of their resources to collect these data and have little or none left to support prevention programs—governmental, non-governmental organisations, or voluntary, community groups—one cannot help but question the wisdom of the exercise. It is time to rethink the whole question of surveillance and force its advocates to answer these tough questions along with those posed by the authors of the commentary.