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Harry Shapiro: Good morning, everybody. Thank you. Thank you, Will, editor of the absolute must-read Filter magazine. Wonderful publication. I hope you are all suitably recovered from last night at the Sphinx. My name's Harry Shapiro. I'm the director of Drugwise, which is a UK NGO delivering drug information online, and I'm also the lead author of the Global State of Tobacco Harm Reduction. I can see people are still drifting in, but I'm not going to stop. I'm going to carry on. I've got two guests with me who will be coming up to the lectern shortly. I've got Sarah Cooney, who's a consultant in science communication, and also Nick Crofts, who is editor-in-chief of the Harm Reduction Journal. And you'll hear from both of those in a minute. Sarah's giving the keynote, and Nick is the responder. By way of introduction, in 2017, British politician Michael Gove declared that the British public were sick and tired of experts. We'd had enough of experts. And he was making a specific reference to the fact that the Bank of England economists had failed to predict the financial crash of 2007, 2008. and they'd also predicted that in the immediate aftermath of Brexit the UK economy would go over a cliff. I'm making no comment about that second prediction given the state that we're in at the moment but Michael Gove was determined that we're not having anything more to do with experts and then along came Covid. Now when Covid hit The BBC and media outlets all over the world couldn't get enough of experts. They were falling over themselves to find every ologist that they could get in front of a microphone. Virologists, epidemiologists, psychologists, pharmacologists. We wanted to hear from these people. We wanted to know what this epidemic was all about, how it was going to affect us, how many people were going to die, how do we cure it, when is there going to be a vaccine, all these questions. We had experts in front of the British media every day giving their charts and predictions as to what was going to happen. scientific dispute about how all of this started. And there was genuine concern about the inequalities about access to vaccines. But the scientists were all pretty much on the same page. The race was on to find the vaccines and to find them quickly. And in the end, there were loud plaudits for the pharmaceutical companies for stepping up to the plate. But those plaudits were reserved for one company that didn't get these plaudits, and that was the Canadian company whose vaccine was refused to be endorsed by the WHO. Why? Because one of their shareholders was a tobacco company. Which, for me personally, that kind of symbolized for me how politics and ideology could trump even the most urgent global public health requirements. Because as many of you will know only too well within the world of tobacco control publishing, much science has been subsumed and subverted to the interests of politics and ideology. From scientists shut out from publishing at all, to the most ludicrous examples of bogus science which has somehow passed muster into the pages of otherwise respectable academic journals. And it seems like the piranhas of public health are only too keen to rip the flesh of academic credibility off the bones of anybody who disputes the anti-tobacco harm reduction narrative. So, is there any good news here? Is there any positives here for those who want to kind of swim in the troubled waters of scientific publishing within the tobacco control world? Well, Sarah thinks there is some good news to be said, some hope and optimism. So I'm going to pass over to her now to explain. Thank you, Sarah.

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Sarah Cooney: Thanks very much, Harry, for that introduction. And I wanted to say it's a great honour to be speaking at GFN. So I wanted to also thank the organising committee, Jerry, Paddy, Jaygosh, and Jess for having this topic and also for inviting me to speak. Oh, I forgot about that.

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Harry Shapiro: Sorry.

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Sarah Cooney: So here is my conflict of interest statement. And what I'm going to do is talk you through why it's important to publish, and because I know people in the audience may not know that much about publishing, I'm going to try and do a bit of a publishing, a really fast Publishing 101, also talk about the barriers to publishing. There are some emerging trends in science publishing that I think it's important for you to be aware of, and I will take you through some kind of case studies and personal experiences that I've had. So, a bit about me. I trained as a geneticist and I did my graduate work at the University of Toronto. I discovered that, although I loved science, my interests were much broader than what you can do at the bench. So I decided to try science publishing, which a lot of scientists end up doing. In order to stay close to science, you go and work for journals. So with my freshly printed Irish passport, I moved from Canada to the UK to work at Current Biology Limited, which was a small publishing company set up by an entrepreneur who was looking to disrupt things. I worked for them for a while and then we were bought by Elsevier. After I left, I went to Nature Publishing Group, so I was working on one of the world's most prestigious journals, which was very exciting. But it's also fascinating to see some of the politics that went on behind the scenes at a very high-level editorial environment. The sorts of papers that didn't get accepted and that were fantastic, and then papers that did get accepted, and you thought, well, I don't understand why. And speaking to editors and learning sort of some of what was going on behind the scenes. Most importantly at Nature, I met my husband, James. Some of you have met him as well. After Nature, I went to the Society of Chemical Industry, which is a small chemistry membership association. They have a small group of journals that they do in partnership with John Wiley and Sons. And after I left the SCI, I went to another start-up, so an open access publisher, Biomedcentral, started by the same innovator who set up Current Biology Limited. I was brought in to add to the senior team as that business was prepared for sale. It was then bought by Springer, and eventually Springer merged with Nature. So I worked in scholarly journals for over 10 years in a wide variety of editorial, product development roles where we were looking at launching new journals, and also publishing roles. And when I left BMC, I was looking to do something different. I wanted to do something different with my skills. And then a bit unexpectedly, I found myself in the tobacco industry, initially joining to help improve the impact of the material that was being published on reduced risk products, But then I got involved in other science communication activities. I oversaw the industry's first dedicated science website and also brought in other industry-first initiatives, a biannual scientific report and also the first visitor engagement program for the industry. After I left the industry, I set up a consultancy focused on science communication and engagement, including publication strategy. I'm working with a variety of other tobacco harm reduction experts. It's a bit of a family affair, so my husband did help with the slides, and my little dog, Fergus, is usually found at my feet during the day. Everybody in this room knows that the tobacco industry has been going through a massive transformation in the last 10 to 12 years, away from combustible cigarettes to reduced-risk tobacco and nicotine products. There's now a wide range of different types of product categories and an abundance of science that supports their reduced-risk nature. So I would argue that a bigger challenge is actually communicating that science and communicating it effectively. So, on to publishing. Why should you publish and why are scientific articles important? So, the research that you carry out is your scientific foundation, but you have to get it out there into the big bad world. I like to say that manuscripts in peer-reviewed journals are like the currency of scientific credibility. Peer review is a process by which other experts in the field review your material, critique it, improve it, so you know that there's an additional kind of quality and credibility stamp associated with a paper in a peer-reviewed journal. These papers can then be used to leverage other types of communication activities, which you can use to manage your reputation, and also can help in engaging with regulators. I also think you all know that publishing in the literature creates transparency and openness and helps you build trust with stakeholders, a wide range of stakeholders, with regulatory dossiers. A lot of that material is kind of hidden in confidential submissions, and I would argue that, and I've heard from other people in the field, that they've been criticised by public health for not getting that material out into the public domain. And again, manuscripts and peer-reviewed journals are a great way of doing that. It also allows you to highlight the incredibly high-quality research that's being done by tobacco and nicotine companies on reduced-risk products. So what are peer-reviewed journals? Well, the sharing of science by manuscript format has been going on for thousands of years. It started in ancient Greece. The first modern peer-reviewed journal was launched in 1665 by the Royal Society in England. And if you fast forward to 2019, the STM publishing industry, that's scientific, technical, and medical journals, had grown to a value of $28 billion annually. At the time there were 35,000 active English language journals and around 12,000 of those were indexed to get an impact factor. An impact factor is a way of ranking journals with respect to each other and it is a metric based on citations to the content in that journal. Impact factors vary wildly in publishing. So top tier journals like Nature and Cell have impact factors of 40, 50, 60 and sort of journals in the polymer section of chemistry, a good journal might have an impact factor of three or four. So it's a metric that is not brilliant, but it's the only metric that people have, and it's been hijacked by university departments and other stakeholders to sort of push people towards saying impact factor is the most important thing. It's not necessarily. Another sort of fun fact about the STM journals industry is that it was one of only two industries that successfully migrated from a print-dominated business to an electronic-dominated business while preserving the same high profit margins. And the other industry was the adult entertainment industry. So STM publishing is a very wealthy sector. It is composed of large commercial publishers, university presses, and learned societies that have some journals. So how do journals work? How does peer review work? Basically, an author will make a submission. All journals today have electronic manuscript handling systems. So you upload your files. The system then will run a series of prechecks to make sure that you're not a crank, you haven't discovered fusion in your basement. They make sure it's a real paper, that all the files are correct. Once those checks have been done, it will be assigned to an editor, The editor will then use keywords to identify scholars in the field who can look at your paper. He or she invites referees. The referees can often be hard to get referees to agree to look at papers. Good journals look to have at least two referee reports. We're starting to see emergence of lower quality journals that are relying on one referee report. But anyway, once your editor gets the two referee reports back, they read them, and they evaluate them, and then they make a recommendation, and they invite the authors to revise, or they reject, or they accept. It's very rare for a paper to be accepted on the first round with a journal, and most scientists agree that peer review tends to improve the quality of the manuscript. It's by no means perfect, it's the best system that we have. Scientists and publishers have been talking about is there a better way to peer review, and there isn't so far. But it can be a painful process and it can take six to 12 months to get your paper published. This can be exacerbated by the difficulty of getting two people to agree to review the paper, getting them to return their referee reports on time, that is extremely painful. You can sometimes have wildly differing referee reports that can reflect bias. And then you often have to get a third referee to sort of adjudicate. And you can go through multiple rounds of revision before you have acceptance. I would make one observation that most journals have very little expertise in tobacco and nicotine. And of course, with the problems with peer review, your manuscripts can get stuck all the time. But it's worth knowing that, as authors, you can intervene, you can get in touch with the journal, and you can get your manuscript unstuck. But it can be difficult to work out who you should contact and what exactly you should say to them. It's also worth remembering that journals are typically dealing with hundreds or even thousands of manuscripts at one time. So if you feel your paper has kind of got lost in the shuffle, it probably has. In the paper-based days, I remember a manuscript fell down behind a filing cabinet and was lost for a couple of months. And when I was at Biomed Central, I used to have to deal with author complaints for manuscripts that had electronically fallen between the cracks. And I would discover that they'd attempted to invite 20 peer reviewers before they got two, and they still didn't have two referee reports. So things do get stuck. And I helped a client recently with a paper that was sort of languishing. reviewed the correspondence, identified what was going on, and we were able to get in touch with the journal, get it unstuck, and then get it published. So there are lots of problems with peer review and another observation I'd make is that the science publishing industry is this massive industry built on the back of unpaid work by volunteers, the peer reviewers. And the peer review community is increasingly under more and more and more pressure. Journals are receiving more and more submissions all the time. So what journals are starting to do to try and cope with this and try and reduce the burden on their communities is to reject without review, and also you're starting to see transfer relationships between journals, and the best example of this is Nature, Nature has a reject rate of 99%, but actually there's quite good stuff that's rejected by nature. So it's cascaded with the referee reports down to the next tier, nature medicine, nature immunology, nature chemistry. And then if those don't quite make the bar there, they're cascaded to a journal called Nature Communications. And then at the bottom of the pyramid is scientific reports. But the key thing is that the referee reports travel with the manuscripts, so they aren't lost. Otherwise, if a manuscript is rejected, all the work that those peer reviewers did is wasted. You also see journals experimenting with new types of peer review systems. Open peer review is becoming more common. Biomedcentral, all of their medical journals have open peer review where they publish the referee report and also the name of the referee. That can actually make it a lot harder to get people to agree to look at manuscripts because there's something about being anonymous that allows you to be not as polite as you would be. And you're also starting to see other types of journals, post-publication peer review journals are also emerging. This is where you publish almost instantly and then they seek peer reviewers. And what can tobacco and nicotine companies do? I would urge all of you to encourage your scientists to volunteer as peer reviewers. Industry is often underrepresented in peer review communities because industry scientists don't tend to publish as much as academics. Journals can be operated in different ways, and I think this is important because it can help in your detective work to figure out who you should be trying to contact to get your manuscript unstuck. It can be owned and managed completely by a commercial publisher with professional editorial staff. This is how Nature operates. The owner has total control and manages everything. You also get journals owned by commercial publishers with academic editors. So these are full-time professors appointed as part-time editors-in-chief, and they receive a small honorarium from the publisher. And then you get partnerships between learned societies and commercial publishers. So Oxford University Press is the commercial publishing partner for the Society for Research in Nicotine and Tobacco, and OUP publishes nicotine and tobacco research on behalf of the society. The Society maintains editorial decision-making and also editorial policy, and the publisher does everything else. So there are lots of barriers to authors getting published. We've kind of been talking about them. It's a big effort to get something written, get it through an approval process, deal with lawyers, find the right journal, submit, deal with referee comments. If rejected, revise, reformat, and start all over again. We see censorship. I'm going to talk more about that in a moment. But the industry can and does publish, even though it's not easy. The two largest tobacco companies have published over 350 peer-reviewed manuscripts on RRP science. This is in a wide range of journals, between 70 and 80 different journals owned by quite a big range of publishing houses. But it does feel like it's getting harder. Some useful journals have changed their policy on considering industry-funded work. Special issues have come under criticism. And a change in journal ownership can be really disastrous. So I'm thinking of Tobacco Regulatory Science, where the original publisher decided to sell, and he unfortunately sold to a predatory publisher, which I'm also going to talk about in a moment. But that meant that the journal basically is no longer fit for purpose. I wanted to take a closer look at censorship. So before I joined the industry, I did a project to examine censorship in journals against the tobacco industry. And my conclusion was that explicit censorship bans are found in journals owned by medical and public health charities that have a small publishing program. So two, three, five, or six journals. These journals would be operated on a profit purpose, but the profit is donated back to the society. And what you see is that the editorial policy of those journals has become aligned with the parent learned society's views about the tobacco industry. My belief is that large commercial publishers are very unlikely to institute blanket bans. They're all on record as saying that science should be evaluated objectively on its merits through the peer review process. You do see some examples of journals owned by commercial publishers that have censorship ban and often this has arisen with the change in editor-in-chief. So regulatory science and tech, sorry, yeah, regulatory toxicology and pharmacology used to be quite friendly to the tobacco industry, but when the previous editor-in-chief retired and they put three new co-editors-in-chief, they decided that the journal had published too much tobacco work and they would no longer do it. I also wanted to mention medical communications agencies. They also are unable to work with tobacco companies. They typically assist pharmaceutical and biotech companies with publication and other sorts of activities. But if they have respiratory drugs or if they have pharmaceutical clients, often it's written into their contracts that those agencies then can't work with the tobacco sector. Another thing is that, you know, that actually, it sounds like an easy fix, but it wouldn't be because they lack the specialist expertise that you need in order to sort of navigate things from a tobacco and nicotine perspective. The overall landscape of publishing is changing. So I talked about the size. It's a, you know, massive $28 billion a year industry. Traditional journals have, they're based on subscription so you, Publishers sell subscriptions to libraries. These journals have limited page budgets, so they can publish 120 articles a year. And success criteria is around impact factor. So this is about novelty and attracting citations to that content. And when submissions rise, like they are doing every year, year on year, the only thing these traditional journals can do is reject more as a way to cope. So open access emerged as a disruptive business model around 20 years ago due to the opportunities created by the internet. It was also influenced by a series, a group of very high profile academics who felt that it was wrong that work funded by governments was hidden behind subscription barriers and that publishers were charging to access this. The business model shifts revenues from library pays to author pays to lift subscription barrier. It was controversial at the time because this model accepts a lower profit margin than traditional publishing. I can tell you a funny story about that another time. I had a friend I used to sing with who was involved in the deal that created Springer Verlag. There was a venture capital funding to create Springer, and this friend of mine came up to me at a choir rehearsal, and he said, oh, I've read all the background documentation. Those profit margins are astonishing. That'll have to change. And so open access changes everything. Rather than success criteria being about impact and novelty, it's financial. Each accepted manuscript attracts a fee. They are typically online-only journals, so there's no issue with page budgets. If a journal receives more, they can keep the same reject rate and accept more. And there's more experimenting with different types of journals. There's a journal called Scientific Data that is just data sets. You write a little bit of narrative around the data sets, and there are new peer-review models emerging. Looking more closely at open access, this focus on sound science rather than novelty is really, really important for the tobacco and nicotine sector, and that's because regulatory research tends to be more applied in nature rather than really, really new and exciting. So the first article that looked at the aerosol of an e-cigarette, that was groundbreaking, and that did get published in a very high-impact factor journal, one of the top toxicology journals. and that paper has now had 30,000 downloads and 200 citations. But the second and third and fourth and fifth chemistry papers like that, they're not got the same level of novelty. So you need journals that are focusing on sound science and Open Access provides this because they're not looking to boost their impact factors. They're looking to publish as much sound science as possible. There's less They're less influenced by moral judgments. You can be faster with open access journals than traditional journals if you prepare the ground in advance by improving the quality of your papers, preparing the submissions, making sure you suggest lots of different referees. And the most important thing is that credible open access journals are owned by commercial publishers and they've invested a great deal in quality control and peer review, robust peer review. So you must beware of predatory journals. So the downside to open access business model is that the barrier to entry to becoming a publisher is now super low. If you have a computer, you can become a publisher. And that's what's happening. So predatory publishers, rather than having high-quality peer review, they don't do any peer review. Or they might have a peer reviewer who knows nothing about this subject area. Instead, they're motivated solely by collecting a fee from the author. Journal titles sound familiar, so it's easy to be fooled. The International Journal of Scientific Reports is not actually the same as Scientific Reports. So organizations may need help to spot predatory journals and also predatory conferences, and the risk to publishing in these places is that it can undermine your very hard-won credibility. I wanted to talk briefly about research integrity. So research integrity is another way of saying good research practice. And the reason I'm bringing this up is that all major publishers now have research integrity functions, and they have teams of people that are looking to help safeguard the academic record. And they are dealing with things like paper mills, they're dealing with fraud, they're dealing with fraudulently made figures. And I think this is something that is important for the tobacco and nicotine sector, because the integrity of the research in this field is very, very high. So the UK Research Integrity Office defines research integrity as the conduct of research in ways that promotes trust and confidence in all aspects of the research process. The Singapore Statement, which came out of the first or second World Conference on Research Integrity, sets out four principles. Honesty, accountability, professional courtesy, and good stewardship. And so I think this is worth bearing in mind when thinking about your strategy. Publication ethics is also very important and what I want to say here is it's very important for everyone to openly and transparently declare their perceived conflicts of interest because it will only come back to bite you if you don't do it. I'm going to take a moment to reflect on some of my own experiences. I mentioned that I did join the tobacco industry. I was approached at first and I was like, what is this? This was 2010. I didn't know that the tobacco industry did any science. I didn't know what tobacco harm reduction was. I grew up in Canada, which is very strong on tobacco control, and so I was like, I'm not sure, but I decided I'd go and meet some people and have a look at the research that was going on, and I was pleasantly surprised, really surprised, at the people I met, at the quality of the research, and how genuinely interesting it was. So I decided to join, and my first focus was around publishing strategy. I overhauled it. I introduced people to the idea of open access and also improved the interaction between staff and journals, which started to improve the acceptance rate. And I would say that relationships are really, really important in publishing. And if you can find any way to build relationships or to meet people or to interact with people on journals, you should take it. If there's a meet the editor session at a conference, just go and make sure you introduce yourself. As part of this, I oversaw the strategy for at least 100 manuscripts on reduced risk products, and it's something that I was very proud of. So you can optimise your manuscript process. You can improve the quality of articles by introducing manuscript polishing services. You can get over the hurdle of reject without review if you're going to traditional journals by preparing the way and explaining why your manuscript is important. You can speed up peer review by being in touch with the journals constantly, and you can build relationships with journals. You have to proceed carefully when you're meeting people. Like everywhere, some people in publishing have very entrenched views about tobacco and the tobacco industry, but usually you can find someone who is willing to open up and have a conversation. I wanted to talk briefly about special issues, which have been incredibly useful for the industry over the years. It's a great way of putting a collection of material together on a single product, and that has worked really well. In the last few years, there have been criticism of a few special issues, in particular the Jules special issue, which I think was deeply unfair. It's a collection of 11 manuscripts, very, very high quality, and the media picked up on the fact that, essentially, the company paid for the open access fees, and this is what the media covered. But the fees were very modest, really, and it was, well, as a publishing person, it was quite shocking. And having spoken to the editor-in-chief, I know that there were at least three peer reviewers on each of those articles, and there were over 100 pages of peer review comments that the authors had to respond to. I do think that over time, as we get away from that kind of media furor about it, I do think that that collection of papers will become increasingly important. I've been a guest editor on a special issue in a Wiley journal this year, Drug Testing and Analysis. This is a journal that normally looks at drugs in other situations, doping in sport. And so the editor-in-chief's quite receptive to the idea of controversial topics, which is why he was interested in having a special issue on vaping. It's also a way for journals to test the water if they're thinking about expanding their aims and scope beyond where they are now. So there's a total of 22 articles. contributions from academia, from research institutes, from outputs from workshops, and also from industry, a wide range of topics, chemistry, toxicology, even some behavioral studies, which are kind of quite far from the normal aims and scope of this journal. But in the context of the special issue, this was OK with the editor-in-chief. We did receive one complaint from a well-known academic in Australia. who was deeply concerned about one of the articles and didn't believe it had gone through peer review and the Wiley staff were wonderful because They emailed myself and the other guest editors saying what's this? What's what's going on? What is what's wrong with this guy? and so we sort of gave a bit of context and the the Wiley publishing people went back to this academic and said thanks for your concerns and It has gone through peer review, the disclosures are there, and if you still have a problem, please write a formal letter to the editor, because they just uploaded a comment through the system, which isn't, that's not the right way to do things. So I was really pleased with how Wiley handled that. Each article has appeared online ahead of print, but the printed collection will be available later this summer, and I'm sure I can get a copy to anybody who would like it. That kind of takes me to the end. It's kind of a hop, skip and a jump through publishing and some experiences being on the other side. I do think that... I'd just like to re-emphasise that I do think the big challenge is getting science out, communicating the great science on tobacco harm reduction, getting it out into the wider world. I do think that publishing in peer-reviewed journals is essential. I do think you should invest in that to make your articles as good quality as possible. You can optimize your approach to publishing and try to remember that relationships are critical. The science journal landscape continues to change, so you may want to have some specialist advice in learning how to navigate that opportunity, or those changes, because it creates opportunities, but it also creates risks such as predatory journals. And there will undoubtedly be other risks that kind of open up. But I'd just like to keep coming back to this idea that could research should stand the test of objective but fair peer review. And that then should set us up for, I'll hand back to, I'll hand over to Nick.

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Nick Crofts: Thank you, Sarah. I'm learning, and that was part of my education. Thank you. I just wanted to pick up on a couple of things Harry said to start off with, quoting Michael Gove, that we don't need any more experts. I've always liked a definition that came out of NASA about what an expert is. An expert is an ordinary person very long way from home. I'm very long way from home, so therefore I am obviously a deep expert. But most of the people in this room don't know me. I've actually been around harm reduction for more than 35 years, but my focus has largely been on harm reduction related to harms associated with illicit drug use. Can I have my slides, please? In terms of tobacco credentials, I was like, oh, do I have to do that? No? There's one before that. Yeah. In terms of tobacco credentials, I have a couple. The first is that I was a smoker for 39 years, up until 15 years ago. One of the implications of that was that for every year for 39 years, I received some very well-meaning and supportive advice from my very good friend and colleague, Alex Wodak. about how and why I should give up. Eventually it worked, Alex. Only took 39 years. My other credential is that I was one of the founders of this organization, not an organization, it was a movement, BuggerUp. I don't know if people know BuggerUp or remember BuggerUp. BuggerUp was billboard utilizing graffitists against unhealthy promotions. And it was one of the most effective health promotion campaigns, activist health promotion campaigns ever. And I'd love to talk about BuggerUp, but that's not the reason I'm up here. So my major contribution to Tobacco Harm Reduction as editor-in-chief of the Harm Reduction Journal has been to appoint the wonderful Marewa Glover as section editor for the journal. I didn't realise when I did that exactly what I was getting into. I have written here that I've seen what I thought was some of the most dirty politics in a whole range of different situations including capital P politics with our Labour Party and internal fighting within our Labour Party in my own suburb, the medical professorial fights that went on when HIV first came along, fights for territory and credibility. But I really was not prepared for what I met when I came into contact with Tobacco Harm Reduction. vitriol that I received, the public health masquerading, puritanism masquerading as public health, and I'm going to adopt another one of Harry's phrases, the piranhas of public health, which I think describes very well what I've been exposed to. I think that one of the things I'd like to see happen more is that tobacco harm reduction become more integrated with the general field of harm reduction. I want to talk a little bit about that and about what we can do about that. I was having this conversation with Mireya and Alex and Colin last night about integration of tobacco harm reduction into the mainstream harm reduction movement, and the International Harm Reduction Conference was on in Melbourne a little while ago. Nothing on tobacco harm reduction. Resistant, as I'm given to understand, to proposals to include tobacco harm reduction in their agenda. I think this is a great problem. I think they need to realise and we need to realise that harm reduction under whatever name, whatever guise, as a human reaction to difficult issues has been around forever. One of my favourite examples is that in medieval China they had a problem with people going out at night time getting drunk and walking home and falling in the canals and drowning or freezing. They tried everything, they tried curfews, they tried prohibition. Nothing worked until somebody had the bright idea of putting handrails along the canals. Harm reduction is a normal human response to difficult problems that aren't going to go away. I think the story of vitamin replacement in, vitamin supplements in alcohol. people dependent on alcohol is worth remembering because there was actually a strong reaction from public health against the idea of vitamin supplements for people with alcohol dependence, not unlike what's happening with tobacco harm reduction here or what I've been exposed to with tobacco harm reduction here. Similarly, with prevention of HIV among and from injecting drug users, large components of the opposition to the establishment of needle syringe programs and sterile needle distribution came from orthodox public health. So let's not forget that history, and let's find allies. Those allies are, I think, within a wide range of other areas. The International Harm Reduction Association, the Harm Reduction Conferences, continue to focus on harms associated with illicit drug use, currently illicit drug use. I'm taking the journal in a different direction. I'm taking the journal towards including a harm reduction approach and harm reduction philosophies across a whole range of human and behavioural issues. It's going places, I think. We define harm reduction as policies and programs which aim to reduce the health, social and economic consequences of a whole range of behaviours without necessarily reducing the behaviours themselves. Classic one in our community, I come from the jurisdiction in the world that introduced compulsory seatbelt legislation and compulsory motorcycle helmet legislation first. Classic harm reduction. In line with that, we've been building the editorial side of the journal. to include section editors with a responsibility for a whole range of different issues, which I don't know if you can read those from back there, but alcohol harm reduction, tobacco harm reduction, as I said, Nurewa has built that section enormously. Substance use harm reduction stays with me and my deputy. Gambling harm reduction, human enhancement drugs, drugs and the internet are really understudied and hugely growing and hugely important area. Reducing the harm of incarceration. Given that the vast majority of people, in my opinion, who are in prisons and jails should not be there, how do we work to keep them out of jails? But also, if they do go in, how do we reduce the harm that's caused by the process of incarceration? Youth drugs and harm reduction is the latest section that we started. And you can see that one of our section editors there is somebody I think known well to this conference, Florian Chavine. We're also looking to broaden our reach to the community and support from the community, and Dr Annie Madden, who was the Executive Director of the Australian Intravenous League, the Australian Drug Users Group for 15 years, has taken on the role as Associate Editor to build that relationship with that community, and I'm looking for further ways to build relationships with other affected communities to bring them into the publishing process, to bring Annie, for instance, is guiding a process to develop ethical guidance for peer review for research that's based around peer researchers. My own prejudice is that, in a simplistic way, often We have harm reduction because we have bad policy. If we had good policy, it would embody the principles of harm reduction. Bad policy in a lot of circumstances means criminalization, criminalization of issues that really are public health issues and do not belong in the criminal justice industry. They don't belong there because either they're normal, they're just normal behavior, or they're public health issues. With illicit drugs, a rough estimate would be that 85% of users don't have a problem. don't need attention from either the criminal justice or the public health sector. Fifteen per cent who do have a problem would benefit from a health response. Healthy public policy is the aim, and the abolition of harm reduction, because we've achieved healthy public policy across every sector, would be something to look towards. I'm therefore changing also the strapline of the The journal is going to become a journal for research and commentary on harm reduction and challenging criminalisation. This seems to be working to some extent. Sarah talked about impact factors. Those blue bars on the left are the impact factors for the journal over the last six years. On the right, there's the downloads for the journal, which in six years, two, four, five years have gone from 600,000 downloads a year to something approaching 3.5 million this year, which is, I hope, I think, is a phenomenal rate of growth. It means that the harm reduction philosophy applied across all these different areas is one that is acceptable, is promoted, is necessary, and is working. The challenges. I'm echoing a lot of what Sarah said in talking about challenges. Peer reviewing has become a real a real issue for most journals. Finding people who are prepared to review it, particularly over the couple of years of the COVID pandemic. I'm not quite sure why. Finding people who are prepared to review, finding people who are qualified to review or want to be qualified to review, want to learn how to review. It's not something that anyone can do. It's a skill that you need to learn and master. And my observation in a lot of academic public health is that the whole idea of mentoring seems to have got lost somewhere. Mentoring people into writing, mentoring people into reviewing. We have a process developing now to mentor young early career researchers and peer researchers into helping them with writing and and with reviewing and trying to build that carter, but it's an increasing problem finding reviewers. The open access model itself that Sarah described so well, what I have there is a quote from my boss, the head of my institute, which I received just the day before yesterday, and I want to read it out. I, the director of the institute, am currently in an academic board meeting at the University In a bun fight about open access publishing, there are various views, but they're all about how to break the publishing houses, also known as the robber barons, pernicious model that makes profit off the free labour of academics. Sarah called attention to the volunteerism that this system is built on. It's not just the peer reviewers who are volunteers. All the editors that I mentioned before, including me, are volunteers. And particularly if you're having success with a journal like this, what that means is increasing amounts of work. I have other occupations, and I must say that through my own academic career I've found that the two most thankless tasks in an academic career are organising conferences and editing journals. Career billing. That's another aspect of my observation of academic public health, that the value that was given once upon a time to editing and reviewing and contributing to the scientific community is decreasingly there within the academic community, university academic environment. That has become much more a business model where you're judged on the grants you get, the publications you get, and the profits that you make and the PhDs you put through. But other contributions around reviewing and editing are not valued nearly as highly. I worry and am working on trying to broaden the access to the journal. There are a whole range of people who are discriminated against or excluded from publishing. I put three there, people for whom English is a second language, have enormous difficulty. And for whatever help we can give, we try. There's not a lot of resources to help people. People from low and middle income country settings, I know from first-hand experience, I've spent a lot of my life working in low and middle income countries, there's enormous energy, initiative, enthusiasm, invention going on across a whole range of areas, including tobacco harm reduction, in a lot of low and middle income country settings that will never see the day of light. The day of light, the light of day, because because people don't have the capacity or the support to publish. And the community, and again, there's enormous research going on amongst affected communities in different ways, lived experience and worth documenting, lots of learning that's worth documenting but will not be documented. In relation to censorship, I'm again echoing Sarah And my experience with the Harm Reduction Journal, I don't want to get into cases, but it's the first time I've run across this. And a couple of years ago, I was informed by my then publisher that the publisher was adopting a policy of not accepting publications that had anything to do with money that had somehow become acquainted with the tobacco industry. I'm not exactly sure how they put it, but it was very broad. And I talked to Morewa. We had a little letting off of steam. And I wrote back a very simple email to them, simply saying, editorial policy is for the editors. Go and get stuffed. That's just an example of the problems of getting experience in publication and research from other parts of the world. The map shows you where our current publication is from. The graph down below, which you probably can't see all that well, but across the bottom there is Canada, Australia, the DAC countries, US, going on down towards Africa and Asia. And that's the acceptance rate, the green line. And that's an illustration of the sorts of difficulties that people have in publishing from low and middle income country settings. And that's something that we've set our cap at fixing. I think that's about all I wanted to say. Thank you very much.

00:50:23 --> 00:52:20

Harry Shapiro: I don't even know where to start with all of that. That was two astonishing and incredibly enlightening presentations, which told me an awful lot I didn't know already. I'm going to sort of take kind of host liberty and sort of punt a couple of questions at you before I throw this open. I notice we've got at least one online question here. I mean, obviously, Sara, your experience is actually trying to get actual industry material published by people who work within the tobacco companies. But my understanding is that it's incredibly difficult for people who might have had some historical or tangential connection, they may have been funded by X some years ago. So getting these, and also the conflict of interest is quite interesting because if your paper is published and it's an anti-tobacco harm reduction approach funded by a medical agency whose approach publicly is to be anti-democratic. Is this a conflict of interest? Yes, I think there is a conflict of interest. It's never actually stated in that way. But you're never going to get away with it if you said, you know, my paper was funded by, you know, one of the companies years ago or, you know, Foundation for a Smokefree World or whatever it happens to be. So there seems to be quite a lot of hypocrisy there and also a problem for people to get their material published who aren't necessarily coming from within the industry.

00:52:24 --> 00:53:13

Sarah Cooney: I would say that people that are receiving funding from the industry directly or indirectly, they have the same, the censorship applies, the number of journals that won't allow them to publish, but they still have other journals that they can publish in. They just maybe follow where industry has managed to be published. And I think that maybe some work needs to be done with a research integrity or a committee on publication ethics, oh dear, to try and get anti-tobacco harm reduction conflicts of interest disclosed equally. I don't know if anybody's ever gone to a publisher or the committee on publication ethics to raise this as an issue. It's probably something that someone should do.

00:53:17 --> 00:54:03

Harry Shapiro: Thank you, which kind of leads me to my kind of next question before I throw open. For people who are on on Clive Bitz's nicotine group list we'll see on a weekly basis Clive kind of forensically taking a lot of medical publications to Bitz and some of the stuff he reveals in terms of methodologies and you know this is almost on a weekly basis that all this nonsense is getting into journals. What's the best as well as getting your material in there are there strategies for actually challenging bad signs.

00:54:03 --> 00:54:59

Sarah Cooney: You can use letters to the editor to challenge bad signs and there have been a couple of examples. Some of the, well, Brad wrote who was really successful in getting one of the Stanton Glance articles retracted which was deeply flawed. It's a huge amount of work to try and get someone to do a retraction like that. But, you know, Again, that's another thing that we should be collectively doing, is challenging the bad science. And that recent paper that Clive critiqued, I was really shocked that tobacco control didn't retract it, that they allowed the authors away with it. And again, it would be interesting to see what someone like Committee on Publication Ethics would, what sort of view they would take of that particular case. I don't know if anybody ever took it to COPE. And I know COPE isn't perfect, It isn't that strong, but it is something that focuses on publication ethics.

00:54:59 --> 00:55:29

Harry Shapiro: So I'm going to throw this open to people who are online and also out here. I think Clive mentioned that there is a bit of a dead zone in the corner here because of the searchlights in the eyes. So if you've got questions, best to try I move into the middle a bit because otherwise I ain't gonna see you. Can you wait for the microphone thing as well?

00:55:34 --> 00:57:47

Marewa Glover: Thank you, is it working? Thank you. Mare Wakalava, thank you for mentioning me, Nick. I just want to acknowledge or add to what you said, especially because Harm Reduction Journal and the tobacco section is so relevant to many of you here, and you could choose to submit at some point because of our focus. So how I got into that position, Gerry and Paddy approached me. They had approached 50 people to consider becoming the tobacco section editor, 50 people. So this sort of censorship and fear of backlash and what's going to happen to you is very widespread and I had just set up my centre I shouldn't say stupidly, it's been a learning experience, but I took it on, so I think it's almost five years or something. I have now shepherded a hundred papers that have been submitted to the tobacco section, and it's all voluntary work, it's a lot of work, and I just want to take the opportunity to apologise if I'm slow. I have a huge program of research myself, and I have to fit this in. And I also want to take this opportunity, if I can, Harry, to ask if there is anyone else here who would be interested in being an associate editor. You know, maybe a younger upcoming scientist who would like to learn, you know, what's involved and be mentored. I've been looking for somebody to join me, because we are getting more and more and more submissions, and I'm having to use this reject before review, because I'm getting stricter and stricter, and narrowing it down, and the criteria for even getting through to go to review. Okay? Thank you.

00:57:47 --> 00:57:54

Harry Shapiro: Thank you. Well, it's actually quite encouraging. You're getting so many submissions, of course, which is good news. Gentleman in the front row here.

00:57:59 --> 00:59:08

Richard Pruen: Hello, Richard Prune from Safer Nicotine Wiki. It's very, very good that I've actually heard what you've said, because we actually share your pain in some of the challenges you face. I was just wondering, we're sort of a layer on top of your journals and published work, actually presenting that to the public. and making it available and accessible for advocates and people to use and to be able to quickly reference what they need to find. One of my questions was, how can we work together better to actually get the information out there quickly so that people can use it? And also, I mean, it was just to say, yeah, we should talk and we should actually tee up cooperating as far as we can to actually help to get the right information to the right people. Thank you very much.

00:59:08 --> 00:59:26

Harry Shapiro: Yeah, I'm going to pause. I just wanted to know, for my absolute discredit, I haven't looked at, say, Vindicazine and Wikia and I doubt what ought to, but so do you make direct links to the sort of published material that we've been talking about? Yes, indeed.

00:59:26 --> 00:59:45

Richard Pruen: Most of our pages contain short summaries, bullet points, ways to make the research more accessible to the general public, and then we would link directly to the full article for those who want to read it.

00:59:45 --> 00:59:56

Nick Crofts: We've got a process with an arrangement with Filter Magazine where we're doing that, and I'd be delighted to talk to you about it. making an arrangement with you, definitely. Thank you.

00:59:56 --> 01:00:00

Sarah Cooney: Likewise, there are probably other things that should be connected in with SaferWiki.

01:00:00 --> 01:00:16

Richard Pruen: Yes. The other thing I was also going to suggest is there are a number of people who work in the background for us just sort of reading through and checking through things. I'm wondering whether they may possibly volunteer to do some

01:00:18 --> 01:00:19

Sarah Cooney: Being a peer reviewer?

01:00:19 --> 01:00:25

Richard Pruen: Yeah, reviewed. Fantastic. Or to look at technical aspects or things like that.

01:00:25 --> 01:00:59

Sarah Cooney: I mean, so, you know, journals are so desperate for peer reviewers, and I mean, everybody here should be added to Marawa's list of potential peer reviewers. But journals are so desperate that they'll try somebody out even if they're a bit skeptical at first. And every time you get a peer review report back in the system I've been using, it asks me to rate the quality of the peer review. Did it come in on time? Was it detailed? What was the quality of the peer review? So you know whether you should use them in future. So if people from industry do high quality peer review reports,

01:01:00 --> 01:01:44

Richard Pruen: Or they don't necessarily have to be... The other one was purely, you know, just as a request to say, you know, we do actually need more people to volunteer for the Wiki, even if it isn't to actually write the public-facing pages, to just go through, read, because scientific papers take some time to read, and actually pull bullet points out of, If people would be willing to volunteer to just do that, or if you as a publisher could forward us on something that we can use as a starting point, it would streamline. We obviously have the same problem as you, time constraints and being very busy.

01:01:45 --> 01:02:53

Harry Shapiro: Okay that's really helpful and I'm absolutely going to go and have a look at it now. I promise. Okay we've got one online question here and it's all about the future of the peer review process. It says given the instances during the pandemic where actions claimed to be science-based were later revealed to be influenced by moral positions and the prevalence of false findings in peer review studies, I'm curious about the future of the peer review process. In your expert opinion, I think this applies to both of you really, where do you see the peer review process heading in the next 10 years? Do you think there will be a renewed emphasis on building trust in scientific research? Or do you believe there is a risk of the system succumbing to regulatory capture, prioritising population perception control over the pursuit of truth? I can't give you a whole day to answer that one, but any thoughts?

01:02:53 --> 01:03:50

Sarah Cooney: I mean, I think, I went to a talk a long time ago that said peer review is the worst system ever invented, but there's nothing else. There is no alternative. So peer review will persist. I think that the importance of research integrity and the efforts that publishers are putting into research integrity departments, I think that will hopefully help to improve things with peer review. Publishers are also starting to offer sort of training courses for scientists to learn how to be a good peer reviewer and what you need to do. And I think a lot of that's happening because as the shift to open access continues, the author is the customer, and so serving the authors better is what publishers need to do, whereas in olden days, the librarians were the customers, because that's where the revenue came from. So I think it will persist, and hopefully it will get better.

01:03:50 --> 01:04:55

Nick Crofts: I couldn't agree more. It's the worst of all systems, except for all the others. Yeah, absolutely. But it works when it's taken seriously. That was my observation, that I'm afraid that I watch my colleagues in public health, academic public health, failing to take the process as seriously as I think it should be taken. The other thing that comes in that hasn't been mentioned is artificial intelligence, and where's that going? I know nothing about it. I'm too old to learn about it. Bugger it. But I had a conversation with somebody else, and I said, given the difficulty of finding peer reviewers now, could we make use of the chat GPT or something like that? And he said, no, we tried that. And he said, the problem at the moment is that it doesn't just create reviews, it creates references. And I didn't realise that. It actually, you can do it, but it comes back with five fake references that it's created. But I don't think that's only temporary. We're only at the start of that whole AI thing. So I think there's going to be something with AI in the future.

01:04:55 --> 01:05:05

Harry Shapiro: I think Alex had his hand up. Down in the second row, thanks.

01:05:05 --> 01:05:44

Alex Wodak: Thank you, Alex Wodak, Australia. My question is to you, Dr. Cooney. I was surprised you didn't make a reference to the International Committee of Medical Journal Editors, and I wonder whether you think there would be scope for individuals or organizations, particularly this conference, assemble the kind of comments you've made and pitch this to that very important committee?

01:05:44 --> 01:06:20

Sarah Cooney: I don't see why not. And you're right, I should have mentioned ICMG. There was just so much to cover. But I think that the societies that support the publishing industry that we need to look at leveraging them more or raising these issues to them more to see if something can be can be done to improve you know to improve the politics and to improve on or at least get well the short answer is yes we should and I'm happy to talk to you about it after and and plan something practical.

01:06:32 --> 01:08:22

Colin Mendelsohn: Thank you. Colin Mendelsohn from Australia. One thought I had was the possibility of linking acceptance of an article for publication to subsequent peer review for that journal. Have you ever thought of saying to authors, well, we'll accept your, or we have a condition in which authors are required to peer review two articles? That was just one thought. But what I wanted to particularly ask Sarah about was You mentioned the obligation of society journals who are aligned, they have an editorial policy aligned with their organisation. Now, I have a problem with that because I don't regard that as a scientific approach. So they publish articles that have a particular bias which go into the media, which are presented as scientific evidence. Then they refuse to publish articles with opposing views, which is what science is all about. And this has happened to me, and I've discussed this with Nick with an article I wrote in response to an article in the journal about tobacco treatment, which totally neglected vaping. I wrote an article which they rejected point blank. They only accepted it when a whole lot of other people signed a letter to them saying, you can't ignore this, and they published it. Then, to cut a long story short, they three months later threatened to retract it. based on a spurious conflict of interest. And I've spent $10,000 on a lawyer having that overturned, although it hasn't been fully overturned. But my point was that I felt this was very unscientific, that they were putting out information, presenting it as scientific, balanced information, which it wasn't.

01:08:23 --> 01:09:43

Sarah Cooney: Well, it is wrong. It's completely wrong. But the project that I did was to try and understand where the censorship bans were coming from, and to try and predict whether every journal was going to end up with a censorship ban. So I disagree with it, just like you do. And I remember when the BMJ instituted its censorship ban, and I remember I helped write the letter that the chief science officer sent in to the BMJ explaining why this was the wrong road to take. The editor just said, don't care, not going to change it, but the letters editor identified it as an interesting piece of content and upgraded it from the online rapid responses. and included it in the print issue. I mean, maybe there's a way to get these organizations, as tobacco harm reduction makes more progress, and as there are more products and the smoking rates continue to come down, maybe there will be an opportunity to persuade these organizations to revisit their policies. I agree it's completely wrong, but it was more of an observation and an explanation for why those organizations have decided to censor wholesale a complete industry.

01:09:43 --> 01:09:59

Harry Shapiro: We've got five minutes left and hands up going all over the place. Right, lady in blue there, then Norbert, then Bengt, then Jenny in that order. Thank you.

01:10:00 --> 01:10:37

Arielle Selya: Hi, I'm Arielle Selya. I work for Pinney Associates and we consult for Juul and I also help Clive out with his weekly PubMed review. Both of you mentioned the difficulty in getting peer reviewers and the high profit margins of publishers and the unpaid labor. So are there conversations being had at the higher levels to compensate peer reviewers? So, like, for example, I've seen some offers, like, if you review for a journal, they give you a discount on the next publishing fee, but academics don't actually pay that out of their own pocket, so is there conversations had about flipping that and offering an incentive? Thank you.

01:10:37 --> 01:10:57

Nick Crofts: I can only speak for my journal, and it's been an ongoing discussion that I've had with my publisher ever since I was editor, and we're making incremental progress, If anyone's got any good ideas, I agree with you about the discount. They will go to the extent of considering a discount, but for academic authors, that doesn't mean anything.

01:10:59 --> 01:11:39

Sarah Cooney: And I would need to check back in with some old publishing colleagues to see what the, to take the temperature on that. But it is, it's only going to get worse. And you start to, I've seen some journals start to experiment with paying for peer reviewers. And I know that was, well, I'm aware that's happened in some journals. Some editors will offer authors a fast-track process for several thousand dollars. I don't think it ever really gets publicly disclosed. So there are things going on and they should develop some best practice around this because it is a very wealthy industry and there should be a way of compensating referees.

01:11:42 --> 01:11:45

Harry Shapiro: Okay, nice and sharp, sure, Norbert.

01:11:45 --> 01:12:42

Norbert Schmidt: Hello, Norbert Zillatron-Schmidt, German Consumers Organization, IGD. Considering all the junk science that passed peer review in several journals, I think, is there any possibility for serious journals to facilitate replication studies? These are seriously lacking. We need more application studies that evaluate the original junk and validate and show the flaws in a real study. Is there any way for real journals to incentivize the scientists to do replication studies, to publish them.

01:12:42 --> 01:12:58

Harry Shapiro: Okay, I'm going to take the next two questions and then we can sort of bundle them together. Ben, this gentleman here. What happened?

01:13:03 --> 01:14:05

Bengt Wiberg: Thank you. I'm Bengt Wiberg, the snooze guy from Sweden. I find something very, very disturbing. Scientific publications of very high importance. I googled while you were talking here, I googled smoking cessation Dr. Ramström, one of the Michael Russell Award winners. What can be accomplished by reducing smoking prevalence, the Swedish example? It has 20 views on Academia. And as we go on and on, I would like to support Richard Proven of the Safer Wiki, trying to make the scientific publications which are written in a scientific way, but are, for normal people, perhaps a bit boring.

01:14:05 --> 01:14:12

Harry Shapiro: You don't get it. Okay. Thank you, Bengt. Thank you. Can you get Jeannie in, and then we'll have to wrap it up.

01:14:12 --> 01:14:24

Jeannie Cameron: Okay. First of all, I just wanted to say to Nick, thanks for reminding about Bugger Up. My mum was a member, and I used to get dragged around to all their meetings.

01:14:24 --> 01:14:25

Nick Crofts: Now I feel old.

01:14:30 --> 01:14:56

Jeannie Cameron: Sorry about that. But my question is a more serious one and it relates to this industry as compared to the pharmaceutical industry. Clearly when you read publications, you see heaps of things from the pharma industry which seems to not apply the same rule. So just from your perspective, how do you see the pharmaceutical industry and its ability to publish on new things and our industry not?

01:15:03 --> 01:16:04

Sarah Cooney: Well, I think the pharmaceutical industry has vast volumes of manuscripts because there are huge numbers of drugs that they're working on. Every big pharmaceutical company has teams of publication planners developing material for journals. I think that the tobacco industry can publish. I think it's just a bit tricky and you've got to But I think it can publish. And I think the evidence is there that we can publish. It feels hard, but there are still doors that are open, good journals that are willing to take the research. And it's a matter of finding those and getting to them first, rather than going to a few journals that reject you and then adding more and more and more time. But I don't think it's impossible. I am optimistic still.

01:16:04 --> 01:16:36

Harry Shapiro: Very quickly, Beng's point about the value of safer nicotine wiki I think is established and is a good enterprise. As far as Norbert's question about replication studies, I don't think the publishing industry is going to do anything about that. I mean, that's just down to university research departments, I assume. But I'm going to wrap it up now. I'm going to wrap it up now. I'm going to say thank you very much to Sarah and Nick. And big round of applause, please.