Publish or perish. Centre for Biomedical Ethics and Culture, Sindh University of Urology and Transplantation, Karachi, Pakistan.

The Centre for Biomedical Ethics and Culture, Sindh University of Urology and Transplantation, Karachi, Pakistan, periodically uploads on its website videos that depict ethically challenging situations in a doctor’s life. Their latest upload is one titled “Publish or Perish”. The title is a catchphrase for practising doctors and needs no explanation. The story is about two busy young doctors who fell behind a colleague in the promotion queue simply because he had the advantage of some publications. And so the drive to quickly publish something to catch up – so familiar a sequence. But the actors have touched on many aspects of this race, so much so that I would have been satisfied even if they had curtailed the desire to be comprehensive.

What issues have they brought up? First, a discussion between them about priorities – should a doctor give his all to look after patients, going home for a few hours of sleep, or is that not as important as publishing? This issue would have been sufficient by itself for a learned discussion on ethics. Especially in resource-starved countries where funding is limited and the staff crunch is commonplace, is it right to insist on publishing even if that means compromising patient care? Can priorities set by the developed world, which evolved a system that permits them, be adopted unaltered in deprived countries?

The other issues that crop up in the video are consequences of the first one, and consequently a tad stretched. One of the two doctors then advises the other to quickly start moving on the publishing front, since that is what it takes to get that coveted promotion. And how does one move on if time and resources are limited? How about copy-pasting from the internet and “creating” a study, with perfect language thrown in as bonus? Or fudging data, like showing a larger number of patients than those actually studied? And how about sharing authorship between us for mutual benefit? Pangs of conscience creep in (“How could you?”) when other actors come into the picture. Plagiarism, anybody? Gift authorship? Terms we’ve seen so often in the publishing world, with medical literature being no exception.

The final episode in the video involves getting past the department head, who is properly disturbed that she isn’t in on the whole thing when she has been their teacher / mentor for so long. How can you come to me with a fait accompli, an article that is shown to me just prior to submission for publication? What is left unsaid is that she must obviously be aware of department happenings and how much of the “study” contents is true. The dramatic finale comes when a submitted article is shown to her for review (didn’t they gift her authorship?), implying that the young authors have gone all the way despite her initial objections.

So many aspects and issues of ethics. The video’s main achievement has been that it has brought the subject up for one more round of discussion. Each of these aspects merits long discussion. And much discussion has occurred in medical literature, suggesting the obvious – that these are problems faced around the world. As I mentioned earlier – but that’s only a personal opinion – just the first issue alone would have sufficed. When fewer doctors manage more patients; when there is no job demarcation between patient care, teaching, research and administrative work in academic institutions (which is essentially only where the issue of publications comes up in any case, with profit-making corporate hospitals involved only to the extent of keeping their tax-exemption status active by showing some “research”); when funding for research is so sparse and obtaining it is a full-time job as it were; and when supporting clinical staff is virtually non-existent; should Western standards be implemented unaltered?

We in India can identify with this situation. I can even extend it by bringing up the issue of giving priority to publication in “foreign” journals, when these “foreign” journals do not share concern for our problems or priorities and regional journals are struggling to stay afloat. But enough for one video upload. The creators should be congratulated for bringing up the issue; it will have achieved its purpose if it stimulates soul-searching in even one policy-maker. And may there be many more such videos to keep discussion alive; there is a sense of relief knowing that others have the same problems.