In 1999, when I was researching a profile of Dr Martin Van Der Weyden, the editor of the Medical Journal of Australia, his friends and colleagues used descriptions like: an unusual character, gruff, witty, quirky, as smart a man as you could meet, erratic moods, abrasive, rumpled, cynical, autocratic, infuriating, warm, larriken, pragmatic businessman, astute clinician, politician, and scientist.

Van Der Weyden described himself as impatient, compulsive, a dreamer, tolerant, and “more left than right”, politically speaking.  He also suggested that he never quite made it into the ranks of Melbourne’s medical establishment, during his time in that city, despite becoming professor of haematology at Monash University in 1985. “There used to be a tradition that if you became a professor you may or may not have been asked to join the Melbourne Club,” he says. “I never got the invitation.”

After many years at the journal’s helm, Van Der Weyden has announced his plans to retire next year, and the hunt is on for  a new editor.

Croakey asked Van Der Weyden to share some of his reflections on life in the hot seat. He writes below of “living dangerously”:

“The recent announcement of my intention to retire in early 2011 after 15 years as the editor of the Medical Journal of Australia, has prompted inquiries about what precisely is involved in being an editor. The following is my considered response to this somewhat challenging question.

Firstly, it is important to remember that editors are first and foremost, human, and are affected by all the vagaries of humanity: they may be radical or conservative, extroverted or introverted, accommodating or arrogant.  In the spirit of simplicity, however, there are in the main two overarching editorial stereotypes: passive or active.

Passive editors are usually found at the helm of a specialty journal. Their major criteria in selecting articles are driven by originality, scientific merit and reviewers’ advice. Their journals tend to have specific and limited interest.

An active editor, on the other hand, takes all these selection criteria on board, but is also moved by additional considerations, such as: an article’s broad appeal, its timeliness and its real life impact beyond the realms of science.  In short, this type of editor usually heads a publication, which aims to capture the interests of the broad readership of a general medical journal, such as the MJA.

To be honest, there is nothing magical about being an editor. You publish: in order to inform, update and engage readers through original articles; to interpret through editorials and commentaries; to integrate and synthesise practice protocols through review articles; to criticise and/or persuade through letters columns or viewpoints. Finally, you publish to promote change.

Most articles in the MJA are peer reviewed, and in this rests potential for friction. Reviewers are advisors to the editor, but do not ultimately determine whether an article is to be published or not. This is the role of the editor and deputy editors, who must also take into consideration the bigger picture such as an article’s appropriateness for the journal’s readership and what has already been published. Disregarding reviewers’ advice about whether to publish or not, can lead to tension, whereupon reviewers can question the rationale behind the final editorial decision.

Some reviewers have been so moved on occasion, that they actually threaten to withdraw from reviewing for the journal. But this is a rarity. Usually, differences of reviewers’ opinions concerning technical or scientific matters can be resolved quite simply by seeking additional, expert advice, by explaining the rationale for the editorial decision, or by seeking an author’s detailed response to criticisms – and in the MJA’s case, by allowing the reviewers to see the comments of other reviewers of the same submission

But at the end of the day, differences in viewpoints, or disputed interpretation or opinions are be settled at the editor’s desk. In this context, it is important to remember that The Journal receives far more submissions than it can ever hope to publish and may occasionally choose to reject submissions without the customary peer review. Such a decision understandably causes an author to become disgruntled. Ultimately, however, according to Stephen Lock, past Editor of the BMJ: “Editors survive by accepting good articles.”

Another potential source of friction is the freedom of editors to express their opinions in signed editorials. Indeed, these may so raise the ire of some readers, that they choose to bombard the Journal with anonymous emails, instead of sending a signed Letter to the Editor.  On inquiring whether such ad hominem attacks are for publication the senders invariably reply “Certainly not!” But it must be said that whenever these judgements are signed, they are respected as sincerely held contrary viewpoints, and are invariably published, thus allowing readers to decide for themselves.

There are also occasions when I am reminded of the observation that crusty old Scottish philosopher David Hume, who famously stated that reason was the slave of the passions. Such passion is aroused whenever we publish articles on controversial issues such as euthanasia, abortion, circumcision or the nature of systemic patient adverse events. Readers question why the owner of the MJA, the Australian Medical Association [AMA], should see fit to allow the publication of views that seem contrary to the parent organisation’s policy.

The answer is simple. The AMA has respected the editorial independence of the Journal at all times. This time-honoured principle has allowed the Journal to explore touchy issues in that selfsame spirit succinctly summarised by Richard Smith, the previous editor of the BMJ:

Stir up, prompt debate, upset people, legitimise and set agendas” And stirring and setting agendas may create animosity, but should this occur I take solace in the advice of Ernst Hart the first editor of the BMJ: “An editor needs and must have enemies; he cannot do without them. Woe be unto the journalists of whom all say good things.” And this captures the essence of the role of any general medical journal’s editor worth his salt: to practise the art of  “living dangerously!

It has been a roller coaster experience over fifteen years, overseeing the rise of the MJA to its position as Australia’s premier medical journal – an ascendancy, which can only be attributed to the scientific rigour of its submissions and the wisdom of its many contributors. Above all, I have been much blessed, in being able to draw upon the insight, dedication and unfailing good humour of a superb editorial team.

Finally, I must also speak of that very rare privilege of having been constantly intrigued, challenged, provoked and overwhelmed by the creativity of researchers and clinicians and the carefully considered viewpoints of a generation of thinkers – thinkers, who have enriched my understanding of the ways of the world and all things medical.”

Croakey continues: The profile that I wrote for Australian Doctor mentioned how Van Der Weyden introduced himself to MJA readers in 1995 with an editorial that was characteristically blunt about the journal’s troubled history. For some years previously it had been financially strapped and unstable, with changes of editors, even periods without an editor.

He wrote of “a perception that the MJA has become irrelevant to mainstream Australian medicine. It has even been labelled the ‘Blue Comic’ and there have been assertions that readers are ‘not getting value for money’.”

Van Der Weyden has done much to change such perceptions. I might have disagreed with more than a few of his editorials but I still enjoyed reading them, and shall miss him, not only for the journal’s sake. If Van Der Weyden was at a press conference or conference, slackers like me could rest comfortably, knowing that he could be counted on to rise to his feet, to raise the challenging and provocative questions that can be difficult to ask. Usually he’d inject a bit of humour and plain speaking, along the lines of “what’s this rubbish all about”? Or perhaps using even stronger langugage that can’t be repeated on a sober blog like this.

As he told me back in 1999: “ Good editors can’t be made. It’s part of the personality. If you look at the first class editors like Richard Horton (of The Lancet) or Richard Smith (formerly of the BMJ), they have all got a twist.”

Let’s hope the new editor also comes with a twist. It keeps life interesting.

Meanwhile, it would be nice to see the MJA on Twitter someday soon…