Editors of Health Services and Health Policy Journals*
25 October 2002

Background. The policy of the journals subscribing to this statement is to consider for publication only original work that has not previously been published. Questions about what constitutes previous publication are arising with increasing frequency because of the growth of electronic publishing and the increasing number of reports and papers being produced by organizations and agencies. Below we provide guidance on this issue.

There are legitimate reasons why research may be disseminated before submission to a journal. Active communication among researchers about preliminary findings or the circulation of draft reports for discussion and critique contributes to the eventual quality of published work. In addition, organizations that support or carry out research have an understandable interest in disseminating their work. From the perspective of journals, these reasons for dissemination must be balanced against two considerations. The first is the value of the peer review process. The rules against prior publication are intended to add some assurance of the credibility of published research. Papers are often improved during the peer review process, with findings, conclusions, and recommendations sometimes changed in response to reviewers' comments. The public and policymakers might be confused or misled if there are multiple versions of a paper in the public domain. Second, from a more parochial viewpoint, journal space is limited, and much time and expense is involved in the evaluation, publication, and distribution of journal articles. Journals must make difficult choices about what to include; there is less value in publishing papers that have already been disseminated to their target audiences.

Rules guiding prior publication. Below, we discuss several types of dissemination and provide guidelines with respect to the prior publication question. This discussion is essentially an elaboration of two rules, the first emphasizing previous dissemination of the material, the second stressing disclosure.

Rule One: If the material in a paper has already been disseminated to a journal's audience, particularly in a format that appears to be a final product, then it is unlikely that a second version will be worth publishing in the journal.

Rule Two: It is the responsibility of authors to let editors know at the time of submission if a paper's contents have been previously disseminated in any manner so that the editors can determine whether to proceed with the review process.

Previous presentation at meetings. Presentation of a paper at conferences or seminars usually does not jeopardize the possibility of publication.

Working papers. Dissemination of "working papers" to a limited audience will not ordinarily jeopardize publication. Working paper series are used by many organizations as a means of enabling researchers to obtain critiques from fellow researchers. Working papers covered by this policy are those that are released by the author or an organization rather than by a publisher, are not advertised to the public, and are marked as drafts that are subject to future revision.

Internet postings. Release via the Internet may jeopardize journal publication under some circumstances. Presentation of the work as a final report is a marker of an attempt to reach a wide audience, particularly when combined with efforts to direct traffic to the work (for example, via links on other sites) and efforts to attract attention (for example, press releases). In contrast, if a document is posted on the Internet only to facilitate communication among colleagues with the aim of getting feedback, and if there has been no attempt to otherwise attract the attention of journalists, the public, or the broader research community to the document, then this is unlikely to preclude journal publication.

In general, when posting on the Internet serves similar functions as presentation at professional meetings--facilitating the development of papers and the improvement of the research, influencing future revisions, and not constituting a "finished" product--it would not be considered prior publication. On the other hand, when the Web-site posting functions as a virtual version of a conventional publication, which may even be copyrighted by the posting organization, the benefit of an additional publication in the journal will be scrutinized carefully.

In cases where there has been little to no exposure at the time that a paper is submitted to the journal, but the circumstances surrounding the posting make it likely that a high level of exposure (such as press coverage) might occur, then the author should remove a posting as a condition for further consideration of the manuscript.

Authors who post papers on a Web site and do not want this to constitute prior publication should also post a disclosure statement such as the following: "This draft paper is intended for review and comments only. It is not intended for citation, quotation, or other use in any form." This statement should be kept on the Web site throughout the review process and until the paper is actually accepted for publication in a journal. Once the paper is accepted, authors should post a message such as the following: "A revised final version of this paper will appear in the XXX issue of (Journal Name)." Authors also should include this statement as a header or footer on every page of the paper.

Formal reports from foundations, academic institutions, institutes, trade associations, and government agencies. The dissemination efforts of foundations, government agencies, research institutes, and other organizations that support or carry out research can complement publication in peer-reviewed journals. If publication in one of our peer-reviewed journals is desired, organizational publications should be timed to coincide with or follow journal publication, with appropriate copyright permissions having been obtained. This sequence ensures that the peer-review process will have an opportunity to correct deficiencies of method or presentation.

Formal, published reports that have gone through an editorial process, that have been intended to reach a wide audience, and that are publicized and available to any interested party (whether free or not) usually will not be considered for journal publication. A paper that is based on such a report might be considered for publication if it were sufficiently different in emphasis or intent. In such instances, the author should explain at the time of submission (or before) how the paper differs from the previously released report and why its publication would represent a distinct and important contribution beyond that version.

Media publicity. If results reported in a preliminary version of a submitted paper have become widely known as a result of media exposure (or even if the potential for widespread exposure remains during review), and that version of the paper is readily available to interested readers (such as through a Web site), an editorial judgment will be made whether journal publication would be appropriate. Authors can help protect their work from unwanted media exposure by making it clear on working drafts, copies presented at conferences, and other versions that it is a draft that has not yet undergone peer review for publication and that findings and conclusions are subject to change. Authors should also request that any "stories" derived from interviews with the media be embargoed until published or released by the publisher (see, for example, P.B. Fontanarosa and C.D. DeAngelis, "The Importance of the Journal Embargo," Journal of the American Medical Association 288, no. 6 (2002): 748-750). Any accepted manuscript released to the media should contain the statement: "A revised final version of this paper will appear in the XXX issue of (Journal Name)." Journal policies involving author contact with members of the media may vary, depending on the issue or journal. Thus, authors should check with the editors before speaking with or distributing papers to members of the media.

Importance of disclosure. In contrast to the editors' decision whether a certain paper has been disseminated too widely to warrant publication in this journal, there is very little judgment involved in whether an author should disclose previous dissemination. Prior to, or at the time of, submission of a paper that has been disseminated in any of the ways discussed above, authors must bring this to the attention of the editor so that a determination can be made before the paper goes into the peer-review process. In so doing, authors should describe in what form and how the work was previously disseminated and how the submitted manuscript differs from previously disseminated versions. Editors might be receptive to a modified version of a paper that has been widely disseminated if the submitted version has a different focus (for example, more emphasis on methods, more sophisticated analytic approach, or discussion of developments that have transpired since the initial dissemination). The key point is to let editors know about any dissemination that will have or is likely to have occurred before the journal article is published, rather than having the editors discover this during or after the review or editorial process. As part of the submittal, authors should include copies of other related papers that might be seen as covering the same material. Failure to disclose could preclude publication in the journal or, if a paper has already been published, could result in a notice in the journal about the failure and may result in its retraction.
If you have any questions or comments about this policy, please contact the Health Affairs editors.

*This statement was developed by a group of editors of journals that publish articles on health, health services, and health policy. Journals currently using this statement include Health Affairs; Health Services Research; Inquiry; Journal of Health Politics, Policy and Law; Journal of Health Services Research and Policy; Medical Care; and Milbank Quarterly.