FROM THE EDITOR

Signing off after two decades at the helm

Daniel J Ncayiyana

Editor Emeritus. profdjn@gmail.com

'To every thing there is a season, and a time to every purpose under the heaven. (King Solomon at the end of his reign - Ecclesiastes 8:1)

1993, the year I was appointed Editor of the SAMJ, turned out to be a Dickensian moment in the history of South Africa. As in The Tale of Two Cities, 'It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us.' In that year, the diverse parties concluded the political negotiations leading to the adoption of a new democratic constitution. At the same time, senseless political violence continued, typified by the deadly attack on worshippers at the St James Church in Kenilworth, Cape Town. Nelson Mandela and F W de Klerk were awarded the Nobel Peace Prize, and activist Chris Hani was assassinated by the right-wing fringe. The Proteas, newly readmitted to international competition after 21 years of the sports boycott of South Africa, walloped Sri Lanka and drew with Australia in test cricket; domestically, the defence force opened fire on a house of an anti-apartheid activist in Umtata, killing five schoolchildren. The atmosphere in the country was thick with trepidation and hope, anxiety and anticipation.

It was in the midst and context of these contradictory sociopolitical developments that the SAM] appointed its first black editor, something that would have been unthinkable just a year before. The SAMJ, founded in 1884 and owned by the Medical Association of South Africa (MASA), had historically served as the Association's unquestioning mouthpiece and was held on a tight leash. MASA was a predominantly white organisation in a racially divided South Africa, and its leadership was widely perceived to be closely aligned with the apartheid government, albeit with strongly dissenting voices from within. The ]ournal was prevented from engaging in any meaningful social commentary - indeed, a reader would be hard put to find the word 'apartheid' in any issue published before 1993. MASA's subservience to the political order of the day was most publicly exposed in 1977 when anti-apartheid activist Steve Biko died in detention at the hands of the security police with the brazen collusion of the state-appointed medical doctors entrusted with his care. After much to-ing and fro-ing, the Association ended up clearing the doctors of ethical misconduct, and moreover prevented the SAMJ from publishing correspondence from concerned members who sought to express their alarm and condemnation. The world was aghast, and MASA was promptly kicked out of the World Medical Association.

However, by 1993 the country was on the move towards a new political dispensation and, in step with the times, MASA was trudging uncertainly towards transformation under the determined leadership of its forward-looking Secretary-General Dr Hendrik Hanekom. And so it was that, when the position of Editor of the SAMJ became vacant, MASA was open to contemplating a black appointee. My official interview was cordial enough, but I had two more organised 'conversations' with certain individuals to reassure pockets of the membership concerned about what my attitude would be towards Afrikaans. In fact, as it turned out, my fluency in Dutch gave me sufficient literacy in Afrikaans to write some of my better editorials in that language.

My appointment as Editor set me on a new and exciting career path, and opened up whole new vistas full of adventure and discovery. The world was eager to connect with the new South Africa, and I was soon welcomed to the international fraternity of medical journal editors. The highlight, perhaps, was my invitation as a guest to a meeting in Oslo of the influential Vancouver Group, now known as the International Committee of Medical Journal Editors. I was appointed to the Editorial Advisory Board of the BMJ, and of the web-based journal Medscape with its editorial offices in New York. Another high point for me was the adoption of my proposal of the name 'World Association of Medical Editors' and the acronym WAME when this organisation was formed in Bellagio, Italy, in the late 1990s. Getting to know the editors of some of the world's leading medical journals personally was a privilege and a wonderful means to learn and grow.

Who does an editor serve?

Scientific knowledge is not knowledge until it is published. Medical journal editors therefore occupy a critical space, and wield what some consider disproportionate power in the knowledge production chain. This places an enormous burden on the editor to act always with the utmost integrity and professionalism. Former NEJM editor Marcia Angell (cited by Van der Weyden¹) has listed the many 'masters' served by the medical journal editor: the public, the authors, the readers and the owners, and sees this complex array of competing interests as a minefield of potential tensions for editors. At the SAMJ we rate the interests of the reader as paramount above all others, and give priority to articles that we deem of pertinent interest to our general readership. This has sometimes caused tension with authors whose submitted work might have been perfectly good science, but was rejected as too esoteric for our readers.

What makes for a good medical journal editor? The obvious attributes include editorial integrity, affirmative relations with authors and other stakeholders, keeping abreast of developments in medical journal publishing, and being good custodians of knowledge. In addition, however, Van der Weyden quotes Richard Smith, former long-time editor of the BMJ, as boldly proclaiming that a good editor should 'Stir up, prompt debate, upset people, legitimise and set agendas.' I certainly did my share of stirring up, prompting debate and upsetting people, as did my colleague J P van Niekerk.

Working for the Journal over the past twenty years has been an absolute delight, not least because of the collegiality among the staff, of whom Emma Buchanan and Marijke Maree were there from the beginning. I am most obliged and grateful to all. JP joined the journal 10 years ago to become Managing Editor. Without his managerial and business skills in addition to his intellectual contribution, there would not be an SAMJ to for me write about today.

1. Van der Weyden MB. On being the editor of the Australian Medical Journal: Living dangerously. Journalology 2012;10:150-157. [http://dx.doi.org/10.4103/0973-1229.91295]