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Political tensions about the goals of the American Medical Association, and their expression to the membership and the laity, have existed since the Association was founded in 1847. The most important is the tension between serving and self-serving. One could call oneself a doctor and practise as such about as easily and as legally as one can be a ‘therapist’ in California. Periodic attempts were made by state medical societies to elevate medical school standards, but they were half-hearted and unsuccessful. Financial anxiety, intellectual restlessness and patriotic competitiveness combined happily to inspire the membership to agree that a journal be founded. The redoubtable Nathan Davis, chairman of the Board of Trustees, sent out a mailing of 40, 000 describing the proposed new journal; he reported at the 1883 meeting that he had received some 2, 000 promises of support, which in addition to the projected advertising revenue should support the publication cost.

Scientific misconduct is now widely recognized as a genuine and significant problem for contemporary science, but too often the participants in the research system—and those outside who are affected by it-suffer from lack of clarity about what constitutes scientific misconduct. Examples are presented in which questions of professional discourtesy, methodological disagreement, and political struggle are misunderstood as questions of honesty.

IN RECENT years, scientists and editors of scientific journals have often noted how few hard data exist on the workings of editorial peer review. Although pressures from inside and out increasingly encourage journals to be more explicit about their practices and more inclined to question their own habits, there is still a good deal of truth in the sardonic observation made 5 years ago that "the arbiters of rigor, quality, and innovativeness in publishing scientific work do not apply to their own work the standards they apply in judging the work of others." 1 This paradox inspired The First International Congress on Peer Review in Biomedical Publication, with its goal of encouraging the systematic and empirical study of journals. Of course, data and rigorous methods are not enough to make a science. The systematic study of peer review is even more deficient in theory than it is in data. Some

STAGES 197 Moral Development: Kohlberg and Some Critics 197 Other Cognitive-Developmental Sequences •......... 200 Development of Ego or Self 202 Structural Models 204 Cross-Cultural Applicability • 205 TRAITS 206 Trait Approaches to Morality 206 Consistency of Personality 208 SELF AND EGO 210 PSYCHOANALYTIC PERSONALITY THEORY 213 CONCLUSION 216

Announcements of new journals arrive on physicians' desks every week, if not every day, along with all the existing journals that still clamor to be read. It has been estimated, for instance, that the ratio of faculty positions in internal medicine to internal medicine journals is about 15 to 1,1suggesting to the innocent mind that more people publish in some journals than read them. The cataloging creativity of librarians and the memory of readers are ever more tested by the proliferation of medical journals. So is the patience of authors, since every journal has its own editorial style, spelled out in small print in Instructions for Authors or in a formal style manual. The fact that articles that are published in medical journals frequently acknowledge the contributions of secretaries as well as those of professional colleagues is a reminder of the sheer technical effort involved in getting a