Academic publishing has its own dialect, a language of polite evasions, soft landings, and decisions that say everything without saying anything at all. After decades in medicine, I thought I had seen every variation of editorial rejection. I was wrong. Recently, I submitted a manuscript describing a structured primary care model for autism diagnosis, a model that worked, was scalable, and addressed the capacity crisis that developmental-behavioral pediatrics has been unable to solve for two decades. The manuscript was sent to a pediatric journal that routinely publishes work on autism systems of care.
What happened next was a master class in editorial ambiguity. I never received a rejection letter. Instead, I received a “transfer recommendation,” an automated invitation to submit my manuscript to a pay-for-play open-access journal in the same publishing family. No explanation. No reviewer comments. No editorial rationale. Just a link to a journal whose business model depends on author fees. In this publisher’s ecosystem, this is the equivalent of being shown the door without the courtesy of a goodbye.
The transfer pipeline is marketed as a convenience: “Your manuscript may be a better fit elsewhere.” In practice, it functions as a silent rejection mechanism, a way to decline a manuscript without issuing a formal decision, without providing feedback, and without acknowledging the underlying reason. It is rejection without rejecting.
The timing made the situation even stranger. The transfer recommendation arrived before I received a formal rejection for a different manuscript, one examining the absence of multisite randomized trials in applied behavior analysis (ABA). That manuscript did receive a letter, complete with editorial commentary. The commentary was revealing: misclassification of developmental interventions as ABA, dismissal of historical evidence, and an invented conflict-of-interest (COI) claim that contradicted the manuscript itself.
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Two manuscripts. Two very different responses. One common thread: discomfort. The structured primary care model challenges the longstanding assumption that autism diagnosis must be confined to subspecialty clinics. The ABA manuscript challenges the assumption that a widely mandated therapy has a mature evidence base. Both manuscripts expose structural contradictions in pediatric practice. And both encountered editorial mechanisms designed to avoid engagement.
The problem is not simply inconvenience. It is ethics. When a journal declines a manuscript and immediately funnels the author toward an outlet that charges more than $2,500 to publish it, the line between editorial judgment and revenue capture becomes uncomfortably thin. Pay-for-play models create a perverse incentive: The more manuscripts rejected from traditional journals, the more manuscripts diverted into fee-based ones. Science should be published because it is true, not because the author can afford it.
The earlier rejection of my ABA manuscript followed the same choreography of avoidance. Instead of engaging with the central argument, the absence of multisite randomized trials, the editor conflated fundamentally different treatment models, labeling developmental interventions as “ABA” to preserve the illusion of evidence. When that maneuver failed, a conflict of interest was fashioned out of whole cloth, claiming I had “developed” an intervention I explicitly stated I did not implement. This was not peer review. It was deflection. And when journals conflate methods and invent COIs to avoid confronting uncomfortable evidence, they are not protecting scientific integrity. They are protecting a narrative.
The contradiction becomes sharper when viewed against one national pediatric organization’s own timeline. In a recent legal brief, the organization condemned aversive practices at a controversial treatment center, stating plainly that such methods violate pediatric ethical standards. Yet two years later, the organization reaffirmed its clinical report on autism, unchanged, unamended, and still endorsing applied behavior analysis as first-line therapy without acknowledging its aversive lineage or the organization’s own legal opposition to it. The reaffirmation preserved silence after the declaration of conscience. When an organization publicly maintains a policy it has already contradicted in court, the inconsistency is no longer theoretical. It is published.
The ethical contradiction is not subtle. The organization’s reaffirmation of its autism guideline stands beside a legal brief that condemns aversive practices as harmful, unethical, and incompatible with pediatric standards. A federal regulator reached the same conclusion when it banned contingent electric shock devices used at the treatment center, calling them dangerous and lacking scientific justification. That ban was overturned not on scientific grounds, but on a narrow technicality about regulatory authority. The underlying judgment, that these practices are unsafe, unethical, and medically indefensible, remains intact. Yet the organization’s reaffirmed guideline continues to endorse applied behavior analysis without acknowledging its aversive lineage, its ethical failures, or the federal determination that its most extreme form should not exist. When a professional organization maintains a policy that has been morally rejected by its own legal brief and deemed unacceptable by a federal regulator, the issue is no longer academic. It is an ethical breach. J’Accuse.
I have spent decades working in this field and designing models that work. I am not new to this process. But the transfer-without-rejection maneuver was new to me. It deserves to be named.
Academic publishing should be transparent. If a manuscript is not a fit, say so. If a topic is too controversial, say so. If a journal is unwilling to confront the implications of a submission, say so. What journals should not do is outsource rejection to an automated pipeline that funnels authors toward fee-based outlets.
Silence is not feedback. Automation is not accountability. And a transfer recommendation is not a decision. It is a refusal to make one.
The pattern was reinforced by the rejection of my structured primary care manuscript from another pediatric journal. The editorial letter cited “priority,” “article type,” and “current framing,” but then contradicted itself by asserting that primary care diagnosis of autism is now widely accepted, precisely the point the manuscript documented. It dismissed national workforce realities, misrepresented published estimates, and critiqued statements that were factually correct. It even suggested that describing real workforce shortages was “personal,” while directing me toward a fee-based outlet. When peer review responds to evidence with contradiction rather than engagement, it is not protecting science. It is protecting an institution.
In a field that prides itself on evidence-based practice, we should expect evidence-based editorial behavior. That begins with honesty, even when the truth is uncomfortable. Especially then.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
