Scientific fraud and misrepresentation
Mark Schreiner MD, Myron Yaster MD, and Lynne G. Maxwell MD
“You are entitled to your opinion. But you are not entitled to your own facts.”
― Daniel Patrick Moynihan
As the lead writer/editor of Ron Litman’s Pediatric Anesthesia Article of the Day, I have done my very best to highlight articles from major journals (and newspapers) that will impact your practice and keep you abreast of the very latest and best of current science and medical practice. Indeed, you are probably reading the PAAD because it is simply impossible for you to keep up with the medical literature, even in a narrowly focused specialty like pediatric anesthesiology. There are simply too many journals, articles, novel medical breakthroughs, important quality improvement initiatives, editorials, and updated clinical guidelines. How do we cull and curate these journals and articles to provide you with the best of what ‘s out there and honor the memory of the late Dr. Ron Litman?
To keep my own sanity, I try to summarize articles only after they have been published in print and not when they’ve been published on line ahead of the print version. I am breaking this rule today because an extraordinary event occurred last week while I was at the annual meetings of SPA and ASA. At the meetings, there was enormous buzz about an editorial that was being published online in the British Journal of Anaesthesia by Britta S. von Ungern-Sternberg and colleagues on authorship misconduct by the editors of an unnamed journal.
Britta is one of the foremost leaders and investigators in our profession, so anything she writes goes right to the top of the list of articles we review. After reading the editorial, I was shocked and debated when to review it for the PAAD…should I wait until it was published in print or do it immediately? However, since the meeting, I’ve received multiple emails about this editorial including one by the editor of the journal Pediatric Anesthesia, Dr. Andrew Davidson, who wanted to make it very clear that the offending journal and editorial staff described by Dr. von Ungern-Sternberg in her editorial was not Pediatric Anesthesia. If Andrew was being forced to acknowledge this editorial, our review in the PAAD simply couldn’t wait for the print version.
This editorial is a very big deal and goes right to the heart of fact, opinion, misinformation, and publishing integrity. What if some of the articles published even the most prestigious journals are FAKE or if the authorship of articles is fake or is being manipulated and/or misidentified? Can our journals and articles be trusted to be fact and not opinion? What a dreadful thought!
Early on in my career, when I was a fellow in pediatric anesthesia and intensive care at the Children’s Hospital of Philadelphia, my mentor, the late Dr. John Downes and his consiglieres, Dr. Russ Raphaely and Mike Broennle, gathered all of the fellows to stress the importance of honesty and integrity in our daily practice. “If you do a consult on a patient, you have to actually see the patient and review the old charts in their entirety.” “If you performed a procedure or gave a drug in the OR, you have to document what happened even if you made a mistake.” When I arrived at Johns Hopkins on my very first day, my mentor the late Dr. Richard Traystman, stressed the importance of scientific integrity and the need to never fake data or manipulate data to improve the likelihood of publication.
And yet, last year alone, over 10,000 articles in the medical literature were retracted because of fake research! Indeed a single researcher had over 200 articles retracted!”1 Compounding and fueling this crisis are articles published in “predatory”, paper mill journals. Indeed, we recently published a PAAD: Hemanth A. Baboolal MD, FRCA: The murky world of predatory publishing (06/04/2024) that addressed some of these issues. Although fake data and research is nothing new, the sheer volume and audacity of what is happening in 2024 is new and it’s getting worse. But I never in my wildest imagination thought the editorial staff of a major journal would not only be complicit but would be actively engaged in deception.
In today’s PAAD, Dr. Mark Schreiner and I will review the editorial by von Ungern-Sternberg et al. and discuss its implications. Myron Yaster MD
Editorial
von Ungern-Sternberg BS, Regli A, Stepanovic B, Becke-Jakob K. Authorship misconduct: professional misconduct in editorial handling of authorship. British Journal of Anaesthesia. Published online October 3, 2024; DOI: 10.1016/j.bja.2024.08.015
Two forms of deceit continue to plague academic publications, ghost authorship and honorary authorship. Ghost authorship involves the exclusion of someone deserving of being listed as an author or contributor. This usually involves a sponsor’s medical writer, statistician or other employee being excluded in order to make it appear that the paper was actually written by the “investigators”. The investigators are often the individuals who enrolled subjects into the trial but didn’t conceive of the study, analyze the data or write the paper. By the International Conference of Medical Journal Editors (ICMJE) criteria, the apparent authors don’t qualify for authorship (below). About 25 years ago, I (MS) stood up and denounced this practice at a session on medical writing annual meeting of PhRMA (a trade group representing the pharmaceutical industry) and was practically booed out of the room.
ICMJE Criteria for Authorship
· Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
· Drafting the work or reviewing it critically for important intellectual content; AND
· Final approval of the version to be published; AND
· Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Honorary authorship means including someone who doesn’t meet all of the above criteria as a “guest”. Usually this means a senior investigator, physician whose patients were included as subjects or someone who obtained funding but did no other work. People who don’t meet all the criteria for authorship should be acknowledged as contributors at the end of the paper. Surveys of inappropriate authorship (inconsistent with the ICMJE guidelines) estimate the prevalence in the neighborhood of 20% but is dependent on the journal and its procedures for ensuring adherence to the ICMJE criteria.2-5
We have always assumed that the role of journal editors was to serve as the gatekeepers, ensuring that those listed on the paper as authors met the ICMJE criteria. Now Britta S. von Ungern-Sternberg has provided a disturbing report of fairly shocking editorial misconduct. The special issue to which they were asked to contribute had two guest editors. The paper dealt with an issue that was an area of her group’s focus. After the paper went through several rounds of writing and editing and was submitted, one of the guest editors insisted that an individual who hadn’t participated in the writing process be included as an author. This was a stunning request. The individual met none of the four criteria enumerated by the ICMJE. Many colleagues told them that they should be resigned to their fate and cave in because doing otherwise might have drastic implications for their careers. They appealed to the editor-in-chief of the journal who did not immediately back up Britta or her team, invoking possible legal consequences to the journal, the guest editor and the journal editor if an effort were made to remove the guest editor. “The actions of the journal in our case, suggesting the senior guest editor made an ‘error’ and asking us to consider a guest author and urging us to pretend that misconduct did not occur, are concerning warning signs of a potentially corruption-prone culture.”
Only after another research team withdrew their paper from consideration for publication did the journal act; the guest editor was removed. Britta’s research team was not tempted to cave in to journalistic blackmail, but more junior investigators might be. “While we personally enjoy sufficient experience and seniority to provide some independence from publication pressure, we urge future academics to develop the skills and knowledge to identify misconduct and the confidence to challenge practices that undermine scientific integrity. The core of academic medicine lies in serving our community to elevate our specialty and ultimately enhance patient outcomes.”
Finally, a word of advice for those of you in academics who face the issues of authorship on a regular basis. I (MY) have found it best to work out these issues BEFORE a project begins rather than at its conclusion when abstracts and papers are being written.
Send your thoughts and comments to Myron who will publish in a Friday reader response.
References
1. Marcus A, Oransky I. An epidemic of scientific fakery threatens to overwhelm publishers. An epidemic of scientific fakery threatens to overwhelm publishers: The Washington Post; 2024.
2. Baskin PK, Gross RA. Honorary and ghost authorship. BMJ (Clinical research ed) 2011;343:d6223. (In eng). DOI: 10.1136/bmj.d6223.
3. Bates T, Anić A, Marusić M, Marusić A. Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms. Jama 2004;292(1):86-8. (In eng). DOI: 10.1001/jama.292.1.86.
4. Marusić A, Bates T, Anić A, Marusić M. How the structure of contribution disclosure statements affects validity of authorship: a randomized study in a general medical journal. Current medical research and opinion 2006;22(6):1035-44. (In eng). DOI: 10.1185/030079906x104885.
5. Wislar JS, Flanagin A, Fontanarosa PB, Deangelis CD. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ (Clinical research ed) 2011;343:d6128. (In eng). DOI: 10.1136/bmj.d6128.