What’s in a name? It’s Fraud… not “Publication Misrepresentation”
Myron Yaster MD and Justin L. Lockman MD, MSEd
Original article
Ashin Mehta, Palak Patel, Thomas J Caruso, Thomas Anthony Anderson. Publication misrepresentation among pediatric anesthesiology fellowship applicants: A retrospective single-center cohort study. Pediatr Anaesth. 2021 Sep;31(9):962-967. PMID: 34214229
Editorial
Michael R Hernandez, Stephanie Black. Integrity with intentionality: Rewriting the script about publication misrepresentation in pediatric anesthesiology fellowship applications. Paediatr Anaesth. 2021 Sep;31(9):918-920. PMID: 34409708
“The fraudster's greatest liability is the certainty that the fraud is too clever to be detected.” - Louis J. Freeh (former director of the FBI)
Today’s article and its accompanying editorial are about the prevalence of fraud in the pediatric anesthesiology fellowship application process. And we are talking about fraud plain and simple. In this paper and the accompanying editorial, the authors define this fraud with the euphemism “publication misrepresentation”. What is publication misrepresentation? It is “peer-reviewed journal citations listed on the (fellowship) application that cannot be located using journal search engines or on which the applicant is not listed as an author”. While we understand giving the benefit of the doubt to applicants (both papers mention the possibility of unintentional/uninformed error), we assert that using the euphemism “publication misrepresentation” is akin to a government spokesman saying “terminating with extreme prejudice” when he/she really means killing someone.
Previous studies have found that “publication misrepresentation” occurs commonly (2-40%) across a diverse range of specialties, and among both residency and fellowship applicants.1-3 The authors of the present manuscript wondered about the rate of such fraud for pediatric anesthesiology fellowship applications submitted to Stanford over a 10-year period? Amongst the 52% of applications in which the applicants listed publications, fraud “was found to occur in 9% or one out of 11” or about 5% of the total applications. Wow! What does this say about ethics, integrity, professionalism, and – as highlighted by the editorial – “how we raise our young”?
Why might this dishonesty be happening?4 We suspect, as Drs. Hernandez and Black also highlight, that there is a perception that publications will provide a competitive advantage in the application process. The incidence is also likely increased by the environment, in which the risks of discovery of fraud are low or nonexistent. And we believe/suspect that this is not limited to applicants for pediatric anesthesia fellowship positions but is pervasive in medical school admission, residency, fellowship, and faculty position applications as well. My (Myron) mentor, Dr. Richard Traystman of blessed memory, was always worried about scientific fraud and always stressed the need to verify data and publications in research and grant funding as well.5 Meanwhile, my (Justin) mentor, Myron Yaster, repeatedly told me, “You don’t have to say yes to everything, but you need to finish everything you commit to.” In other words, agreeing to something and then not doing the work does not entitle one to authorship.
As discussed in the previous PAAD Authorship: Credit and Credibility (August 15): “Authorship is used in science to communicate research findings to peers and the public, denote credit and responsibility, document personal accomplishment, and advance careers, while it is used outside science by institutions whose interests often differ, such as for promotion and tenure processes, metrics of faculty productivity, and ranking institutional programs and reputations”. 6 In other words, “in academic departments, paper authorship and position in the choo choo train is the “coin of the realm” for promotion, tenure, salary, etc.”6 Thus, is it any surprise that fraud is a temptation that many cannot resist? Not really. Indeed, as the editorial points out: “If trainees are subject to a hidden curriculum that values publication output over other characteristics of a great physician, can we be surprised to see publication misrepresentation in fellowship applications?” Ominously, the authors also speculate that this publication misrepresentation in fellowship applications may escalate as the unintended consequence of the Accreditation Council for Graduate Medical Education-mandated requirements for scholarly output and quality improvement participation among residents and fellows! We applaud the clear statement by Drs. Hernandez and Black in the editorial (as program directors of two of the largest and most academic-oriented programs in the country) that “We care less about the number of credits to your name than the content of your character.”
One method of deterrence suggested by the authors is to require all applicants to attach an electronic PDF of each publication they cite in their applications. We think this is a great and sensible idea. Additionally, we would urge all of you to take this opportunity to search through your own CVs today to check for their accuracy/veracity. And when submitting a paper to a journal or textbook for publication, ensure that all participants know whether they are being credited and where their names will appear in the authorship choo-choo train.
Myron Yaster MD and Justin L. Lockman MD, MSEd
References
1. Bilge A, Shugerman RP, Robertson WO: Misrepresentation of authorship by applicants to pediatrics training programs. Acad Med 1998; 73: 532-3
2. Wiggins MN: Misrepresentation by ophthalmology residency applicants. Arch Ophthalmol 2010; 128: 906-10
3. Chung CK, Hernandez-Boussard T, Lee GK: "Phantom" publications among plastic surgery residency applicants. Ann Plast Surg 2012; 68: 391-5
4. Fargen KM, Drolet BC, Philibert I: Unprofessional Behaviors Among Tomorrow's Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions. Acad Med 2016; 91: 858-64
5. Singh Chawla D: 8% of researchers in Dutch survey have falsified or fabricated data. Nature 2021
6. Kharasch ED, Avram MJ, Bateman BT, Clark JD, Culley DJ, Davidson AJ, Houle TT, Jiang Y, Levy JH, London MJ, Sleigh JW, Vutskits L: Authorship and Publication Matters: Credit and Credibility. Anesthesiology 2021; 135: 1-8
What’s in a name? It’s Fraud… not “Publication Misrepresentation”
Things are even worse. Many articles have falsified data or are zombie trials.
False individual patient data and zombie randomised controlled trials submitted to Anaesthesia.
J. B. Carlisle. Anaesthesia 2021, 76, 472–479 doi:10.1111/anae.15263
Editorial: Hundreds of thousands of zombie randomised trials circulate among us.
J. P. A. Ioannidis. Anaesthesia 2021, 76, 444–447 doi:10.1111/anae.15297