Fake Science: More Common Than You Think

Yet again the edifices of peer review were shaken by recent retractions in The New England Journal of Medicine and Cochrane Reviews. The article (and another “expression of concern publication”) retracted in the NEJM was authored by a Brigham and Women’s Hospital researcher (an institution of which I am a graduate), Dr. Piero Anversa, who has been implicated in the fraudulent publication of as many as 31 cardiac stem cell articles. Meanwhile, under seeming political pressures from a group of patient activists that decried an analysis entitled: “Exercise as treatment for patients with chronic fatigue syndrome,” deeming it a personal affront to their suffering, the editors of the prestigious Cochrane Reviews decided to withdraw it. The scientist who did the actual review for the journal lodged a bitter complaint about this “editorial” decision; it is hard to miss the irony here of Cochrane Reviews being a supposed impartial arbitrator of medical scientific quality that drives clinical decision-making. Fraudulent scientific results, politics trumping science, what is a reader to believe?

None of the above events should be interpreted as truly shocking. In fact they are merely minor blips in the everyday world of peer-reviewed scientific journalism. Moreover the issues at hand do not necessarily reflect inherent defects in either of these two prominent journals. Scientific fraud is as old as science, and the unwitting publication of such fraudulent results is sadly a common occurrence. Meanwhile the political skirmish going on inside Cochrane Reviews is merely a window into the proverbial sausage factory of so much of science, and especially the generation of medical guidelines. My issue is not with what happened to either of these storied publications but with the persona these journals seek to portray to the public. Although both journals pretend to embrace some magical and uncompromising review process, the result of which is only truth, it ain’t true! Despite their unimpeachable facades, the NEJM and Cochrane Reviews are very human and inherently flawed institutions; peer review, no matter how diligent will never be able to suss out all forms of dishonesty and political influences. My beef with these prestigious journals is that they too often pretend otherwise, and by doing so undermine the very inherent skepticism that is essential for truly great science. Science is not correct because it is published in important journals like the NEJM or Cochrane Reviews, but because it can stand up to even the most withering analysis. It is replication that makes science believable and true. Many academics will stoop to the lowest levels to get published in these prestigious and important journals, as witnessed in these recent controversies, and when that does happen, it is that much harder to challenge the science in question. How ironic that these esteemed journals are prone to sowing the very seeds of their own undoing.

Of course Cureus would love to be among the pantheon of famous journals, and over a long enough time, just maybe we will compete with 200-year-old NEJM. But for now, Cureus is content to be a straightforward, humble, easy-to-use and access journal that does its best to bring our readers straightforward medical knowledge. Ironically, Cureus’ relative lack of prestige may mean the content within is even more believable. No matter, our journal is more than happy to facilitate any and all debate by either skeptics or champions, through the publication of either contradictory or replicative analysis. Ultimately it is not individual genius (or vaunted journals) that reveals scientific truth, but rather the actual struggle to find it.

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Towards a Cureus Data Repository

*Co-authored by John R. Adler & Achim Schweikard

Most scientific articles come with some form of data. For Cureus, our data includes medical images, graphics, drawings and tables. Access to such data enables a reader to verify the content and credibility of an article while also better understanding it. Many types of data, provided they are findable via search, can have value to readers independent of the article with which it was originally connected; medical imagery and genetic sequencing information being cases in point. For example, with modern methods of machine learning requiring large data sets for training, journals are a logical repository for such information. Therefore a peer-reviewed article that provides access to data will oftentimes prove much more valuable than that same article without data. Especially for internet-based media with access to large amounts of digital storage space, data sharing between authors and readers would and should become a standard. As an example, instead of showing data for a single representative case in an article, which is typical for traditional journals, we could make data for all cases in this article available to readers. Readers could then download such enhanced data sets directly in electronic format.

Given the above argument, it would appear highly desirable for Cureus to develop practical methods for structuring data and making it accessible via search. It goes without saying that the additional effort needed on the side of the authors should be minimal while the cost of making data available to others needs to be reasonable. With these objectives in mind, how might the Cureus community go about setting up an article-linked data repository?

Currently, most medical images in Cureus are in JPEG or PNG formats. Clearly, our repository should be open to standard medical image modalities in common formats. This includes CT, MR, x-ray, ultrasound data, and others in Dicom format.

Although all data would be available in electronic format, additional tools would be needed to enable intelligent search. Perhaps a straightforward way to address this problem would be to add label fields for images in the journal interface, which would let authors set tags for the image content in various ways. Such label fields could for example be modality, anatomy, pathology, entity, etc.

Finally, we would need a way to include the data in the peer-review process. Reviewers should be able to check whether the images submitted are adequate in terms of content, space requirements and other conditions. This is necessary, because once published, data sets must remain available without limitations.

Such a repository would require additional effort on the side of the editors and reviewers, but also on our journal’s programming team, and last but not least, on the side of the authors.

Now, if we decide to go this route, here is what we’d propose as a first step towards our new data repository:

  • We now allow for uploading full DICOM image data sets, and other types of numeric or image data.
  • DICOM image data sets are typically associated with images within the article. While the images remain in their native formats (.jpeg, .png, etc.), the DICOM image sets (3D or even 4D image sets) are made available for download behind the current images.
  • When uploading the data sets, authors must fill in tag fields, on pull-down menus. The tags provide information on image modality, anatomic site and entity.
  • If the article is a case report, we allow for uploading image data for the single case in point.
  • If the article is a study, with data for more than one patient, data for all patients can be uploaded.
  • Based on the tags provided by our authors, data sets from all papers across the entire data base are included into the journal’s internal search engine. This would allow us to report, for instance, all image data sets available within the data base for a specific anatomic site, and entity.
  • In addition, data correlations can be made available. This means that, for instance, matching image data and ECG data can be found.

We would love to know what the Cureus user community thinks about the above proposal. Leave a comment and let us know!

Conflicts of Interest and Financial Disclosures: It’s Time to Take a Stand Against Dishonest Authors

The recent announcement that the Chief Medical Officer of Memorial Sloan Kettering Cancer Center failed multiple times to report significant financial conflicts of interest in journal articles and letters authored or co-authored by him has justifiably stirred up quite a hornets nest of controversy.

Truth be told, I too am personally quite angry about his glaring oversight, which at its worst, involved opinions communicated broadly to the medical community via the New England Journal of Medicine. As a physician innovator, entrepreneur and scholar I have sought to play by these disclosure rules, which simply mandate transparency, because I think they are the best tools for fairly communicating possible bias to readers.

Continue reading “Conflicts of Interest and Financial Disclosures: It’s Time to Take a Stand Against Dishonest Authors”

Is it Time to Start Publicly Shaming Plagiarists?

Publishing is a privilege, not a right. The vast majority of Open Access journals, such as PloS, Frontiers, BioMed Central, etc., charge authors several thousand dollars for this privilege. Part of the publisher’s service to the author (and ultimately readers) involves a plagiarism check, the cost of which is readily borne by the substantial Open Access fees paid by authors. Alternatively, authors are afforded a similar service when they surrender their copyright to subscription journals.

In Cureus’ free publication model plagiarism, and the cost of checking for plagiarism, represents a bigger challenge. Each and every article we publish must be checked for plagiarism. When we discover that content has been taken from other sources without proper attribution, the article is blocked and the academic department leadership of the offending institution is notified. This process costs our journal meaningful time and money.

Because plagiarism undermines Cureus’ philosophy of providing free Open Access publishing, we want to do everything in our power to deter and prevent plagiarists from submitting to Cureus. This is no easy task, but we believe it’s worth it. How might we do this? One idea is the use of old-fashioned public shaming. Perhaps if the offending authors are suitably exposed, these “authors” and/or institutions will clean up their act. After all, we at Cureus know who the plagiarists are and where they’re located. The question I would now like to pose to the community of Cureus users is, how far do you think we should go? Should we list plagiarists by name on a digital “Wall of Shame”?

While most of the institutions where plagiarists were situated have taken their responsibilities seriously when confronted, one such institution, located in Srinagar, India, recently refused to acknowledge the seriousness of their offense; what type of ethics is such an institution teaching its students and residents?. Regardless, in a first step to put a spotlight on plagiarists, the following world map illustrates the location of authors who have submitted articles with plagiarized content to Cureus in the past 2 years. We want to protect the integrity of our responsible authors, and you can help. I urge you, our Cureus users to sound off on this topic of concern for all of us!

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You Call it High Academic Standards, I Call it Racism

I’m not a big fan of identity politics, where, in my opinion, allegations of racism are too often used as a political cudgel to bludgeon an opponent. But sometimes it really is important to call out blatant racism, especially when there is a greater societal good at stake, such as in this case protecting the integrity of peer-reviewed science. I had this very “opportunity” thrown at me just last week.

To introduce our journal, and its unique crowd sourced quality score (SIQ) to new physician authors, Cureus utilizes email to reach specific communities of authors who have published articles in other Open Access journals, inviting them to promote the scoring of their articles via social media and email. While away on business in Beijing last week, I was surprised to see one email and two voicemails on my phone from a (unknown to me) senior and accomplished author in other journals. His messages quickly revealed a surprising anger over having his article promoted by Cureus. I replied with a brief email explaining how the Creative Commons copyright system supported such fair usage by Cureus, but this merely precipitated yet another profanity-laced email volley. Not wanting to inflame matters further, and even more so wanting to understand the true source of his angst, I decided to call the author. To say the call was unpleasant would be an understatement. I am a neurosurgeon and have fairly tough skin but it is never fun to have all kinds of profanity thrown at you, especially when you’re sure it is unjustified.

I let him vent a little, as my primary goal was figuring out why he was so upset. No matter how patiently I asked this guy to explain the source of his anger, he repeatedly deflected. Finally, after having asked multiple times, this rather accomplished researcher frustratingly blurted out that he did not want his article promoted “alongside the University of Pakistan.” In that instant, everything became clear. There is no institution named The University of Pakistan. Cureus, however, recently published several articles from South Asian-based institutions, namely India and Pakistan. What I suddenly realized is that this person was merely pissed (and seemingly offended) that his “aristocratic” article (allow me some artistic license here) might appear alongside “unworthy” South Asian articles. To put it more bluntly, this otherwise truly accomplished author was just a racist old fool.

In an effort to defuse the situation I complied with his request to remove his article. Upon further reflection I now feel a deep sense of gratitude to this old racist for providing me the opportunity to expose how racism—implicit and overt (like this case), sadly lurks in the background of all peer-reviewed journals. Truthfully I am amazed that so many in this day and age are still clueless about what is happening in medical science. As I sit writing this in a world-renowned Chinese hospital, I am surrounded by the very type of medical excellence that my racist critic deems unworthy of his association. A close American friend of mine (and Cureus editorial board member) is one of the premier pediatric cardiac surgeons in the world, having invented several important heart operations. He has visited several South Asian hospitals that have refined his original operation, enabling them to operate on vastly more patients than him, and do so at less than 10% the price of a U.S. hospital. In light of this, it strikes me as complete foolishness to restrict such important medical knowledge. Scholarly racism is utterly self-defeating for authors, readers and the world at large.

Although I could find no formal studies documenting the extent of racism within scholarly journals, there is a modest body of research and other evidence pointing towards the existence of sexism, as well as prejudice against non-academic physicians, in the world of academic publishing [1-3]. Perhaps it is time to formally study the extent of racial bias in peer-reviewed journals. Any takers?

Recently, the CEO of an authoritative digital health website shared an interesting statistic with me: 40% of the articles published in the New England Journal of Medicine, arguably the most important medical journal, originate within a 200 mile radius of the journal’s headquarters. No one would disagree that Boston, New York and New Haven are centers of academic excellence, but the medical community that dominates the NEJM represents but a tiny fraction of world physicians, thus excluding an immense amount of clinical experience and knowledge. Although such willful blindness or elitism is not as blatant as the prejudice exhibited by my new acquaintance, does a hugely influential and even entitled societal institution like the NEJM not have a responsibility to open itself up to more of the world of medicine?

While I will continue to respect the world’s leading medical journals for the important work they publish, I remain proud that Cureus serves the vast numbers of physicians truly in the trenches of medicine who have been disenfranchised through what might be best termed “scholarly elitism.” Lastly, I want to thank this narrow-minded dolt for reminding me yet again why Cureus’ mission is so important to the world of medicine.

References:

1). Pololi LH, Civian JT, Brennan RT, Dottolo AL, Krupat E. “Experiencing the Culture of Academic Medicine: Gender Matters, A National Study.” J Gen Intern Med. 2012 Aug 31; [Epub ahead of print] PMID: 22936291. [PMC free article] [PubMed]

2) http://www.sciencemag.org/news/2015/05/plos-one-ousts-reviewer-editor-after-sexist-peer-review-storm

3) From abstract to impact in cardiovascular research: Factors predicting publication and citation. Eur Heart J. 2012 Winnik S, Raptis DA, Walker JH, Hasun M, Speer T, Clavien PA, et al. From abstract to impact in cardiovascular research: Factors predicting publication and citation. Eur Heart J. 5 June 2012 [Epub ahead of print] PMID: 22669850. [PMC free article] [PubMed]

The Long, Arduous Journey to Publication: It Doesn’t Have to be That Way

I recently co-authored an article submitted to Nature Urology, a subdomain of the Nature publishing group. It took roughly eight weeks of review before we received feedback from the editorial office. In December 2016 we were finally presented with several reviewer questions that had to be answered before a final decision could be made. After all outstanding questions and reviewer requests had been answered the article was finally, mercifully “accepted in principle” on February 3rd. That was far from the end of it, however, as another round of editing requests arrived on May 11th.

This time the requests came directly from the Nature editorial office. The majority of the requests concerned tightening up the narrative flow and bringing the article in line with their in-house style. At this time, we discovered that the edits already made by the editorial office were so extreme that the editors had to check with us to make sure the meaning of our words (and indeed the entire article itself) had not been altered by their editing process. All of this for arbitrary language and formatting issues.

On May 15th, with the article still unpublished, we were yet again asked to check affiliations and other minor aspects of the article. The article was finally published yesterday, May 23rd, roughly eight months after submission. (And it could have been worse!)

How does this kind of perfectionism serve the scientific community? Why does the editorial office of the Nature publishing group change the text of professional scientific authors in a way that even they are not sure if the scientific information is still correct? The editorial work of so-called high-end and high-ranking journals has reached a level where their interaction is beyond thoroughness. It is absurd to edit every paragraph, every sentence, and even every word. This does not serve the scientific community. Instead it unnecessarily prolongs the publication process to guarantee the house style of a specific journal. The scientific message does not change with this heavy editing, but an article may look better and therefore may be better sold by the publisher based on the work of scientific authors.

The process (and underlying philosophy) are different with Cureus. In short, we rely on the individual capabilities of our authors, who also retain their copyright. We want to make the publishing process fast and efficient, so while we provide a certain level of support to our authors, we do not intend to alter their scientific message. Instead, we appeal to their own sense of pride and responsibility for adequate language and general accuracy.

In the end it is the scientific community that will evaluate if the article is scientifically sound, informative and correct. If it is not, the article will be met with heavy criticism, both via a low SIQ score and negative comments attached to the article. This system is not only much faster but also unbiased and transparent. We want to keep the focus of scientific publishing on what we feel is most important – the fast, fair and uncomplicated dissemination of interesting findings around the world.

In the Name of Truth and Reconciliation: A Plagiarist’s Mea Culpa

Dr. John Adler, Founder and Editor-in-Chief of Cureus: Speaking as a physician-scholar and an editor-in-chief, damn do I hate plagiarists! The entire idea of plagiarism sucks the life out of something that I believe to be almost sacred. Idealism aside, fraudulent behavior among authors is all too common, and maybe even rampant, within the world of scientific journals. To combat such fraud, Cureus, like most credible journals, has made it a formal policy to aggressively police plagiarism when we encounter it, as stated explicitly in our guidelines for authors’ section:

“Cureus pledges to rigorously enforce all standards, and promptly follow up on any transgressions. In extreme cases, this may call for article retraction and the reporting of individuals to their employer, institution or some appropriate body for further investigation.”

To date, Cureus’ policy appears to have ended the careers (sadly) of some young ambitious physicians; it is the aspiring younger academic who in my experience appears most tempted to cheat, especially given Cureus’ liberal willingness to publish credible science. In response to the cheaters, Cureus’ editorial team has always sought to be ruthlessly punitive, believing it to be the best defense against future plagiarism. Once exposed to the leadership of their medical institution, a plagiarist’s career tends to end in the quiet of the night, which unfortunately does little to communicate the seriousness of such cheating to others.

Therefore, I recently made a decision (for better or worse and somewhat capriciously I might add) to not report a plagiarist to his senior leadership. In the name of “truth and reconciliation” I instead demanded that the attempted-plagiarist explain their underlying motivations so as to serve as a warning to future authors who might be similarly tempted. That is the impetus for the below anonymous blog post. It is my hope and prayer that future potential plagiarists might read this post and come to their senses before very possibly destroying their own medical careers.

My decision for leniency under the current situation was done with great hesitancy. I can rightfully be criticized as undermining our journal’s clear warning to authors. Therefore, I wish for the record to say that as long as I am Editor-in-Chief of Cureus I intend to never ever repeat such leniency towards a fraudulent submission. Any author who might be tempted otherwise, consider yourself to be hereby forewarned.

Anonymous Cureus user: Most residents desire to do research and get published in a journal, for both the academic benefits and to develop one’s resume when applying for future fellowship training. Being such a young ambitious physician, but also having no significant experience in publishing research, I recently made the biggest mistake of my professional life, and this error has haunted me every day since.

A couple of months ago I decided to publish a case report on an interesting patient I had just seen in the clinic. I decided to submit the report to Cureus. As I began to write I realized my research writing skills were seriously wanting. By chance I found a similar case and heavily “borrowed” portions of text; my only focus was on getting my first publication and I turned a blind eye to the consequences of such actions. In fact, I hardly changed any words or sentences and simply submitted this report to Cureus thinking that in this particular case the objective was the same.

Why did I do it? Regretfully I now have only stupid explanations to fall back upon. Nevertheless, it is worth saying that in the country where I was raised, the topic of plagiarism is never discussed or seriously acknowledged. Plagiarism just isn’t such a big deal.

Soon after submitting my manuscript I received an email from Cureus’ editor who told me that I plagiarized and he sent me a link to the original source. I was humiliated, and even more so now very scared. By all rights the editor could and maybe should have reported me to my program director. If that were to happen, I realized that it could very well end my career in medicine. So many years of hard work was potentially destroyed by a single incredibly stupid decision! I pleaded and begged the editor for mercy, and the consequence of that plea is the confessional blog you are now reading.

Once again I ask myself why did I do such a stupid thing? Thinking back now I realize I had been blinded by ambition and was totally dishonest to myself. It disappoints me to know my poor decisions mostly reflect my greedy nature and a willingness to get ahead without hard work; I was largely jealous of my friends and colleagues who were publishing. Blinded by such emotions, I failed to ask myself how dangerous such actions would be for my character, my occupation, my career and my family. In hindsight, had I thought deeply about the potential consequences of my careless act, I would have never done it, and that mistake taught me a very tough lesson.

As a resident, I already knew that laziness can make the difference between the life or death of a patient. However I failed to consider that laziness towards publishing medical research is potentially even more dangerous, as it can put many other lives at risk. My actions can only be described as utterly immoral and unethical; my behavior is completely inexcusable. Although it is the ethical right and privilege of the editor to report me to my departmental chair and residency director, I am sincerely grateful for the career-saving opportunity I have been afforded. I am determined that this painful lesson will lead to my honest behavior in the future, as God is my witness.