Nephrol Dial Transplant (1998) 13: Editorial Comments
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Nephrol Dial Transplant (1998) 13: 1365-1367
Honesty in publication
Alexander M. Davison
Editor Emeritus
Department of Renal Medicine, St James's University Hospital, Leeds, UK
The recording of original observations and the results
of investigative studies are essential to all who practice
medicine or undertake medical research and is the
raison d'etre for medical journals. It is, however, an
absolute requirement that published material is accurate and records honestly the observational findings.
This is what is expected by readers of journals. No-one
would wish to waste time reading or, worse, subsequently devising an investigative protocol to further
study a subject which is inaccurate or false.
Unfortunately it is becoming increasingly recognized
that both fraud and plagiarism exist in medical publishing and, although it is difficult to quantify the
extent to which this occurs, many would suggest that
it is more common than we realize. The Editors of this
journal have detected three cases of fraud prior to
publication but, as yet, are unaware of any fraudulent
material having been published. This Editorial is published, however, to make it perfectly clear where our
journal stands with respect to these issues which have
raised much emotion in the recent past.
Fraud is the use of false representations to gain an
unjust advantage. In medical publishing this would
include the falsification of data to make the results of
an investigation more impressive and so persuade the
editorial team that the submitted material was worthy
of publication. However there is a wide spectrum of
fraud from the omission of a few patients from a study
because they did not 'fit', to the complete fabrication
of the results of a study which was never undertaken.
In the latter instance it is clear that the fraud is of the
gravest magnitude but in the former it is less clear
although the effect may be just as serious. In drug
trials it is absolutely necessary to include all results
and not just those which support a beneficial therapeutic action because there may be idiosyncratic results
which could have important implications for particular
patients. Thus there is no 'grey' area when it comes to
recording data however much there is a temptation to
'clean up' results. Fortunately the number of instances
where there has been complete fabrication of results
are few but there have definitely been instances where
this has been uncovered after publication.
Correspondence and offprint requests to: A. M. Davison, Department
of Renal Medicine, St James's University Hospital, Beckett Street,
Leeds LS9 7TF, UK.
It might be considered that if fraud is detected it is
relatively easy to publish a retraction at a later date
but this may be missed or ignored. In 1874 Haeckel, a
German zoologist, published a series of drawings showing embryonic development in Anthropogenie, or the
Evolution of Man. It was subsequently shown that
some of the drawings were complete fabrications and
Haeckel was convicted of fraud at the University of
Jena court in the early years of this century. The
fascinating aspect of this case is that the drawings
continue to be used indicating that although they had
been demonstrated to be fraudulent this has not been
appreciated by many in the scientific community and
it is likely that today many are completely ignorant of
the events of a century ago. This emphasizes the
importance of ensuring that published material is
accurate as later retractions may not be known about
or may be ignored.
Plagiarism is the taking and using as one's own the
ideas and writings of another person without due
acknowledgement. It is entirely correct to reproduce
text from another persons publication providing that
the original source is detailed. It is seldom necessary
to reproduce more than a few words or sentences but
where a longer quotation is necessary it is customary
to obtain permission from the holder of the relevant
copyright. It is clearly improper to publish large sections of previously published text or even complete
articles as one's own as this is in essence stealing and
false representation. There are many instances where
plagiarism has been uncovered and this includes articles
in this journal.
A particular form of plagiarism which is difficult to
detect is when a journal reviewer delays or rejects a
manuscript so that his (or her) research team or
institution can take the idea and perform a study and
subsequently publish the results as if they had devised
the original concept. This is clearly a blatant abuse of
a privileged position and one which deserves the maximum of retribution. A further abuse of the position
of a reviewer is when material prior to publication is
taken from a manuscript and used in a presentation
without the knowledge or permission of the author.
There is a strong tradition that reviewers are not
named but if such a practice were introduced it would
make this form of plagiarism more easy to detect.
Dual publication is the simultaneous publication of
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the same material in two different journals. This is a
practice which should attract the same degree of anger
as fraud and plagiarism because it is equally potentially
harmful. Dual publication may be the publication of
identical texts or the manipulation of data to make it
appear that a separate study has been undertaken. The
latter most commonly involves the addition of a few
more patients to a study. The former may be acceptable
in certain circumstances such as publication in another
language or in a journal with a different circulation,
but even this must be accompanied by reference to the
original source. Another practice is the so-called
'salami slicing' which is a technique to ensure the
maximum number of publications from any study.
Usually the material section of the text contains exactly
the same patient data base while the methods section
describes subtle differences in the way the study was
undertaken. It can be appreciated that dual publication
will lead to particular problems when any meta-analysis
is performed and may result in inappropriate conclusions. In drug trials, the dual publication of data may
give the impression that many more people have been
treated with a certain preparation and so may falsely
enhance the apparent beneficial effects of a therapeutic agent.
Why does fraud, plagiarism, and dual publication
occur? This is a difficult question to answer because
there are many different reasons. The most common
cause must be to enhance a curriculum vitae (CV) for
some gain. Such enhancement may be because continuation of the persons employment may be dependent
upon demonstrating a certain degree of intellectual
activity. This is often difficult to assess and some
institutions take the easy way out by counting numbers
of publication rather than making an assessment of
the worth of the publications by evaluating each for
originality and overall impact. This can be further
compounded by obtaining the impact factor of the
journal where a person publishes in the mistaken belief
that this will give academic weight to a particular
publication. This is completely false as the impact
factor of a journal does not correlate with the scientific
merit of any single article contained within the journal.
In spite of this, academic institutions will request such
information because they do not have the manpower
or time to properly evaluate published works.
Enhancing a CV may also be because a person is
seeking advancement in position or appointment to a
different post. It is precisely because employing authorities pay more attention to quantity than quality that
employees resort to all means possible to enhance the
apparent merit of a CV. Those assessing a CV rely on
the expertise of the editorial team of a journal and
assume that if a manuscript is accepted for publication
then it must have merit. This may or may not be the
case as there are many reasons for accepting material
for publication and each journal will have particular
policies which will not be known to those making such
assessments. Once again it comes down to the fact that
to many the weight of a CV is more impressive than
the contents.
Nephrol Dial Transplant (1998) 13: Editorial Comments
In some instances fraud and plagiarism are impossible to understand because they are committed without
the need for CV enhancement. Often this involves
people in respected and secure positions and for whom
the addition of a few more publications on their CV
is of no importance. Is it some mid-life crises or a
desire to be seen to be still active and productive at a
time in their career when greater attention should be
paid to the advancement of more junior members of
staff? There is no doubt that it is difficult for some to
make the transition from active research worker to
leader of a team and subsequently to adviser on future
projects. Perhaps some wish to retain perpetual youth
by retaining the same degree of activity in spite of
advancing years and declining faculties.
Finally some fraud occurs for financial gain. There
is increasing competition in the commercial exploitation of new therapeutic agents and companies are
anxious to be the first in the market place with the
introduction of some improved therapy. This can place
those involved in drug evaluation in a very difficult
position. Some companies are willing to spend considerable amounts of money if they suspect the a new
preparation will corner a significant share of the market
and as a result reap financial dividends. As a consequence they are willing to pay handsomely for
information regarding the results of clinical trials.
There is thus temptation for the clinical trialist to
include a few additional fictitious patients or to
'improve' the results obtained to make it appear that
the agent being studied is more efficacious. In some
instances there is pressure from the company to obtain
quick results and, as those involved in drug trials
know, it is not always possible to recruit and retain
patients in trials. This may result in falsification of
results so that the trial can be completed in a timely
manner.
What can be done to detect and prevent fraud,
plagiarism, and dual publication from occurring? The
most important factor will be the recognition the such
activities are counterproductive and not in the interests
of anyone. However it is unlikely that there will be
any significant reduction in plagiarism and dual publication unless there are some sanctions taken against
those who perpetrate these deeds. It is impossible for
editorial teams to know if a manuscript is submitted
to two different journals but if such is detected then
the manuscript should be rejected by both journals, as
is the practice in this journal. If dual publication is
detected after publication then the authors should be
given a chance to explain their actions but if no
satisfactory explanation is forthcoming the journal
should consider refusing to accept for review any
further submissions from that particular author or
institution for a given period of time, perhaps 3 years.
In addition the Editors should publish details of the
matter in their journal and indicate what sanctions
have been instituted. Journals need to pay greater
attention to letters of submission to ensure that they
indicate that the material contained is original and not
being submitted elsewhere. Reviewers should have
Nephrol Dial Transplant (1998) 13: Editorial Comments
access to an information searching database such as
Medline to be able to identify whether there is a
possibility of any irregularity. In time it may be possible
to establish a network information system for Editors
to detect whether a manuscript has been submitted
simultaneously to two or more journals. Fraud will be
more difficult to detect and thus should have more
severe penalties imposed upon detection. It may be
necessary for journals to enter a common agreement
that none will consider any further submission from
an author of fraud. This may seem harsh but what
else can be done? It would seem reasonable to impose
the greatest penalty when trust has been betrayed
because it may occur a second time.
Honesty in publication involves all. There is an
obvious requirement for an author to submit only that
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material which is original and factually correct. There
should be complete agreement between all the authors
of a manuscript and the letter of submission should
state this. Any previously published material or any
patients previously reported should be clearly identified. The editorial team should respect the confidentiality of the submitted material and should make a
statement to this effect in their journal. It is only with
the involvement of all that the present unacceptable
state will be improved but as long as it is accepted
that the strength of a CV is based on quantity rather
than on quality it is likely that fraud, plagiarism, and
dual publication will continue. The Editors would be
grateful to any reader who brings their attention to
any such features in the material published in this
journal.