EDITOR’S CORNER
Ethics in Publishing - Today’s Epidemic
I
n this time of seemingly increasing prevalence of epidemics from the likes of Ebola, West Nile and other agents, The American Journal of the Medical Sciences (AJMS) seems to be experiencing an epidemic as well. However, there is no evidence that the problem at the AJMS is related to any infectious process, as suggestive as the evidence would seem to be that it is spreading like an infection. Our little mini-epidemic is the medical misconduct, specifically plagiarism. At least plagiarism represents the part of the iceberg that we are aware of. At the first blush, one might say that plagiarism is not nearly as serious as the potential consequences of Ebola, and so on, and the comparison is weak and poorly chosen. Maybe! However, the hope would be that deeper reflection will lead the reader to the conclusion that this represents issues with the most fundamental ethics of medicine and that this unethical behavior is of the highest possible importance. Plagiarism of previously published material is part of this web of scientific misconduct or unethical research behavior, which includes fabrication of data, misappropriation of authorship, unethical treatment of research subjects and unethical editorial management. According to a number of industry and other sources, all are increasing.1 Without being too dramatic, would any patient want a physician guiding him or her through the complexity of potentially lifesaving medical decisions making—if that physician had anything other than the highest possible level of ethical motivation and behavior? The AJMS was not aware of any episodes of plagiarism around the mid-2000s, the time the present editorial team assumed that position. Unfortunately, we cannot say this today. Presently, we are experiencing issues of medical misconduct at a rate of several per year. Furthermore, our data suggest that the frequency of medical misconduct is increasing. One could quickly and correctly conclude that technology has allowed discovery of some of this misconduct, especially plagiarism, with increased ease and frequency and that this increased discovery largely explains our newfound problem. This is undoubtedly true. However, to be fair, we had several episodes of reviewer identified plagiarism in intervening years, before recruiting our computer programs, and this was in stark contrast with no experience with plagiarism 7 or so years ago. However, national data for the past 5 to 10 years support the fact that scientific misconduct is increasing worldwide at an alarming rate.1 Plagiarism is reported to be a large part of this scientific misconduct.1 So, what is going on? To be sure, it is complicated. Over the past decade or more, we have seen a perfect storm of confluent circumstances for medical misconduct. It is presumed that one of the major driving forces contributing to this phenomenon is the increased pressure to publish.2 It remains unclear why this pressure is greater now than it was in the past or is perceived as greater than it was in the past. It has been clear for many decades that academic advancement was mostly dependent on academic productivity, which largely equated with research funding and publication record. Competition for limited research funding resources is keener than ever. The number at risk in the denominator has also increased, as the numbers of faculty have increased substantially, perhaps doubled in some academic medical centers in the past decade.2,3 Perhaps, the number of less academically inclined or less research inclined “teaching physicians” has increased, and this is a new pejorative issue. However, to our knowledge, there is no evidence that this group of academicians is making an unbalanced contribution to the problem of research misconduct or plagiarism. According to data The American Journal of the Medical Sciences
from iThenticate (Oakland, CA), that is supported by a report from Thomson Reuters Web of Science that appeared in the Wall Street Journal, there has been a near doubling increase in number of published articles since 2001.1 The number of investigators has increased greatly, to nearly 7 million worldwide. It is said that the number of scholarly journals has increased to nearly 32,000 in the past decade (and new on-line journals seem to appear every second). Much of the published material is questionably reviewed. In concert with the data above, some 23% of submitted material is reported to be rejected by 1 publisher because of plagiarism. The rate of retraction of published material has increased dramatically to about 800 papers per year, reflecting a 10-fold increase in retractions of published material during the past decade. Data from Thomson Reuters Web of Science that appeared in the Wall Street Journal suggested a 15-fold increase in retractions since 2001 (is that alone not a staggering statistic?). All of this to say, data from many sources and every direction indicate that this is a real problem.1 Perhaps, most concerning of all, 1 of 3 scientists admits questionable research practices.4 The consequences of this medical misconduct are even more bothersome.3 It costs the involved organization about $500,000 or more to investigate 1 case of medical misconduct with a total cost of over $100 million for all investigations into misconduct in 2010.3 And then, there are the more personal consequences resulting from this misconduct: the lost productivity; revoked degrees; grants returned; patents lost, revised, compromised; and the most important consideration by far, the patients potentially harmed by unethical decision making or interventions based on paradigms that have come out of misconduct. These and other considerations amount to a monumental financial and human loss.3 It is a fool’s game to try to beat the system with plagiarism in the present day. Publishers have incredibly powerful software search engines at nearly every journal’s disposal. As impossible as it seems, these programs have the capability of searching the published literature for identity of words and phrases. The likelihood of discovery of plagiarism is very high (unless the software is not used), and the personal cost of discovery is huge, perhaps career ending. Discovery of plagiarism seems to have derailed the political career of a likely candidate for future Chancellor of Germany.5 Alternatively, how hard is it to play by the rules of highest standards for ethical behavior: quote it and reference it or in the least acceptable case, recast the essence of the thought and rewrite it giving appropriate credit to the origin? How can we correct or prevent medical misconduct or unethical medical behavior? To start, the quality of individual selected to be in medicine should obviate it. Collectively, we need to make sure that only the highest quality ethical material that will become our future authors comes through our doors. A very high priority should be mentorship of our trainees to emulate the highest level of ethical behavior. Hopefully, academic and teaching physicians and scientists will exhibit the highest level of ethical behavior and this will be absorbed, ingrained and emulated by the students taught and mentored by them. It is doubtful that medical misconduct is the result of a deficiency of computer-based training modules dealing with ethical research conduct or medical authorship. It also seems doubtful that classroom instruction can instill the basic principles that will make a scientist or author of honor. Mentorship, vigilance and direct participation in research and
Volume 348, Number 4, October 2014
269
Editor’s Corner
authorship activities by the mentor will set an example for behavior worthy of copying.3 Coming soon will be the mandate that every author submits his or her material to voluntary plagiarism software analysis before submission for publication.
David W. Ploth, MD
2. Pressure to publish. iThenticate White Paper. Available at http://www. ithenicate.com/pressure-to-publish-free-white-paper. 3. True costs of research misconduct. iThenticate White Paper. Available at http://www.ithenticate.com/resources/papers/researchmisconduct.
REFERENCES
4. Fanelli D. How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data. PLoS One 2009. Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal. pone.0005738.
1. Gatum N. Mistakes in scientific studies surge. The Wall Street Journal 2011. Available at http://online.wsj.com/article/SB10001424052702306271045764 11850666582080.html.
5. Boston W. Germany: plagiarism claims take down Guttenberg. Time World 2011. Available at http://www.time.com/time/world/article/0, 8599, 2056525,00.html.
Editor-in-Chief
270
Volume 348, Number 4, October 2014
Ethics in Publishing - Today’s Epidemic
I
n this time of seemingly increasing prevalence of epidemics from the likes of Ebola, West Nile and other agents, The American Journal of the Medical Sciences (AJMS) seems to be experiencing an epidemic as well. However, there is no evidence that the problem at the AJMS is related to any infectious process, as suggestive as the evidence would seem to be that it is spreading like an infection. Our little mini-epidemic is the medical misconduct, specifically plagiarism. At least plagiarism represents the part of the iceberg that we are aware of. At the first blush, one might say that plagiarism is not nearly as serious as the potential consequences of Ebola, and so on, and the comparison is weak and poorly chosen. Maybe! However, the hope would be that deeper reflection will lead the reader to the conclusion that this represents issues with the most fundamental ethics of medicine and that this unethical behavior is of the highest possible importance. Plagiarism of previously published material is part of this web of scientific misconduct or unethical research behavior, which includes fabrication of data, misappropriation of authorship, unethical treatment of research subjects and unethical editorial management. According to a number of industry and other sources, all are increasing.1 Without being too dramatic, would any patient want a physician guiding him or her through the complexity of potentially lifesaving medical decisions making—if that physician had anything other than the highest possible level of ethical motivation and behavior? The AJMS was not aware of any episodes of plagiarism around the mid-2000s, the time the present editorial team assumed that position. Unfortunately, we cannot say this today. Presently, we are experiencing issues of medical misconduct at a rate of several per year. Furthermore, our data suggest that the frequency of medical misconduct is increasing. One could quickly and correctly conclude that technology has allowed discovery of some of this misconduct, especially plagiarism, with increased ease and frequency and that this increased discovery largely explains our newfound problem. This is undoubtedly true. However, to be fair, we had several episodes of reviewer identified plagiarism in intervening years, before recruiting our computer programs, and this was in stark contrast with no experience with plagiarism 7 or so years ago. However, national data for the past 5 to 10 years support the fact that scientific misconduct is increasing worldwide at an alarming rate.1 Plagiarism is reported to be a large part of this scientific misconduct.1 So, what is going on? To be sure, it is complicated. Over the past decade or more, we have seen a perfect storm of confluent circumstances for medical misconduct. It is presumed that one of the major driving forces contributing to this phenomenon is the increased pressure to publish.2 It remains unclear why this pressure is greater now than it was in the past or is perceived as greater than it was in the past. It has been clear for many decades that academic advancement was mostly dependent on academic productivity, which largely equated with research funding and publication record. Competition for limited research funding resources is keener than ever. The number at risk in the denominator has also increased, as the numbers of faculty have increased substantially, perhaps doubled in some academic medical centers in the past decade.2,3 Perhaps, the number of less academically inclined or less research inclined “teaching physicians” has increased, and this is a new pejorative issue. However, to our knowledge, there is no evidence that this group of academicians is making an unbalanced contribution to the problem of research misconduct or plagiarism. According to data The American Journal of the Medical Sciences
from iThenticate (Oakland, CA), that is supported by a report from Thomson Reuters Web of Science that appeared in the Wall Street Journal, there has been a near doubling increase in number of published articles since 2001.1 The number of investigators has increased greatly, to nearly 7 million worldwide. It is said that the number of scholarly journals has increased to nearly 32,000 in the past decade (and new on-line journals seem to appear every second). Much of the published material is questionably reviewed. In concert with the data above, some 23% of submitted material is reported to be rejected by 1 publisher because of plagiarism. The rate of retraction of published material has increased dramatically to about 800 papers per year, reflecting a 10-fold increase in retractions of published material during the past decade. Data from Thomson Reuters Web of Science that appeared in the Wall Street Journal suggested a 15-fold increase in retractions since 2001 (is that alone not a staggering statistic?). All of this to say, data from many sources and every direction indicate that this is a real problem.1 Perhaps, most concerning of all, 1 of 3 scientists admits questionable research practices.4 The consequences of this medical misconduct are even more bothersome.3 It costs the involved organization about $500,000 or more to investigate 1 case of medical misconduct with a total cost of over $100 million for all investigations into misconduct in 2010.3 And then, there are the more personal consequences resulting from this misconduct: the lost productivity; revoked degrees; grants returned; patents lost, revised, compromised; and the most important consideration by far, the patients potentially harmed by unethical decision making or interventions based on paradigms that have come out of misconduct. These and other considerations amount to a monumental financial and human loss.3 It is a fool’s game to try to beat the system with plagiarism in the present day. Publishers have incredibly powerful software search engines at nearly every journal’s disposal. As impossible as it seems, these programs have the capability of searching the published literature for identity of words and phrases. The likelihood of discovery of plagiarism is very high (unless the software is not used), and the personal cost of discovery is huge, perhaps career ending. Discovery of plagiarism seems to have derailed the political career of a likely candidate for future Chancellor of Germany.5 Alternatively, how hard is it to play by the rules of highest standards for ethical behavior: quote it and reference it or in the least acceptable case, recast the essence of the thought and rewrite it giving appropriate credit to the origin? How can we correct or prevent medical misconduct or unethical medical behavior? To start, the quality of individual selected to be in medicine should obviate it. Collectively, we need to make sure that only the highest quality ethical material that will become our future authors comes through our doors. A very high priority should be mentorship of our trainees to emulate the highest level of ethical behavior. Hopefully, academic and teaching physicians and scientists will exhibit the highest level of ethical behavior and this will be absorbed, ingrained and emulated by the students taught and mentored by them. It is doubtful that medical misconduct is the result of a deficiency of computer-based training modules dealing with ethical research conduct or medical authorship. It also seems doubtful that classroom instruction can instill the basic principles that will make a scientist or author of honor. Mentorship, vigilance and direct participation in research and
Volume 348, Number 4, October 2014
269
Editor’s Corner
authorship activities by the mentor will set an example for behavior worthy of copying.3 Coming soon will be the mandate that every author submits his or her material to voluntary plagiarism software analysis before submission for publication.
David W. Ploth, MD
2. Pressure to publish. iThenticate White Paper. Available at http://www. ithenicate.com/pressure-to-publish-free-white-paper. 3. True costs of research misconduct. iThenticate White Paper. Available at http://www.ithenticate.com/resources/papers/researchmisconduct.
REFERENCES
4. Fanelli D. How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data. PLoS One 2009. Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal. pone.0005738.
1. Gatum N. Mistakes in scientific studies surge. The Wall Street Journal 2011. Available at http://online.wsj.com/article/SB10001424052702306271045764 11850666582080.html.
5. Boston W. Germany: plagiarism claims take down Guttenberg. Time World 2011. Available at http://www.time.com/time/world/article/0, 8599, 2056525,00.html.
Editor-in-Chief
270
Volume 348, Number 4, October 2014
