Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=156969
Story Retrieval Date: 9/20/2014 1:01:22 PM CST
The frequency of fraud in scientific research is likely underestimated, rarely exposed and on the rise. And the commercialization of medical journals lies at the heart of this troubling trend, according to industry experts and recent data analyses.
“From my experience and perspective, it’s clear that fraudulent, unethical behavior is a more common problem than it used to be,” said Dr. Arnold Relman, editor of the New England Journal of Medicine from 1977 to 1991 and professor emeritus at Harvard Medical School.
A recent investigation of an influential 1998 study that linked vaccines to autism, for example, revealed a “dishonest,” “unethical” and sloppy body of research fraught with alleged conflicts of interest and falsified data, according to the General Medical Council, a panel that oversees British doctors and medical practices.
The Lancet, the prestigious British medical journal that published the flawed article in 1998, officially retracted the study two weeks ago. The study’s lead author, Dr. Andrew Wakefield, maintained that the study is valid.
The retraction is a reminder that the world of science and medicine are not ideal lab settings for a study in ethics: lies, deceit, manipulation and scandal fester below the surface of scientific research and publishing. And recent research on science research highlighted some startling trends. (Read about the findings in the supplementary story found in Related Links.)
“My strong suspicion is that the frequency of fraud is much greater today than it has ever been,” Relman said.
He cites two reasons for this trend: intensifying financial pressures – including the “domination of corporate interest and control of medical practice behavior and research by financial institutions” – and the fact that more and more clinical studies are being conducted every year.“The economic pressures on authors who conduct the studies are much higher.”
“The commercialization of medicine poses the greatest threat to U.S. health care,” Relman said.
Dr. Alan Blum, former editor of the Medical Journal of Australia and the New York State Journal of Medicine, agreed: “This whole popularization and commercialization of peer-reviewed medical journals is sickening. There are very few truly independent publications left – that is something that I think the public doesn’t understand.”
The proliferation of “herd journals” and the distracting influences of popular news media have diluted the integrity of science research and publishing, Blum said.
Dr. Jerome Kassirer, editor in chief of the New England Journal of Medicine from 1991 to 1999, said the purpose of a medical journal is "to provide information to doctors. Period."
"There is a tendency for medical editors to want their papers to be published in the New York Times," Kassirer said. "We never had that as a consideration – I never cared. I never paid attention to whether there were ads or not."
He acknowledged that medical journals have “evolved enormously” in the past decade or so. “The major problem is it’s becoming more and more difficult to support them. Circulation has dropped.”
While former editors were eager to raise awareness about the troubling trends, the current editors of some of the major medical journals – including the New England Journal of Medicine, the Journal of the American Medical Association and The Lancet – declined to comment.
A spokeswoman for JAMA, however, referenced a 2008 editorial on the adverse effects of industry influence: “The profession of medicine, in every aspect—clinical, education, and research—has been inundated with profound influence from the pharmaceutical and medical device industries,” the JAMA editorial began.
The experts and data paint a compelling picture of the vulnerable state of science. The combination of two phenomena – the increasingly powerful financial influences such as pharmaceutical companies and the struggling business of science journals – has coalesced to create a perfect storm.
Opportunity for exploitation and manipulation thrives, experts said. Poorly funded scientific researchers under pressure to publish may fudge a bit of data to keep their study afloat. Similarly, medical journals trying to navigate a more competitive media landscape may lower their standards and yield to the influence of money.
“We might be putting too much faith in medical journals,” Blum said.
To curb this misconduct, science journals should require a thorough review process, have all information on conflicts of interest and insist that an investigation committee approved the study, the former editors said. Journals should reduce their reliance on advertisers and other outside sources that entail vested interests, Blum added.
On journal retractions and The Lancet
The Lancet retraction shows that even the most venerated journals are susceptible. The behavior of lead author Wakefield suggests that scientists may get away with more than anyone ever realizes.
The British study, which linked the measles, mumps and rubella vaccine to autism, launched a heated anti-vaccination movement that persists today.
Vaccination rates in the United Kingdom and United States plummeted after the study’s publication, and a measles resurgence ensued.
“Legitimate questions should’ve been raised as to whether the article should have been published at all," Relman said. "When I was editor, I think we would’ve looked askance at a study with such a big claim and so little research to support it.”
Kassirer agreed. “You have to be very wary of squishy data, especially if they have widespread influence on public health," he said. It's a sloppy job on behalf of The Lancet "not only in publishing a poor study, but also in failing to dig into the conficts of interest."
"The article did damage, there's no question," Blum said. "But any journal can get burned by research – every journal has."
The medical community – including 10 of the 13 authors of the original paper – rejected the validity of the findings years ago. Little to no scientific evidence supports the study’s findings, and subsequent studies have refuted its claims.
Despite all of this, an outspoken anti-vaccination faction thrives. Thousands of families with autistic children remain firmly convinced the connection is real.
“It’s so controversial and has caused so much concern and confusion,” Relman said. “It’s surprising that the final retraction of the article came so late after publication.”
Kassirer said authors generally retract their own papers. "It takes a lot to retract a paper, because it's the author's paper," he said. "It's hard to identify fraud, and the editor can't be a detective. I always believed that when I get data from an author it's true, it's been scientifically tested."
The retraction came less than a week after the General Medical Council concluded its damning investigation of the study, which began in 2007 and was the longest in the council’s history. The investigation identified several financial and scientific conflicts of interest.
"[Wakefield's] interpretation could've been strongly influenced by money," Kassirer said. "Money is a powerful stimulus."