The Importance Of Accuracy And Ethics In Peer-Reviewed Publishing

I am an author of a paper, titled “The Top 100 Most Cited Foot & Ankle Articles,” which will soon be published in the Journal of the American Podiatric Medical Association (JAPMA). I came up with the idea to write this article after reading similar articles from other specialties.^1-3

I will not review the specifics of the article in this blog as I hope you will take the time to read it once published. One point I will cover here is something I have talked about in prior blogs because I believe it is critical to our future. The podiatric profession must produce high-level research to prove our value in patient care and the marketplace. The decisions we are making on the future of healthcare hopefully are based on evidence-based medicine. That point possibly is debatable, but the certainty of the podiatry’s future resides with legislative advocacy and evidence-based outcomes combined with cost effectiveness.

As my deadline for this blog came and went, I knew I wanted to cover this topic, but I was looking for a different angle to take on the discussion. I remembered an article I read earlier in the year from the Journal of Bone and Joint Surgery by Buckwalter and colleagues in the American Orthopedic Association Critical Issues Section.⁴ I found the section placement of the article to be revealing. The article is titled “How Do You Know It Is True? Integrity in Research and Publications.”

We must produce more and better research than we have, but this research must be honest and ethical, standing forthright to the highest level of scrutiny.

Buckwalter and colleagues quote the U.S. Office of Research Integrity’s definition of misconduct as “fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.”^4,5 The authors define fabrication as “presentation of observations or events that in fact never occurred; the experiments were never performed.” They then provide a jaw-dropping example of a study on the role of cyclooxygenase-2 (COX-2) specific inhibitors in orthopedic postoperative pain control.⁶ The study was published in a peer review journal and authors subsequently cited it multiple times, but it was completely fabricated.^6-8

The authors discussed falsification as “the modification of scientific data so that it supports a particular hypothesis.”⁴ They described the world-infamous case of the measles, mumps and rubella (MMR) vaccine and autism that led many parents to forgo vaccinations for their children.9 Subsequent investigations proved the data from this study was falsified. As the authors state: “This is an instance in which falsification has compromised public health worldwide.”^4,10,11

The definition of plagiarism in the article is “the inappropriate use of previously published information without attribution and with representation that the work is original.”⁴ The authors described a case of plagiarism in which two different journals published the same article with only the titles and list of authors changed.^12-14 They also discussed the subtler version of plagiarism as “an intentional failure to acknowledge previous work, intentionally incomplete or inaccurate description of methods, and repeat publication of similar work.”⁴

Discernment is critical with industry-sponsored studies, which have a 3.6 odds ratio of pro-industry findings.¹⁵ Other studies have shown similar results with industry funding and favorable outcomes.¹⁶ As the authors state, “While these reports do not necessarily indicate wrongdoing, they suggest possible increased risk of bias when interpreting results from industry-sponsored clinical trials.”⁴

Fang and coworkers’ review of retracted published articles showed a tenfold” increase in retracted articles since 1975.¹⁷ Fraud was the leading cause at 68 percent followed by duplicate publication and plagiarism at 43 and 14 percent respectively.

Buckwalter and colleagues also discussed the issue of the more than 4,500 open-access journals.⁴ The concern with open access journals is the limited or complete lack of peer review of published articles. Additionally, this method of publication is now a multimillion-dollar industry requiring authors often to pay a fee to have their paper published, raising concerns about an authentic peer review.⁴ They discussed the work of Ioannidis in evaluating published materials.¹⁸ He has shown that most Level IV case studies will be proven false or inaccurate, that up to 40 percent of Level I studies will be disproved, and that repeated randomized clinical trials are only reproducible two out of five times.

These examples of breaches in research integrity are critical to keep in mind as the podiatric profession hopefully strives to produce more high-level research. Our future most likely depends upon it but the research must meet the highest ethical standards. If not, more harm than good will occur.

References

1. Eshraghi A, Osman N, Gholizadeh H, Ali S, Shadgan B. 100 top-cited scientific papers in limb prosthetics. BioMedical Engineering OnLine. 2013;12(1):119.

2. Lefaivre K, Shadgan B, O’Brien P. 100 most cited articles in orthopaedic surgery. Clin Orthoped Rel Res. 2010;469(5):1487-1497.

3. Kavanagh R, Kelly J, Kelly P, Moore D. The 100 classic papers of pediatric orthopaedic surgery. J Bone Joint Surg Am. 2013;95(18):e134 1.

4. Buckwalter J, Tolo V, O'Keefe R. How do you know it is true? Integrity in research and publications: AOA critical issues. J Bone Joint Surg. 2015;97(1):e2-e2.

5. The Office of Research Integrity. Definition of Research Misconduct | ORI - 2015 [cited 12 September 2015]. Available from: https://ori.hhs.gov/definition-misconduct .

6. Reuben S, Buvanendran A. Preventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques. J Bone Joint Surg Am. 2007;89(6):1343-58.

7. Goodman S. Multimodal analgesia for orthopedic procedures. Anesthesia Analgesia. 2007;105(1):19-20.

8. White P, Rosow C, Shafer S. The Scott Reuben Saga. Anesthesia Analgesia. 2011;112(3):512-515.

9. Wakefield A, Murch S, Anthony A, Linnell J, Casson D, Malik M et al. RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351(9103):637-641.

10. Deer B. How the case against the MMR vaccine was fixed. BMJ. 2011;342(1):c5347-c5347.

11. Deer B. How the vaccine crisis was meant to make money. BMJ. 2011;342(4):c5258-c5258.

12. Eid K, Thornhill T, Glowacki J. Chondrocyte gene expression in osteoarthritis: Correlation with disease severity. J Orthoped Res. 2006;24(5):1062-1068.

13. Jalba B, Jalba C, Vladoi A, Gherghina F, Stefan E, Cruce M. Alterations in expression of cartilage-specific genes for aggrecan and collagen type II in osteoarthritis. Rom J Morphol Embryo. 2011;52(2):587-91.

14. Buckwalter J, Wright T, Mogoanta L, Alman B. Plagiarism: An assault on the integrity of scientific research. J Orthoped Res. 2012;30(12):1867-1868.

15. Bekelman J, Li Y, Gross C. Scope and impact of financial conflicts of interest in biomedical research. J Am Med Assoc. 2003;289(4):454.

16. Khan S, Mermer M, Myers E, Sandhu H. The roles of funding source, clinical trial outcome, and quality of reporting in orthopedic surgery literature. Am J Orthop. 2008;37(12):205-12.

17. Fang F, Steen R, Casadevall A. Misconduct accounts for the majority of retracted scientific publications. Proceed Natl Acad Sci. 2012;109(42):17028-17033.

18. Ioannidis J. Why most published research findings are false. Plos Med. 2005;2(8):e124.