Two independent reports published just this month call in to question the integrity of medical research publishing and the effectiveness of the peer review process.
Publish or Perish and Peer Review
Academic careers are made or destroyed on the number of publications one has in high ranking peer-reviewed journals. In many cases, it’s not the quality of the research but the quantity of publications. The industry insists that peer review is the gold standard that ensures only quality research is published. More and more, however, we are finding that this may not be the case and that economic interests often override ethical behavior.
Conflicts of Interest
Just last week, a report in the Archives of Internal Medicine found that 71% of committee chairpersons responsible for instituting clinical guidelines had significant conflicts of interest with industry. In many ways, those clinical guidelines set the tone for what will be accepted in leading medical journals. As we and others have reported before, publication bias, the tendency to publish only those studies that present positive results (e.g. support accepted clinical guidelines) in scientific journals is rampant and can seriously jeopardize patient care.
Even Worse: Fraud and Misconduct in Medical Publishing
Earlier this month a report published in the Proceedings of the National Academy of Sciences found that in 2012, one in every 10,000 medical articles published is retracted. This is compared to one in every 100,000 articles that was retracted in 1975, a ten-fold increase. Strikingly, 67% of the retractions were due to misconduct and the vast majority (43%) for fraud or suspected fraud (fabricated or falsified data, plagiarism).
The increased rate of fraudulent research retraction, combined with the high publication bias, the industry sponsored ghostwriting scandals, the recognized conflicts of interest on many peer review panels, and the overall lack of transparency in medical publishing make it very difficult for physicians or patients to trust the veracity of ‘clinical evidence’. The lines between science and profit have been blurred so much that the integrity of the once revered peer review process is questionable. According to the Richard Horton, editor of the Lancet:
“journals have devolved into information laundering operations for the pharmaceutical industry.”
A New Model
Much like the broken healthcare system where physicians are rewarded for the number of services and tests they provide rather than the quality of care or positive outcomes, medical publishing and by association medical research are tangled in skewed economic model; one that rewards quantity over quality and positive results over negative. If peer review is no longer the stopgap to medical information fraud that it once was, we need a new model. Some suggest open data and crowd-review are the answers. We’ll explore the open data debate in subsequent posts. What do you think? Should raw, health or clinical trials data be open to all, presuming personal identity can be concealed?