Ethics of Medical Writing:Problems and Solutions

Fikri M Abu-Zidan, MD, FRCS, PhD, DipApplStats Fikri M Abu-Zidan, MD, FRCS, PhD, DipApplStats

Statistics Editor, Emirates Medical Journal,Associate Professor, Head, Trauma Group,

Faculty of Medicine and Health Sciences, UAE University

Generate knowledgeGenerate knowledge

Why to publish?Why to publish?Why to publish?Why to publish? Fame and FunFame and Fun

Seeing your own name Seeing your own name in printin printPromotionPromotionFinancial gainFinancial gainImprove knowledgeImprove knowledgeContactsContacts

Atruistic motives

Egoistic motivesEgoistic motives

Fabrication, falsification, plagiarism Fabrication, falsification, plagiarism [FFP], or other practices that seriously [FFP], or other practices that seriously deviate from those that are commonly deviate from those that are commonly accepted within the scientific community accepted within the scientific community for proposing, conducting, or reporting for proposing, conducting, or reporting research. It does not include honest error research. It does not include honest error or honest differences in interpretations or or honest differences in interpretations or judgments of datajudgments of data Us Office of Research Integrity

Nature 1999; 398: 13-17

Research misconductResearch misconduct

When Captain Cook arrived in When Captain Cook arrived in Australia, he was in the Australia, he was in the

company of a local Aboriginal company of a local Aboriginal chieftain when he saw his first chieftain when he saw his first kangaroo. He asked the man, kangaroo. He asked the man, ““What is that?” The chieftain, What is that?” The chieftain,

not understanding English, not understanding English, replied “Kangaroo?” which replied “Kangaroo?” which meant” What did he say?” in meant” What did he say?” in

his native tongue.his native tongue.

WorkWork

BiasBias

FalsificationFalsification

AuthorAuthor

HonoraryHonorary

GhostGhost

DualDualSalamiSalami

PlagiarismPlagiarism

• Fitting a question for the results Fitting a question for the results • Details of methods Details of methods • Breaking the codeBreaking the code• Interim analysisInterim analysis• Commercial biasCommercial bias• Political biasPolitical bias• Reviewers’ biasReviewers’ bias• Editors’ biasEditors’ bias

BiasBias

  More than half of 111 papers about More than half of 111 papers about non steriodal anti-inflammatory non steriodal anti-inflammatory drugs trials omitted references that drugs trials omitted references that do not agree with them.do not agree with them.

Gotzche PCBr Med J 1987; 295: 654

Reporting biasReporting bias

Studies with statistically significant results Studies with statistically significant results were more likely to: were more likely to:

be published than those with negative be published than those with negative results ( [OR] 2.32 [CI] 1.2-4.28). results ( [OR] 2.32 [CI] 1.2-4.28).

be published in journals with a high impact be published in journals with a high impact factor. factor.

lead to a greater number of publications lead to a greater number of publications Easterbrook et al,

Lancet1991; 337: 867

Editor’s biasEditor’s bias

At 0815 h Chicago time last At 0815 h Chicago time last Friday Jan 15, George Lundberg Friday Jan 15, George Lundberg was dismissed as editor-in-chief was dismissed as editor-in-chief of of JAMAJAMA during a brief during a brief telephone call to his home from telephone call to his home from the executive vice-president of the executive vice-president of the American Medical the American Medical Association (AMA), E Ratcliffe Association (AMA), E Ratcliffe Anderson , Jr.Anderson , Jr.

Political Bias

It was this conjunction of a sex survey with President Clinton’s impeachment that infuriated Anderson. He accused Lundberg of dealing in “sensationalism here, not science.”

LancetLancet

BMJBMJ

Ann OncolAnn Oncol

Mendel's published figures on the Mendel's published figures on the genetics of peas were so closed to genetics of peas were so closed to the expected ratio of 3:1 that it the expected ratio of 3:1 that it would have taken 'an absolute would have taken 'an absolute miracle of chance' to produce them.miracle of chance' to produce them.

Hamblin TJ Br Med J 1981; 283: 1671

FalsificationFalsification

University of California, San DiegoUniversity of California, San Diego

Rober A Slutsky, 1985Rober A Slutsky, 1985

Reported statistical analysis that was not performedJ Am Coll Cardiol 1985; 5: 273-9.

Experiments that had never been performedExperiments that had never been performedRadiology 1985; 154:733-5.Radiology 1985; 154:733-5.J Am Coll Cardiol 1985; 5: 1132-7.J Am Coll Cardiol 1985; 5: 1132-7.

Radiology resident and Associate Clinical ProfessorRadiology resident and Associate Clinical Professor137 articles137 articles48 questionable48 questionable12 fraudulent12 fraudulent

Multiple authorship in surgical journalsMultiple authorship in surgical journals

F Abu-Zidan & S. Shaban

Br J Surg Br J Surg 1969-20011969-2001

Over the last 20 years the number of BMJ Over the last 20 years the number of BMJ authors of original articles increased, authors of original articles increased, mainly because of the rise of authorship mainly because of the rise of authorship among professors and department among professors and department chairpersons.chairpersons.

Drenth JPJAMA 1998; 280: 219

Honorary authorsHonorary authors

Authorship credit should be based on substantial Authorship credit should be based on substantial contributors to:contributors to:

(a)(a) Conception and design or analysis and Conception and design or analysis and interpretation of data; and to interpretation of data; and to

(b)(b) Drafting the article or revising it critically for Drafting the article or revising it critically for important intellectual content; and onimportant intellectual content; and on

(c)(c) Final approval of the version to be publishedFinal approval of the version to be published

AuthorshipAuthorship

Conditions (a), (b) and (c) must all be met.

Ann Intern Med 1997; 126: 36-47

Participation solely in the acquisition Participation solely in the acquisition of funding or the collection of data of funding or the collection of data does not justify authorship. does not justify authorship.

General supervision of the research General supervision of the research group is also not sufficient for group is also not sufficient for authorship.authorship.

Ann Intern Med 1997; 126: 36-47

Schein et al Br J Surg 2000; 87: 1610.Schein et al Br J Surg 2000; 87: 1610.

Even the best salami loses flavor at its Even the best salami loses flavor at its cut edges. The more it is sliced into cut edges. The more it is sliced into tiny pieces, the more of its original tiny pieces, the more of its original taste you lose.taste you lose.

Salami publications

Multiple publication of a given piece of Multiple publication of a given piece of work in different scientific journals is work in different scientific journals is dishonest and adds nothing to the dishonest and adds nothing to the literature and progress of science.literature and progress of science.

The author wants to be paid twice for the The author wants to be paid twice for the same jobsame job

Dual publicationDual publication

                            

Individuals not named as Individuals not named as authors but who contribute authors but who contribute substantially to the substantially to the preparation of an article.preparation of an article.

William Gosset published under the name William Gosset published under the name of Student because Guinness Brewery in of Student because Guinness Brewery in Dublin would not let him publish under his Dublin would not let him publish under his own name (1908).own name (1908).

Ghost Ghost authors authors

11% of articles published in six peer reviewed 11% of articles published in six peer reviewed journals involved the use of ghost authors. journals involved the use of ghost authors. 19% had evidence of honorary authorship.19% had evidence of honorary authorship.  "The practice is well –known, scandalous, and "The practice is well –known, scandalous, and outrageous. It is a perfect illustration of outrageous. It is a perfect illustration of deceptive authorship practices for commercial deceptive authorship practices for commercial reasons.reasons.   Flanagin et al

JAMA; 1998: 280: 222

Latin word plagiarius: Latin word plagiarius: kidnapper, literary thief. kidnapper, literary thief. To take (ideas, writing etc) from To take (ideas, writing etc) from (another) and pass them off as (another) and pass them off as one's own" one's own" Easily detectedEasily detected

PlagiarismPlagiarism

Br Med J1980; 5th July

Br J CancerBr J Cancer1977; 36: 5501977; 36: 550Br J CancerBr J Cancer1977; 36: 5501977; 36: 550

J Surg OncolJ Surg Oncol1979; 11: 1291979; 11: 129J Surg OncolJ Surg Oncol1979; 11: 1291979; 11: 129

‘‘If you copy from one author it’s If you copy from one author it’s plagiarism. If you copy from two, it’s plagiarism. If you copy from two, it’s research.’research.’

The best antidote to plagiarism is always The best antidote to plagiarism is always to cite your sources. to cite your sources.

Schein et alBJS 2000, 87: 1610

Wilson Mizner

  Causes of research misconductCauses of research misconduct

Peer reviewPeer reviewReplicationReplication

How is fraud detected?How is fraud detected?

Does not always workDoes not always work

Rotten apple theoryRotten apple theoryRotten system theoryRotten system theory

• Quality of medical careQuality of medical care

• Research fund misdirectionResearch fund misdirection

• Scientific communityScientific community

• Co-author reputationCo-author reputation

Victims of fraudVictims of fraud

A search of Medline from 1996 to A search of Medline from 1996 to August 1997 revealed that 235 August 1997 revealed that 235 articles had been retracted, 86 of articles had been retracted, 86 of which were deemed to be due to which were deemed to be due to misconduct. These 235 article had misconduct. These 235 article had been cited 2034 times after the been cited 2034 times after the retraction notice had appeared .retraction notice had appeared .

Farthing MJLancet 1998; 352(Supp IV): 11

Early independenceEarly independence Excessive publication Excessive publication Journal's responsibilityJournal's responsibility Failure to report suspicionFailure to report suspicion Failure to retain dataFailure to retain data

Failure of scientific communityFailure of scientific community

Education Education

• Research Training Research Training

• Research ethicsResearch ethics

• Publication ethicsPublication ethics

Prevention of research misconductPrevention of research misconduct

Farthing MBr Med J 2000; 87: 1605

• Protocol driven Protocol driven

• Establish contributorsEstablish contributors

• Define methodologyDefine methodology

• Ethical approvalEthical approval

• Project and personal licenseProject and personal license

• Supervision Supervision

The Research The Research

Farthing MBr Med J 2000; 87: 1605

The Publication The Publication

• Disclose conflict of interestDisclose conflict of interest

• Disclose previous publicationDisclose previous publication

• Approval by all contributorsApproval by all contributors

• Submit to one journal at a timeSubmit to one journal at a time

• Assume research data audit. Assume research data audit.

Farthing MBr Med J 2000; 87: 1605

Faculties must present work frequently inside and Faculties must present work frequently inside and outside the hospital.outside the hospital.

All coauthors must be prepared to back the published All coauthors must be prepared to back the published work.work.

Head of Departments must take responsibility for Head of Departments must take responsibility for work presented.work presented.

A committee should be set up to prevent misconduct A committee should be set up to prevent misconduct in research.in research.

NIH committee guidelines:NIH committee guidelines: