Ethics of Medical Writing: Problems and Solutions

Ethics of Medical Writing: Problems and Solutions 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

Why to publish? Fame and Fun Egoistic motives Seeing your own name in print Promotion Financial gain Improve knowledge Contacts Atruistic motives Generate knowledge

Research misconduct Fabrication, falsification, plagiarism [FFP], or other practices that seriously deviate from those that are commonly accepted within the scientific community for proposing, conducting, or reporting research. It does not include honest error or honest differences in interpretations or judgments of data Us Office of Research Integrity Nature 1999; 398: 13-17

When Captain Cook arrived in Australia, he was in the company of a local Aboriginal chieftain when he saw his first kangaroo. He asked the man, “What is that?” The chieftain, not understanding English, replied “Kangaroo?” which meant” What did he say?” in his native tongue.

Work Author Dual Bias Salami Falsification Honorary Plagiarism Ghost

Bias • Fitting a question for the results • Details of methods • Breaking the code • Interim analysis • Commercial bias • Political bias • Reviewers’ bias • Editors’ bias

Reporting bias More than half of 111 papers about non steriodal anti-inflammatory drugs trials omitted references that do not agree with them. Gotzche PC Br Med J 1987; 295: 654

Editor’s bias Studies with statistically significant results were more likely to: be published than those with negative results ( [OR] 2.32 [CI] 1.2-4.28). be published in journals with a high impact factor. lead to a greater number of publications Easterbrook et al, Lancet1991; 337: 867

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

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.”

Ann Oncol BMJ Lancet

Falsification Mendel's published figures on the genetics of peas were so closed to the expected ratio of 3:1 that it would have taken 'an absolute miracle of chance' to produce them. Hamblin TJ Br Med J 1981; 283: 1671

University of California, San Diego Rober A Slutsky, 1985 Radiology resident and Associate Clinical Professor 137 articles 48 questionable 12 fraudulent Experiments that had never been performed Radiology 1985; 154:733-5. J Am Coll Cardiol 1985; 5: 1132-7. Reported statistical analysis that was not performed J Am Coll Cardiol 1985; 5: 273-9.

Multiple authorship in surgical journals Br J Surg 1969-2001 F Abu-Zidan & S. Shaban

Honorary authors Over the last 20 years the number of BMJ authors of original articles increased, mainly because of the rise of authorship among professors and department chairpersons. Drenth JP JAMA 1998; 280: 219

Authorship Authorship credit should be based on substantial contributors to: • Conception and design or analysis and interpretation of data; and to • Drafting the article or revising it critically for important intellectual content; and on • Final approval of the version to be published Conditions (a), (b) and (c) must all be met. Ann Intern Med 1997; 126: 36-47

Participation solely in the acquisition of funding or the collection of data does not justify authorship. General supervision of the research group is also not sufficient for authorship. Ann Intern Med 1997; 126: 36-47

Salami publications Even the best salami loses flavor at its cut edges. The more it is sliced into tiny pieces, the more of its original taste you lose. Schein et al Br J Surg 2000; 87: 1610.

Dual publication Multiple publication of a given piece of work in different scientific journals is dishonest and adds nothing to the literature and progress of science. The author wants to be paid twice for the same job

Ghost authors Individuals not named as authors but who contribute substantially to the preparation of an article. William Gosset published under the name of Student because Guinness Brewery in Dublin would not let him publish under his own name (1908).

11% of articles published in six peer reviewed journals involved the use of ghost authors. 19% had evidence of honorary authorship."The practice is well –known, scandalous, and outrageous. It is a perfect illustration of deceptive authorship practices for commercial reasons. Flanagin et al JAMA; 1998: 280: 222

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

Br J Cancer 1977; 36: 550 J Surg Oncol 1979; 11: 129 Br Med J 1980; 5th July

The best antidote to plagiarism is always to cite your sources. Schein et al BJS 2000, 87: 1610 ‘If you copy from one author it’s plagiarism. If you copy from two, it’s research.’ Wilson Mizner

Causes of research misconduct Rotten apple theory Rotten system theory How is fraud detected? Peer review Replication Does not always work

Victims of fraud • Quality of medical care • Research fund misdirection • Scientific community • Co-author reputation

A search of Medline from 1996 to August 1997 revealed that 235 articles had been retracted, 86 of which were deemed to be due to misconduct. These 235 article had been cited 2034 times after the retraction notice had appeared . Farthing MJ Lancet 1998; 352(Supp IV): 11

Early independenceExcessive publication Journal's responsibilityFailure to report suspicionFailure to retain data Failure of scientific community

Prevention of research misconduct Education • Research Training • Research ethics • Publication ethics Farthing M Br Med J 2000; 87: 1605

The Research • Protocol driven • Establish contributors • Define methodology • Ethical approval • Project and personal license • Supervision Farthing M Br Med J 2000; 87: 1605

The Publication • Disclose conflict of interest • Disclose previous publication • Approval by all contributors • Submit to one journal at a time • Assume research data audit. Farthing M Br Med J 2000; 87: 1605

NIH committee guidelines: Faculties must present work frequently inside and outside the hospital. All coauthors must be prepared to back the published work. Head of Departments must take responsibility for work presented. A committee should be set up to prevent misconduct in research.

Ethics of Medical Writing: Problems and Solutions