The two most prestigious journals in medical research,The Lancet YNew England Journal of Medicine,they have simultaneously fallen into the same error and damaged the reputation of science in the midst of a pandemic with hundreds of thousands of deaths.
March 17, 2020, day 77 of the pandemic. The world has accumulated more than 180,000 cases and 7,000 deaths from COVID-19 since the notification of the outbreak of pneumonia of unknown origin associated with the Wuhan food market. The infectology group of the Marseille hospital, led by Didier Raoult publishes a controversialpreprint –Not peer-reviewed manuscript– showing a significant reduction in the detection of the virus in the respiratory tract of patients treated withhydroxychloroquine. The study and its findings would be discussed at length in the following weeks.
March 21, 2020, day 81 of the pandemic. Reported cases: 282,895, deaths: 11,266. Donald Trump, president of the United States, announces via Twitter that the combination of hydroxychloroquine and azithromycin could turn the pandemic around and become one of the greatest discoveries in the history of medicine. Over the next few weeks, the tweet accumulates more than 100,000 retweets and almost 400,000 likes. Hydroxychloroquine had formally entered the political agenda.
May 1, 2020, day 122 of the pandemic. Reported cases: 3.2 million, deaths: 232,864. MagazineNew England Journal of Medicine publishes a study, based on data from the US firm Surgisphere, which evaluates the risk of death from COVID-19 in patients with cardiovascular diseases.
May 22, 2020, day 143 of the pandemic. Reported cases: 5.07 million, deaths: 333,399. The Prestigious MagazineThe Lancet publishes an article on the use ofhydroxychloroquine in COVID-19 patients led by Mandeep Mehra, a well-known vascular surgeon affiliated with Harvard University. Mehra and his collaborators have used a database also from the Surgisphere company with detailed information on more than 96,000 patients from 671 hospitals around the world.
Theconclusions of this study are conclusive: the drug being tested in more than 135 clinical trials around the world is associated with higher hospital mortality. In less than 48 hours, drastic actions are taken, the World Health Organization decides to temporarily stop the hydroxychloroquine trials of its international clinical mega-trial Solidarity. In his speech announcing the suspension of the trial, the WHO director makes explicit reference to the article byThe Lancet, and the authors' conclusions on mortality. Sanofi also stops its clinical trials with the drug, the University of Oxford requests a preliminary analysis of the safety of its RECOVERY study and thousands of doctors modify their therapeutic behavior around the world.
May 28, 2020, day 149 of the pandemic. Cases: 5.7 million, deaths: 355,389. An open letter begins to circulate, signed by more than 100 prestigious scientists questioning various aspects of the study published byThe Lancet with data from Surgisphere. The#LancetGate.
June 2, 2020, day 153 of the pandemic. Cases: 6.2 million, deaths: 375,431. MagazineNew England Journal of Medicine, also the target of criticism as a result of the study it published linked to Surgisphere, publishes a "note of caution" about the study and its data, a few hours laterThe Lancet imitate the gesture. In both cases, they refer to an independent audit “commissioned by the authors”, not by the journals.
June 4, 2020, day 155 of the pandemic. Cases: 6.5 million, deaths: 385,737.New England Journal of Medicine YThe Lancet They publish retraction notes (written by the authors) for their respective articles. One of the chapters of thescientific scandal largest related to the pandemic so far. The two most prestigious journals in medical research have simultaneously made the same mistake and made a dent in the reputation of science when it is most needed, during a pandemic with hundreds of thousands of deaths.
How could this happen simultaneously to the two most prestigious medical journals in the world?
We believe that the answer lies in four key points:
- Greed for notoriety. This notoriety is sought after by publishers and authors. Magazines, once they have achieved a status that places them among the most prestigious, seek to maintain it by maximizing readings and citations. For this, it is necessary to filter and refine until obtaining only articles of great impact that guarantee a level of reading and citation in accordance with the journal. The combination of a large database, fashionable analytical processes (big data, artificial intelligence andmachine learning) and institutionsa priori Trusted (like Harvard) appears to be promising under this status view. The authors want to publish in prestigious journals because it represents an endorsement of their careers according to most scientific and academic evaluation criteria. Very few scientists manage to publish original articles in these journals, and doing so increases the possibility of attracting future research projects, increasing reputation among colleagues, and advancing in scientific careers. The excessive ambition of certain authors leads to unethical and scientifically reprehensible behavior.
- A delicate balance between rigor and speed. The dissemination of scientific knowledge is usually a slow process. Editorial peer reviews and corrections typically take weeks, sometimes even months. Then you have to add the edition and finally the publication. This process tries to guarantee the quality of the information disseminated. But in times of a pandemic caused by a new virus, there is a great demand for knowledge and the best known scientific journals (such asThe Lancet) to meet that demand. Editors and team members must evaluate a high volume of manuscripts and although shortcuts are taken, the process is difficult to shorten if you want to follow the steps, quite standardized in almost all journals. Medical staff and researchers seek to satisfy their craving for information in repositoriespreprint where manuscripts are placed without peer review, editing or fraud control.Pubmed is hurt frompreprints.
- Agenda beyond science. Many scientific journals seem to have the need to show a certain “editorial line” and play a role in public policy decisions at the national and international level. It is, of course, a tempting procedure but one that departs from its main mandate, which is the dissemination of knowledge. From this perspective, an analysis that ends the controversial use of a drug endorsed by the controversial president of the United States can be seen as a very attractive opportunity.
- The system. The scientific publishing industry has become a bizarre business. It is possibly the only business in the world in which consumers (a) send raw material free of charge to industry (magazines and publishers), (b) contribute free of charge to the processing of the material in their work as associate editors , (c) perform quality control through peer reviews and finally (d) pay to see the final product published, either through the rates ofopen access or through subscriptions to magazines.
Scientists are known to be poor at handling money. It is a perverse system that is based on making profitable the reputation criteria that are the basis of the perception of research quality, deepens in the contempt of academic activity as a productive sector and stimulates that mistaken 'goodness' that assumes that "by science ”We must help each other altruistically. We are all part of the system, partners in the scandalous employment and remuneration situation of most researchers and co-responsible for the perversion of the current system of scientific publications.
Let's learn from this hydroxychloroquine debacle
The peer review process also carries flawed practices. Reviewers rarely disclose their identity and their comments are rarely published. This facilitates unfair competition, particularly in specific fields. All in an academic environment where reputation can open more doors than the content of what is written and that encourages the culture of ‘publish or perish’ (publish or perish). This culture, which ties career advancement to the number and impact of posts, leads to inappropriate incentive-oriented behaviors.
The well-known #LancetGate has been nurtured by numerous vices in the academic and publishing world, but it gives us a good opportunity to correct them. We suggest some possible changes here.
Make manuscript reviews open and publish alongside accepted papers. This would include publishing the initial manuscript, the reviewers 'comments, the names of the reviewers, the authors' responses, and the final version. This change would make reviewers play a visible role, assigning them a public responsibility that can help their work to be both more accurate and their language more respectful. In addition, it would encourage rigor and attention to detail in the process.
This in turn should be associated with the recognition of the economic value of the work of the reviewers for publishers, which are still private companies that benefit from the work of millions of volunteers each year.
The post-publication review system has been the only effective safety net in the Surgisphere article scandal. Now is the time to open the door to an Amazon-style post-release review system that allows each consumer to see other consumer reviews before purchasing the product and that gives value to reviewers through proper recognition. Likewise, authors must be allowed the possibility of improving the manuscripts sent with revised versions, that is, giving the possibility of taking into account comments from other public reviewers. It is time to leave behind the vices typical of 19th century print publishing.
Science has advanced the way we communicate and consume. It is time for the new media and consumption to advance the way science is communicated.
Authors: Carlos Chaccour, Alberto García-Basteiro and Joe Brew