The health of our medical literature, which is intimately linked to the health of our patients, is facing a serious threat. Medical journals disseminate evolving knowledge, providing a compass for guiding evidence-based clinical practice. But while practitioners around the world use the medical literature to inform high-stakes decisions, the literature we rely on is in trouble. Retraction rates are on the rise, irreproducible research is far too common, and a flood of inconsequential publications distracts attention from higher-value scholarship. Academic medicine must identify the root causes of our literature’s decline and quickly implement effective solutions.
Threats to the Integrity of the Medical Literature
Influential leaders have already sounded this alarm. Speaking to the integrity of the medical literature, Dr. Richard Horton,1 editor-in-chief of The Lancet, recognized what a growing number of academics are beginning to fear: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.” Echoing this sentiment, Dr. Marcia Angell,2 former editor-in-chief of the New England Journal of Medicine, wrote, “It is simply no longer possible to believe much of the clinical research that is published.”
But isn’t this to be expected? Predictably, some of what we believe today will be debunked by tomorrow’s research: Such is the pattern of scientific progress. The principal concern here is about publications that start out wrong and disseminate misinformation because of weak peer review, sloppy science, or even fraud. One (insensitive) indication of this problem is the dramatic increase in retractions of published articles in recent years. Grieneisen and Zhang3 found that the rate of retractions in academic journals increased 11-fold from 2001 to 2010, after adjusting for publication volume and repeat offenders. In a separate study evaluating over 2,000 retracted articles from biomedical and life sciences journals, Fang et al4 found that scientific misconduct accounted for two out of every three retractions.
Another threat to the academic literature comes from its dilution. An enormous volume of papers that may be accurate but provide little information or information of little consequence are published and often pushed to readers. Though physicians could respond by restricting their reading to the highest-quality journals, these journals are often less accessible because of a high subscription price (when institutional access is not available) and the complexity of highly specialized content. Because of these barriers, many physicians end up getting at least some of their information from the free journals that show up in their mailboxes or online.
Predatory Publishing in Academic Medicine
A principal driver of this scenario is the explosive growth of a “predatory” subsegment of the academic publishing industry. Predatory journals are seemingly designed to provide one thing: rapid and loose reviews leading to speedy publication in exchange for hefty publication fees. Mass e-mails to physicians and researchers solicit submissions, and many respond in order to expand their list of publications. To test the peer review integrity of these journals, Dr. John Bohannon,5 a correspondent for Science, submitted a purposefully flawed scientific paper with meaningless results to 304 suspect journals. A responsible peer review process would have promptly rejected the paper, yet over half of the journals accepted it.5
In an attempt to curb the damage caused by predatory publishing, Jeffrey Beall, a librarian and assistant professor at the University of Colorado, created a list of predatory publishers and updates it yearly. Multiple criteria are used to determine whether a publisher makes this list, which is intended as a warning for the scientific community, including academic promotions committees. Despite this increased transparency, the predatory publishing industry continues to grow, with the number of predatory publishers on Beall’s list increasing from 18 in 2011 to 923 in 2016.6 A recent study found that predatory publishers published about 420,000 articles in 2014, representing a nearly eightfold increase from the 53,000 articles published by predatory journals in 2010.7
Unfortunately, academic physicians and scientists are easy prey for these journals. The specter of “publish or perish” hangs over faculty in academic medicine as it does for scholars in other disciplines. Both the quality and the number of publications are considered in promotion and tenure decisions. However, because discerning the quality of publications is difficult (and subjective), the number of publications often becomes a proxy of academic productivity and overall impact. As a result, practices of squeezing multiple papers out of minimal data, redundant publication, casual inclusion of multiple authors, and allowing results to retrospectively reframe research questions have become all too common. Predatory journals are poised to exploit this vulnerability.
How Can the Medical Literature Be Protected?
First, clinicians, scientists, journalists, and the public must be aware that predatory publishers exist and must look carefully at the sources of biomedical information they use. Predatory journals must be deprived of the legitimacy afforded by inclusion in prestigious databases like PubMed. PubMed, operated by the National Library of Medicine, is heavily used by researchers and clinicians to search the medical literature. Efforts by predatory publishers to gain inclusion in the PubMed database through strategies such as purchasing journals that are already PubMed indexed must be thwarted.
Second, the efforts of many promotion and tenure committees to emphasize the quality of an individual’s scholarship and deemphasize the number of publications in promotion decisions should be applauded, encouraged, and publicized to faculty. Convincing faculty that value actually trumps volume will be essential to influencing faculty behaviors that keep predatory journals in business. Concrete steps like excluding publications in journals on the predatory publishers list from consideration in academic promotions and federal agency grant reviews is an important first step. Likewise, mandatory inclusion of retractions on a CV and sanctions for repeated retractions or duplicate publications should be considered.
Finally, we recommend that organizations such as the National Science Foundation; the National Academies of Science, Engineering, and Medicine; and the Agency for Healthcare Research and Quality convene expert panels to better understand this problem and develop strategies to combat it.
Clinicians must rely on the biomedical literature to harness the best available evidence for the benefit of our patients. Diluting the literature makes it more difficult for physicians to separate “wheat from chaff,” and corrupting it causes more direct harm. The emerging predatory publishing industry threatens the integrity of this literature, while our historic approach to academic promotion makes us particularly vulnerable. It is time to confront these issues to ensure that we make the best possible decisions when our patients’ lives hang in the balance.
1. Horton R. Offline: What is medicine’s 5 sigma? Lancet. 2015;385:1380.
2. Angell M. Drug companies and doctors: A story of corruption. N Y Rev Books. January 15, 2009;56:813.
3. Grieneisen ML, Zhang M. A comprehensive survey of retracted articles from the scholarly literature. PLoS One. 2012;7:e44118.
4. Fang FC, Steen RG, Casadevall A. Misconduct accounts for the majority of retracted scientific publications. Proc Natl Acad Sci U S A. 2012;109:1702817033.
5. Bohannon J. Who’s afraid of peer review? Science. 2013;342:6065.
7. Shen C, Björk BC. “Predatory” open access: A longitudinal study of article volumes and market characteristics. BMC Med. 2015;13:230.