Medical Ethics Journal Infected by Anti-Vaxx Fraud (guest post by Christian Munthe)

In a couple of recent posts at his blog, Philosophical Comment, Christian Munthe, a professor of philosophy at the University of Gothenburg, has detailed the progression of a publication scandal at the Indian Journal of Medical Ethics. Below is a guest post* I asked him to write, describing the situation and issues at stake.

[Anthony Moman, “Clarity” (detail)]

Medical Ethics Journal Infected by Anti-Vaxx Fraud
by Christian Munthe

In the last few weeks, a publication ethics scandal has been brewing, as an author, calling himself “Lars Andersson”, who has published a number of articles in various medical and health research journals with a consistent anti-vaccination (“anti-vaxx”) theme, has been exposed as a fraud. The author’s real name is not “Lars Andersson” and his stated credentials and affiliation to Karolinska Institutet are completely fake. This would normally be nothing for philosophers to worry about, except noting yet another publication ethical and research fraud scandal in the field of medicine. However, this time, the scandal touches the applied part of philosophy, as the author has recently got an article published in a medical ethics journal, namely the Indian Journal of Medical Ethics (IJME).

One of the challenges in his field of bioethics is to include and empower researchers and institutions from low- and middle-resource settings. The leading journal, Bioethics, runs the side journal Developing World Bioethics as a way of addressing this concern, and over the past few years a number of other journals have appeared, based at institutions outside of the most affluent parts of the world, with a natural focus on bioethical issues of relevance to such settings, as well as global health related issues. The IJME, which has quickly been rising in the ranks and attracting respect for its consistent work, is one of these.

Unfortunately, the “Lars Andersson” incident casts serious doubts on the standards of this journal, both in regard to the review and publication process, and the editor’s eventual decision not to retract the article and not to disclose the true identity and affiliation of the author.

Ole Petter Ottersen, president of the Karolinska Institutet, remarks on the incident here, noting that “leading researchers with intimate knowledge of the vaccination field have identified serious flaws in the published report and its conclusion” and that “a publishing system that allows papers to be published under false identities and affiliations might easily foment distrust of the medical publishing process and of research in general.” The IJME editorial team declared the deception “unacceptable” in a “Statement on Corrections,” but “decided to keep the article on the site as issues raised by it are important and discussion on it is in public interest.” The author’s true name has not been revealed. IJME editor Amar Jesani defends the journal’s decision here.

I have explained at greater length most what I find problematic about the IJME’s actions and stance in two blog posts here and here. In short:

  • A journal focusing on applied ethics decides to consider publishing an empirical article in the field of epidemiology, vaccination, HPV-virus and cervical cancer prevention. One of the cornerstones of academic publishing is that journals (and book series) keep to topics in which they claim expertise. This is necessary, among other things, to ensure high standards of quality in the selection of external reviewers, so that articles undergo appropriate peer review. The same, of course, also holds if a metaphysics paper would be submitted to, say, The Lancet. The only acceptable editorial action in any of these cases is to issue a desk rejection on the ground that the submitted article falls outside the journal’s topical area and urge the author to submit to a more appropriate journal. The IJME editorial management violated this elementary principle.
  • The IJME assigned two editors to handle the submission, one who lacks a PhD, and one who lacks any research qualifications in the general area of the article. They reportedly consulted an external expert on statistics, but no expertise in the area of the article. This is a very clear illustration of the importance of adhering firmly to the principle of keeping to a journal’s topical area of expertise.
  • The IJME editorial management made these decisions in spite of the fact that the area of vaccination research for several decades has been under onslaught from an avalanche of fraudulent papers that so-called antivaxx activists, often connected to what has become a flourishing industry of quackery under the guise of “complementary” or “alternative” medicine, try to peddle to all kinds of journals. The tactic is well-known from the days when the tobacco-industry did its best to plant doubts over the health risks of smoking, and lately we have had a similar experience from so-called climate skeptics. In all such areas, where partisan politics and/or business interests are directing what research papers are being submitted, it is of the utmost importance for serious journals to be extra careful of rigorously upholding strict standards. The IJME management has failed to observe such vigilance.
  • When the IJME editor, Amar Jesani, was informed about the fraud of the article, he decided not to retract it, but only to remove the author name and affiliation from its heading. (See their statement here.) But it is, of course, elementary for publication ethics to retract all publications where fraud has been proven. This goes not only for manipulation of data or plagiarism, but also for other kinds of dishonesty, such as untrue claims regarding the existence of research ethics permissions (a standard ground for retracting articles).
  • When Amar Jesani was criticized because of this, he claimed that he now knew who the author is, but that this identity and the academic affiliation was being kept a secret due to the criticism that would otherwise be wielded against the author, and that knowledge of author identity and affiliation is of no importance of the assessment of a research publication. This is, of course, complete nonsense and after-the-fact rationalization. The author has lied to Jesani, and then offers an explanation that, first, Jesani has no reason to trust and, second, has no valid bearing on the case anyhow, as researchers who publish have to accept that there will be criticism. Moreover, knowing the identity and affiliation of authors is vital for the assessment both of the truthfulness of claims regarding the how the research has been undertaken, and of conflicts of interest. Finally, it is of vital importance for the research community to be informed about the names and affiliation of proven research fraudsters, so that other journals, researchers, and research institutions can take appropriate precautions, and so that the research institution of the fraudulent author can take appropriate disciplinary action. The apparent fact that the editor of IJME is unaware of such basic things is deeply troubling, and undermines the status of the journal.
  • The editorial management team of IJME has concentrated its efforts entirely on trying to deflect criticism, mostly in a dishonest way. They have tried hard to shift the topic to be about what Karolinska Institutet has done or not done regarding detecting the fraud (“he seems to have deceived the KI too, and that since 2014. Why are you not talking about the flaws in the way the KI is run?”), but of course this has no bearing on what the IJME should do. They have also, in a rather disturbing fashion, chosen to answer critiques against Amar Jesani, not by presenting arguments, but by devotedly assuring how highly they regard the ethical standards of their editor. This unconstructive way of handling justified criticism, of course, adds to any suspicions that might have been awakened towards the journal’s editorial standards due to the other events listed above.
There is still time for a shift of position to save the journal’s reputation, albeit the window is rather narrow due to the unprofessional actions of the editorial management so far. I have been informed that many members of the IJME editorial board, several of which are well regarded international researchers in bioethics (many of which are philosophers), have contacted the editor and his team about this issue. Hopefully, we will in the near future see a forceful shift of policy, maybe also some changes of the editorial management, to get the IJME back on its formerly very promising course. I, for one, very much hope that this will occur, as applied ethics very much needs high-standard journals based in more than just the wealthiest parts of the world.

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