Medical Journals should look for other sources of revenue than advertisements to avoid Conflict of Interest- Prof. Farhad Handjani

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Publication Ethics Conference Proceedings-IV

Medical Journals should look for other sources of
revenue than advertisements to avoid Conflict
of Interest - Prof. Farhad Handjani

Editors are accountable and should take responsibility
for what they publish - Dr. Charlotte Haug

SHIRAZ (IRAN): The first session on Day two of the conference on Publication Ethics organized by Shiraz University of Medical Sciences in partnership with COPE UK was chaired by Dr. Mohammad Irfan from Pakistan and Dr. M. R. Panhehshahin from Iran. Foirouzan Akrami was the first speaker who discussed Iran’s challenges in protection of Copy Rights.  It was stated that protection of intellectual property rights leads to job and growth of economy.  He also emphasized the importance of capacity building, promotion of culture of early childhood education besides providing economic, cultural and legal infrastructure.

Dr. Firoozeh Yaganeh from Iran spoke about redundant publications among Iranian English Medical Journals. Duplication publication, it was stated means  same hypothesis and same results while Salami slicing means splitting the data  from the same study into more than one papers while redundant  publications are waste of time and it also destroys the journal reputation. They looked at  480 manuscripts and found   twenty five duplicate publication during  2006-2009 and  34 during  2010-2013 and the total duplication publications during these two periods were  fifty nine which accounted for  6.1%. It may be a bit higher if one takes into account the articles published overseas by Iranian authors. It also showed that the authorities in Iran have been successful in checking duplicate publications through education and creating awareness about scientific misconduct.


Dr. Behrooz Astaneh along with Dr. Zoe Mullan and Prof. Farhad Handjani
chairing one of the scientific sessions during the Congress on
Publication Ethics held at Shiraz recently.

Dr. Parisa Khani discussed frequency of reporting ethical protection in human subjects in manuscripts published in Iranian Journal of Medical Sciences. They reviewed 1460 human subject articles of which 52.9% were in Persian and the rest in English. 443 reported ethical approval, 686 mentioned about informed consent, 341 declared conflict of interest, 595 manuscripts mentioned about the financial support. It also showed that English Journal reporting was better and over the years we have made some improvement in all these areas.

Prof. Farhad Handjani was the next speaker who talked about ethical advertisement policies of medical journals. He was of the view that the advertisements should carry clear information and it should also be evidence based. However, when the journals sell the reprints of the manuscripts published and make money, it brings in the conflict of interest. He further stated that it is important to carefully look at the quality and contents of the advertisements. Leading journals like BMJ and JAMA who are members of the ICMJE as well continue to get huge revenue from the advertisements. Advertisements must contain information regarding indications, contra indications, and dose but in practice, many of these advertisements make misleading claims.  Prof. Farhad Handjani suggested that the medical journals should explore other sources of revenue than advertisements to minimize the conflict of interest. Participating in the discussion Mr. Shaukat Ali Jawaid from Pakistan remarked that in Pakistan when Tegaserod was launched, the company made exaggerated claims regarding its efficacy in IBS and all the gastroenterologists promoted this drug by name but eventually it had to be withdrawn after a year. He was of the view that it is not only the pharmaceutical companies but the members of the medical profession are also equally guilty in such unethical practices.

Dr.  Zoe Mullan described Lancet experience on confronting ethical misconduct. In the first case she presented, was related to case series of twelve children with regressive development disorder and intestinal abnormalities. In eight children parents associated onset of symptoms with receipt of MMR vaccine. This paper was published in 1998 despite disenting remarks by two of the authors. In February 2004 the journal received allegations of lack of ethics approval, bias in the study design and conflict of interest.  The journal asked all authors to respond to these allegations and also asked the institution concerned to conduct investigations. In March 2004, ten of twelve authors formally retracted interpreted association between MMR vaccine and the syndrome described.  In January 2010 General Medical Council in its hearing found three authors were involved in ethical lapses, dishonesty and conflict of interest. Hence this manuscript was eventually retracted by the editors in February 2010.


Dr. M. Irfan along with Dr M.R. Panjehshahin from Iran chairing one of the
scientific sessions during the Publication Ethics Congress held at Shiraz, Iran.

What we learnt from this episode, she said, was that never publish such papers with small number of patients, descriptive findings which has the potential of misinterpretation. It was also decided to publish source of funding of such studies besides information about potential conflict of interest. She also described two more cases in detail and said that since then the journal now requires registration of randomized trials before the start of the study, submission of a pre-specified protocol for scrutiny with the paper and confirming the newly added fourth criteria for authorship by the ICMJE.  We also learnt that one should contact as many bodies and institutions as possible for help and assistance in dealing such cases. If it is impossible to resolve, one should avoid withholding important data to ensure full transparency.  She concluded her presentation by stating that one should take all alerts of possible misconduct and other ethical concerns seriously.  Regular meetings to consider difficult cases, one should be  open and transparent regarding editorial decisions and if still there are some doubts, the case should be referred to COPE for advice. Responding to a question as to why Lancet published the first case when two of the authors had dissenting notes, Dr. Zoe Mullan said, it is very rare. It was also pointed out that the Ethics Committee job is very difficult. In the past  there was a trust between the editors and authors but unfortunately this trust is now being betrayed quite frequently.

In the second session which was chaired by Prof. Farhad Handjani, Behrooz Astaneh and Dr. Zoe Mullan, Dr. Bibi Sedigheh from Iran talked about inadvertent plagiarism and ethical misconduct. She was of the view that at times it is inadvertent due to over reliance on others. It is useful to know the reviewers. If the reviewers have been suggested by the authors, one should ask them about their published papers. She further stated that students should be taught how to avoid plagiarism. Many students do not realize the importance of time and leave the manuscript writing till the end and then they are under pressure to publish, hence the temptation to indulge in scientific misconduct. In another case on author submitted a manuscript to IJBMS and also suggested three reviewers. When favorable comments were received, it was detected that it was the author himself who had sent these comments but made them look as if they were from the recommended reviewers. The next presentation by Ali Mohammad and colleagues was on comparison of five plagiarism detection software’s. It was pointed out that iThenticate software was one of the best which is more accurate. It is superior as it also covers some other languages than English alone; it is also easy to use. He also talked about the salient features of other software’s like Plagiarism Checker X and Plagiarismdetection.org and pointed out that one should go into details of plagiarism instead of just looking at the similarity index score.

Dr. Ali Vahadani from UAE spoke about research and publication ethics. Giving details about Iranian Red Crescent Medical Journal, he said that it is published by Iranian Hospital in Dubai and in 1998 its title was changed. Since 2011 it is a monthly publication and our manuscript processing time is one to three months. We use iThenticate software for detecting plagiarism.  Best defense, he said, was to educate the authors, editors and reviewers. These guidelines need to be customized and improved for different regions.

Dr. Charlotte Haug made a presentation on Corrections and Retraction.  She referred to a Japanese researcher who claimed to have found an easy way to grow stem cells in his paper. This could not be replicated. When the institution was contacted, it was investigated and this paper was retracted in July this year. Eventually the author Yoshiki Sasai committed suicide. She then quoted Rennie D who had reported that science does not exist unless it is published. Publication is integral to research. Advance in science, she stated,  is seldom made by single researcher but it is by various scientists who make the difference.  She highlighted the importance of quality and integrity of scientific literature.  The first retraction by authors was reported on June 24th 1756 and since then the number of retractions has been going up. Since 1997, Science, Nature have made most of the retractions. Editors, Dr. Charlotte opined, are accountable and should take responsibility what they publish. When the editors have clear evidence that the findings are unreliable, the paper should be retracted.  Such publications report unethical research.  If findings have been published somewhere else without proper cross referencing, it also constitutes plagiarism.

Continuing Dr. Charlotte said that one should not retract a paper just to punish authors who misbehave if small part of the article reports flawed data. When change of authors is required but there is no reason to doubt the validity of the findings it should be accepted. Honest errors have to be corrected. Retraction notice, she said, should be linked to the retraction article and it should also be clearly defined as to why this manuscript was retracted. The best practice is let the authors retract themselves but if they do not, then the Editors should retract such manuscripts. The retractions do show up in the PubMed. She also referred to threats from the lawyers and in case of total silence from the authors; the editors have to find a way. Sometimes the publisher’s lawyers wish to retract the paper to avoid law suits.

Ms Sarah Masoumi discussed ethical standards from the viewpoint of various indexing systems and emphasized the importance of the journal being indexed. As a result of international recognition, indexing in important databases, she said, will increase the visibility, will have increased submissions and reputation of the journal will also increase. ISI, Medscape, DOAJ, PubMed Central all have their own requirements for indexing of journals. It is related to quality, quantity, and some  technical requirements.

Continuing Ms Sarah Masoumi pointed out that ISI looks at timely publication, international editorial board, per review system, editorial contents, and citation analysis. Medline looks at scope, quality, international editorial board, production quality, types of contents, geographic coverage.  PMC looks at scientific quality, technical evaluation, XML files but it has no ethical requirements and no check for ethical issues. DOAJ look at if the journals follow WAME and COPE guidelines. Scopus looks at contents, peer review, regularity of publication, reasonable contents, publication ethics and malpractice statement. Statement regarding following WAME, ICMJE and COPE guidelines should be mentioned.  She also talked about PERK guidelines on publishing ethics.  Index Copernicus   looks at scientific quality, standard, printing quality, website scope, and editorial quality. Scopus was the only database which made publication ethics mandatory.  WAME, ICMJE, COPE guidelines can be used and they are all very helpful.  She further stated that Editors, Reviewers, Publishers and Society at large all are responsible for ethical behaviour. One should know how the cases suspected of scientific misconduct are to be investigated. There does exist some gap between the indexing systems and journals. Increased interaction between them and training of authors, editors as well as reviewers will bridge this gap, Sarah Masoumi remarked.

In the last scientific session Dr. Majid Asadi Samani speaking about internet scam and fraudulent publications said that one must pay attention to the website of the journals. Make sure that you have access to the past issues of the journal or contact the editor for verification. Evaluate the overall design of the website and if any one offers to publish your article fast, reject this offer.

Dr. Leila Ghahremani discussed difficulties of producing evidence based journalology. Editors, she said, are gate keepers of research and reviewers are supposed to increase the validity and quality of reports.  To study the peer review system in Iran, they included 51 journals in the study. Editors were contacted every two weeks. One article was selected for open peer review and one for blind peer review. Nine editors felt that blind peer review is the best while five editors said that they have not yet taken a decision. Medical editors, it was stated, should pay more attention to improvement and publication. They want to improve the quality and they were also competing with citation of their journal.  Dr.Behrooz Astaneh opined that Editors should compete to have evidence based for which we need co-operation to produce evidence.

Dr. Trish Grove from BMJ talked about ethical aspects of Open Access Publishing through video conferencing from London  She discussed at length the advantages and disadvantages of open access and history of open access. The gold standard open access publishing is the documents published by the journal while green stands for self archiving of authors work including those accepted for publication.  From 1992 to 2009, there were over five thousand open access journals. In predatory open access it is the authors who pay. Open access, she further stated, has given birth to many online publishers and many of them have no peer review system at all. She then referred to COPE principles of transparency in scholarly publishing. Peer review, process, she said, should be clearly explained. Editorial Board should be listed and editorial team contact information should be given. Author’s publication fee should also be clearly stated besides explaining the sources of revenue as well as the advertising policy. Publishing schedule, frequency of publication should also be clearly mentioned, she added.

During the discussion sanctions against Iran having an adverse impact were also discussed whereby   ISI database was not giving access to Iran. COPE, it was stated, has a policy of more inclusive and allowing reasonable access to resources. Some of the participants felt that such issues like sanctions against Iran should be discussed by COPE members. However, COPE council members pointed out that it is an independent organization which does not interfere in administration. Journals should always look at the contents on the paper; there are some legal issues in which COPE was not at all involve

Prof. Lorraine Ferris head of Ethics Committee of WAME made a presentation through video conferencing from Toronto and discussed Editors dealing with errors and allegations of research misconduct.  This presentation highlighted the fact that editors have an important role in safeguarding integrity of scholarly publishing. They should not pass any judgment until all the facts have been collected.  They should recognize the possibility of problems and be prepared, educated how to deal with such problems. They should stay involved in these issues till conclusion or decision is made. They should be fair, sensitive, respect both complainant and those against whom allegations are leveled. Provide both the parties an opportunity to respond, discuss both the responses before deciding about the next step. They must ensure to handle matters timely and take appropriate actions. Errors are mistakes, inaccuracies. Journal website, it was pointed out, should have definition of research misconduct. The editors should also ensure screening for plagiarism and image manipulation.  Editors, it was further stated, have an important role in safeguarding integrity of scientific record.

Omid Asemani spoke about the right of intellectual possession or academic conventions to be the criteria of authorship while Dr. Al-Taitoon from Bahrain highlighted the importance of educating the editors on ethics. The editors, she opined, must understand morality; they should know their rights, roles and responsibilities. They are also expected to educate the reviewers on what and how they are working. Editors, she concluded, should be honest and when in doubt consult the support staff, organization and the respective institutions.