Essential components of responsible research include moral
value related to ethics, professional standards, and research
culture at institutions & peer review at journals where it is evaluated
6th PAME National Conference on Medical Journals
LAHORE: Delivering his Keynote lecture at the inaugural session of 6th PAME National Conference on Medical Journals organized by PAME in collaboration with University of Health Sciences and Eastern Mediterranean Association of Medical Editors (EMAME) Prof. Khalid Khan a noted researcher and former Chief Editor of British Journal of Obstetrics & Gynaecology advised the medial editors to prefer Open Peer Review system to improve publication process and ensure transparency. This is the way the world is now moving, he remarked. The title of his presentation was “Responsible Medical Research & Publications”.
Held at the UHS Campus on October 21st the conference attracted a large number of editors, faculty members and postgraduates who benefitted from the rich experience of distinguished editors, from UK, Canada, Iran, India, Cairo from UAR, Bahrain and Spain besides editors of medical journals from Pakistan. The speakers also included former Presidents of World Association of Medical Editors, and current President of Eastern Mediterranean Association of Medical Editors.
Prof. Khalid Khan
Prof. Khalid Khan who after graduation was trained in epidemiology at McMaster University, have authored two books i.e. Systematic Reviews to Support Evidence-Based Medicine and Integrity of Randomized Control Trials, spent twenty five years in UK holding consultants posts in NHS and purely Academic Positions, editing journals and is now faculty member at University of Granada Spain spoke from his rich experience and discussed various important issues related to scientific publishing. He pointed out that he published is first paper in 1990 and first systematic review in 1995 and investigated numerous research studies and evaluated over ten thousand manuscripts prior to publication which provided him an opportunity to look at all the aspects very closely which also proved to be a great learning experience. The question of integrity in research and publications is extremely important. Medical Journalism, he further stated, is a combination of Art and Science.
Medical graduates during their training are not at all exposed to medical editing and we have all learnt through experience. After the research is completed, the manuscript is prepared for publication following the IMRaD. During initial screening and internal peer review the editorial staff also looks at tables, figures, whether the authors have followed the journal instructions, it is compelte submission with all the essential documents. At this stage the paper may be rejected, the authors may be advised to revise it or it may be accepted for external peer review before publication. The authors try to impress with title and abstract ensuring that it has a good impact in structured abstract which is then further improved with discussion and conclusions. The manuscript may be published once it is approved after external review by subject experts.
He then shared the story of Retraction of a paper from Stanford University USA last year. There were complaints about it and these complaints were made again and again. It took ten years to complete the investigations and as a result this paper was then retracted. The author, head of the university had to resign, leave his post in the interest of science. Retraction of published papers is common all over the world and Pakistan is no exception.
Speaking about the essential components of responsible research, Prof. Khalid Khan listed moral values which is related to ethics, following professional standards, the research culture at the institution where the research is conducted and finally the journal where this research is evaluated through peer review system which leads to its publication. If research is conducted following appropriate standards, there are no problems when transparency is respected. However, there is a grey zone as well wherein the errors if any are discussed with colleagues, honest errors can be responded and corrections made, still there is no problem. When complaints are received, they are investigated, there should be no cause for concern.
However, the problem arises when these errors are made intentionally, fabrication, falsification of data. Genuine errors in published papers may be reported and the authors might suffer the consequences for alleged fraud. In some cases no complaints are made and such research publications remain available to the readers and the authors continue to cite them. At the British Journal of Obstetrics & Gynaecology as well as at all other standard peer reviewed journals, the submitted manuscripts are evaluated by editorial team following the proper Guidelines by World Association of Medical Editors (WAME), International Committee of Medical Journal Editors (ICMJE) and Committee on Publication Ethics (COPE). It is the responsibility of the journals to do a thorough review and detailed scrutiny of submitted manuscripts before publication. It is extremely important that the Journals should strengthen their Evaluation and Peer Review System. Finally some papers are published while others are rejected. All these bodies like WAME, ICMJE and COPE are self-regulatory bodies with no legal role in publications. At BJOG I was involved in a large number of studies which were evaluated.
This system also provides opportunity to train others. Most of the editors have had no instructions on medical editing, peer review and any other aspect of publications during their medical school training. We all learnt it from experience. It is self-learning through attending conferences, workshops through which one can acquire knowledge and hopefully my lecture will also contribute to this training. Prof. Khalid Khan said that peer review is very important but we all know that it is compromised that is why many papers are retracted every year. Last year a record number of published papers were retracted. Through peer review people wish to know how the manuscripts are processed for publication, they may also try to detect any fraud. However, most importantly it is academic requirement and people need it for their academic progress and master how research is published. Through this process some people become experts in peer review. They have no competency and required training because initially they lacked this training but through experience acquire this knowledge.
Editors, he further stated, are not robots, they are human beings. They have their own opinion scientific and personal. Editors should be aware of their personal biases and competencies affecting the peer review process. Sometimes even inappropriate review leads to publication of manuscripts. It is said peer review can be improved and it must be aligned to responsible conduct. Single blind peer review is not at all good, it hides the reviewer. Open peer review is the best and the reviewer’s comments should be available. When the editors and peer reviewers evaluate the manuscript they look at it i.e. is this something new, is it true and can it be further improved. Use of check list is encouraged to ensure open-ness and transparency. Registration of clinical trials before the enrollment of patients in the study is essential which ensures transparency. Results should not be manipulated, it is now being advocated that the public and patients should be involved in peer review process. Not only they should be enlisted as co-investigators just like lay people being inducted as members of Ethics Committees, Institutional Review Boards but they should also be involved in evaluation. He also referred to publication of studies related to antimalarial during the Covid pandemic which later proved that instead of any benefit, they did harm and eventually increased mortality.
Integrity in research can be an issue at any stage. Various studies have showed that 10-15% of scientists have admitted that they were engaged in questionable research practices. In the days to come these check lists related to integrity of research will be available through automation just like we check plagiarism. The main objective of manuscript evaluation, peer review, editor’s assessment, rejection, revision and the whole publication process should be to highlight the element of transparency to ensure confidence remains and is also increased. However, compromise in peer review, integrity issues, questionable publishing practices are being now discussed openly in the media. Sometimes it forms the breaking news on the electronic media and social media. All this, Prof. Khalid Khan opined, can be avoided with prospective registration of clinical trials, data sharing, at the time of publication, if professional standards are followed, professional ethics are upheld, and authenticity from the institutions where the research has been conducted is ensured through Ethics Committees/Institutional Review Boards. It must be ensured that peer review and evaluation process is at par with the details which are submitted at the time of trial registration. It will improve confidence and faith in science, scientists and in published material.
Doubts about the peer review process are now forcing the Funders to insist that the studies should be available on Pre Prints to ensure transparency. Journals are also moving towards collaborative peer review. He concluded his presentation by highlighting the importance of Pre Prints, Collaborative Peer Review and Post Publication Peer Review. Even as published papers can be amended and improved with time. Integrity in research is the responsibility of everyone involved, let us move towards ethical publishing to ensure transparency. Start introducing Open Peer Review, make it possible to give feedback to the researchers to improve even their published papers, he remarked.
Note: This presentation is also available at: https://youtu.be/Dco4wCPJemk
