Portal de Periódicos da CAPES

Scientific rot: Unsustainable publishing practices threatens trust in medicine

2024; Wiley; Volume: 30; Issue: 6 Linguagem: Inglês

10.1111/jep.13989

1365-2753

Espen Heen, Henrik Vogt,

Biomedical Ethics and Regulation

The number of new scientific publications indexed in the medical research database Medline was more than 1.7 million during 2022, a sixfold increase from 1980.1 Experienced researchers, once able to keep up with most primary research within their subspecialty, are now occasionally forced to read abstracts of research syntheses so as not to fall behind.2 Web of Science and Scopus, databases with a broader scope, can display even faster growth.3 In and of itself, this boom in published works may just be a mark of a needed and wanted expansion of scientific knowledge. However, hidden in the structure of this gigantic and rapidly growing tower of information is rot—an expanding process by which medical knowledge production is undermined by serious structural faults. This rot threatens the quality of the foundation researchers rely on to build new and sound discoveries from existing knowledge. It also threatens the critically important trust that decision-makers and the public historically have had in science-based medicine. The problems are linked not only to apparent weaknesses but to the best of intentions. After the widespread implementation of Open Access Publishing and Article Processing Charges (APC)—a fee to compensate for the loss of journal subscription income—pseudo, hijacked, fraudulent and predatory journals are increasingly polluting the research world with unsupported scientific conclusions. As most researchers with an email account can testify, the journals are phishing manuscripts through flattery and lies. They may fake the whole peer-reviewing process and approve everything and anything in exchange for money.4 The number of predatory journals has now passed 12,000, according to Cabells, an institution dedicated to their blacklisting.5 The magazine Scientific American claims their share in the scientific publishing enterprise is growing fast and approaching 20%.6 One proof that academic integrity is not immune to this deluge of publications free of quality control, is the steady trickling of articles from predatory journals into PubMed search results. In several subdisciplines, their ratio is now 10%−20%. Even when such journals are blacklisted, there is no consensus about what to do with the articles already published.7, 8 A scam manuscript with deliberate and obvious errors and contradictions was accepted about every second time when submitted to dozens of journals vetted by the Directory of Open Access Journals. DOAJ is meant to be an independent body to increase 'reputation, usage and impact of quality, peer-reviewed, open access scholarly research journals globally.'9, 10 A study looking at what impact such articles have, compared to articles from renowned journals, concludes that their citation rate is lower. Still, half are cited by other research works.11 Predatory journals as well as kindred publications in the grey zones towards critical and high-quality publishing are exploiting human and academic aspirations and conflicts of interest. One of the most obvious is the institutionalized career requirement to 'publish or perish'. Academic institutions in many parts of the world face limited resources. As they attempt to pull themselves by the hair onto the global scene, the high APCs in many reputable journals, combined with an equally high rejection rate and, possibly, a long and unpredictable peer-reviewing process have become a major obstacle.12 When a journal offers an almost free seat to the last slot in their next edition, the opportunity can easily override sound reason. The strongest expression of this publication despair is the possibility to buy authorship in articles from papermills—an illicit industry fabricating what may look like scientific papers at first glance. Countries like China, Russia, Pakistan and Saudi Arabia seem to be major hotspots for this activity, and a major reason for the steep increase in retracted articles in recent years, 2023 being the absolute worst with more than 10,000 retractions.13 However, it is not only inexperienced researchers who prioritize visibility over credibility to get published, cited and funded. In a recent anonymous cross-disciplinary survey of almost 7000 academic researchers working in the Netherlands, 'publication pressure' was the strongest predictor of misconduct. Implementation of strong internal codes of conduct alongside a high perceived risk of being 'caught' were preventive measures.14 Winding back some generations, the scientific publishing enterprise was mainly run by the researchers themselves through hundreds of scientific societies and university presses on a not-for-profit scheme.2 Although proud remnants prevail, the scene has changed. Since the beginning of this century, five large publishing houses, Elsevier, Wiley-Blackwell, Taylor & Francis, Springer Nature and Sage, have steadily increased their share and are now publishing more than half of all articles at an estimated revenue of 10 billion US dollars a year. Their growth has mainly come from establishing new journals and engulfing their smaller competitors.15, 16 Although insights into the profit margin of the 'big five' is hard to attain, it is generally considered to be around 30%.17 Elsevier, the biggest fish in the pond, had a 2022 profit margin and a return on investment of 38% and 13%, respectively.18 The 2012−2022 average increase in stock value for its mother company RELX was a breath-taking 25% per year, contrasting the meagre 5% average of the 50 biggest companies constituting the EU Stock Market Index.19, 20 The unprecedented profit is made possible by free events (planning and conducting research happens mainly with funds from governments and the pharmaceutical industry), free text production (the scientists both write and format the manuscripts at the journal's requirements) and free quality control (voluntary, nonpaid peer-review by colleagues). This coexists with a high barrier cost to get a stamp of 'confidence in research' to quote an Elsevier collaborative project.16, 21 Whereas the in-house publishing cost per article page may be as low as 20−40 USD, a typical APC is nearing 2000 USD, Elsevier again beating the market at an average of more than 3000 USD.22 In several health research disciplines, three out of four dollars in publishing-house revenue are now provided by academic libraries, the majority funded by the tax-payers money.17 The goal of scientific journal owners to make such a large return on money is an obvious, massive and dangerous conflict of interest. Success goes like this: Increase your visibility through branded layouts and clever use of social media and conferences. Ensure a high proportion of articles with positive findings and regular 'ground-breaking' news. Enrich the articles with journal self-citations to boost your impact factor.8 Limit your resources spent on rejection decisions and make sure the revision process is fast-paced so that peer-reviewers get little time to scrutinize the underlying methods and data of the manuscripts. The economic interests of the industry could only be checked by very strong academic integrity. Unfortunately, the highly competitive 'prestige culture' within academia instead paves the way for protocol-study changes, p-hacking, selective outcome reporting, publication bias and the high likelihood of non-reproducible findings, the latter of which seems to be a bigger problem in the highest ranked journals.23, 24 In sum, the gatekeepers of the quality of health science are compromised. Considering the damage this can potentially do to trust in science and academia, we register surprisingly little alarm and debate related to the topic. One must ask: Is this because it is a painful subject for science and academia to confront, and perhaps, also a subject that journals are not very interested in exposing? And yet, we all agree that health research ought to be about carefully investing collective resources for improved health and the common good of humanity, not about counting money, publications, citations and visibility. We are not heading towards scientific and academic success in the long run if we continue along this path. The risk to human health as low-quality publications are churned into the scientific soup is obvious. Taking a broader view, there is a threat to human collective learning, the hallmark of our species, which science has refined. Building layer upon layer of knowledge through time is a key human enterprise. A structure based on unfit building materials and sloppy practices will create problems for future generations. How do we stop active scientific rot from progressing into the scientific fabric? There are preservatives to instil: Researchers and academic institutions could shift focus from publication quantity to quality, from 'my' study to collective evidence synthesis, from counting citation metadata to assessing long-term impact. In Latin America, the not-for-profit university press has never given up publishing, possibly because articles in Spanish and Portuguese have had less commercial appeal. Their APCs are just a fraction of what journals in Europe and the US are charging, without obvious compromise of the quality control.21 There is a paradox that the business of scientific publishing has become so profitable during the area of digitalization and democratization of publication technology. Subsequently, science and academia do not need to—and should not—be the least powerful player in this game. Researchers could direct their free work in new directions.25 Collaborative university structures may redevelop their previous publishing systems. Establishing tailored standard software and infrastructure would surely require some substantial start-up costs. But with the prospect of AI-assisted editing and proofreading, organizing open science this way should not require more time from the researchers than what the interaction with journals demands at present. Public rivals in the publishing enterprise should soon puncture the balloon of piracy and bring down the profit of commercial players to a reasonable level. The bulk of saved money could be diverted to rigorous open research platforms with adherence to the FAIR (Findable, Accessible, Interoperable and Reusable) principles. Here, open data sets, version control, and syntax on all analyses performed can thrive. Like with clinical trials, it should be mandatory for any health study to start with a published protocol or a registered report.26 Independent—fairly paid—reviewers would provide open feedback at every stage of the research process till the final manuscript decisions. The research quality could be rated with similar, standardized tools as already used in the assessment of study quality in systematic reviews. Detailed, predefined meta-data templates describing key variables in studies would pave the way for increased use of AI in finding, aggregating, and analysing evidence. Crucially, building on the best from initiatives like Pubpeer and the former Publons, we could elevate the role of the peer-reviewer in the scientific culture by documenting and weighing this particular quality-assurance work heavily in the requirements to obtain tenured jobs at academic institutions.27 Review work for high-quality journals should be especially rewarded, while review work for predatory journals should be sanctioned. If the quality and impact of the scientific activities are more important than publication quantity, and peer-reviewing contributions a merit, we may again reach a future where it makes sense to read primary research, confident in the comprehensiveness and conclusions it conveys. It may sound like a dream, yet it is a tangible possibility. Turning it into reality will require much personal courage, wise university leadership, visionary politicians and a collective willingness to fight unhealthy commercial and academic interests over time. The reward may be the next level of human interaction through sustainable science and academia, reignited with trust, that can last generations. Ad notam: When researching the facts for this article, two of the relevant references turned out to be retracted and two others were published by MDPI, which is now under watch for possible predator-like activity. Both authors are medical doctors with clinical licences. Espen Heen has a background in internal medicine and psychiatry. He has for many years been a teacher in medical ethics, community medicine, and global health and established and led a regional INGO, supporting capacity building within healthcare in Eastern Africa. His research experience is related to nutrition, neonatology and research methods. He currently holds a PhD research fellow position focussing on methodological evaluation of iodine nutrition assessments. Henrik Vogt's education and working experience revolves around medical general practice, history, philosophy, medical ethics, as well as journalism. His research interests are directed where healthcare ethics (with concrete, clinical consequences) are influenced by deeper questions and 'blind spots' in the philosophy of medicine and science. He currently holds an associate professor position at the department. The authors declare no conflict of interest. Data sharing is not applicable to this article as no new data were created or analysed in this study.