A team of Australian medical writers who analyzed four decades worth of retractions has reached the conclusion — we trust you’re sitting — that people in their profession are more honest than, well, the rest of us.
According to the authors, articles in the medical literature are substantially less likely than other papers to be retracted for any reason, including mistakes or misconduct, if they have a medical writer as a declared co-author. The same applies for articles produced with the help of drug and device makers, either financial support or authorship assistance, the study found. And when both occur, retractions are vanishingly rare. Indeed, they found no instance of a retraction resulting from misconduct.
The study, which appears in Current Medical Research & Opinion, has flaws, which we’ll lay out in a minute. But the main conclusion strikes us as reasonable and not terribly surprising. After all, industry may have a bad habit of trying to hide its fingerprints in publishing, but the stakes of perpetrating fraud in the process are orders of magnitude greater than the PR bruises of poor disclosure.
What’s more, medical writers are, in the end, largely transcribers of the ideas, often communal, of others. Going off the reservation isn’t encouraged. And they’re not involved in the generation or analysis of data, so whatever mischief they can effect is limited. Plagiarism, perhaps, but fabrication and other fraud, less likely.
The researchers, led by Karen Woolley, CEO of ProScribe Medical Communications (which “specialises in writing scientifically credible, high quality documents” for clients in pharma, biotech and academia), found 520 retractions in Medline of papers published between 1966 and 2008 that involved human subjects, or about one a month over the 42-year-period. Of the 520 papers, only 463 made the analysis — studies that had “both the full original retracted publication and the associated retraction notice available online.”
Of those, 213 (46%) were retracted because of misconduct, according to the researchers. That figure is nearly twice as high as the 28% found by Liz Wager and Peter Williams in their new paperon how journals deal with retractions — raising the uncomfortable possibility that fraud is more common in the literature involving human subjects.
In the Woolley study, of the papers with acknowledged medical writers, 23 were retracted, but only two involved misconduct. Of the 36 retracted articles (8%) with industry support, 8 (4%) involved misconduct. And when medical writers and industry support collided, the researchers found only two retractions, neither of which involved misconduct.
Retractions for fraud or other reasons occurred much more often with papers having one author, articles from countries considered to be low or middle income — Iran, China, India, etc. — and papers with an author who’d had at least one other retraction. All of which matches our brief experience covering this subject and, as far as the first part, makes perfect sense: after all, it’s easier to get away with fraud when there’s no one to rat you out.
The authors present some rather unconvincing odds ratios to stratify the incidence of retractions — papers that did not receive industry support were a whopping 3.7 times more likely to be retracted for misconduct than for an error. But it’s probably best not to dwell on those since they’re really just statistical tinsel.
Which brings us to those flaws. The biggest caveat that we can see is that, although the study claims to be looking at retractions linked to medical writing, what it’s really looking at is retractions linked to fully disclosed medical writing. Valuable information, sure, but a much different breed of marsupial.
We spoke with retraction scholar and medical writer Grant Steen about the paper, and his reaction was cool:
I think [Woolley is] trying to give a free pass to medical writers based on very flimsy evidence.
The authors declare the two major limitations of their study to be its exclusion of papers written in a language other than English and of articles that did not address non-clinical issues.
We also can’t help but chuckle at the last couple of lines of the paper, an off-putting blend of self-serving defensiveness, faux piety and meaningless expression.
The results from this study justify increased attention on factors that were significantly associated with misconduct retractions, such as the absence of declared medical writers, the absence of declared pharmaceutical industry support, single authorship, and the first author having at least one other retraction or an affiliation with a low/middle income country. These results suggest that the risk to the integrity of the literature from non-commercial factors must be managed with as much vigor and rigor as the risk from commercial factors.
So, medical writers and pharma industry good, academics, disadvantaged foreigners and people with “non-commercial” interests — if anyone knows what that means, please let us know — bad.
Now, if only we could find a few good medical writers…