BMJ journal yanks paper on cancer screening in India for fear of legal action

BMJ Global Health has pulled a paper that criticized U.S. research of the effects of cervical cancer screening in India over defamation concerns.

That’s not what the notice on the paper says, however — at the moment, it just reads:

This article has been withdrawn.

However, forwarded email correspondence between the first author and an associate publisher reveals the journal published the paper and planned a press release, then realized it should be reviewed by a legal adviser. When first author Eric J. Suba at Kaiser Permanente San Francisco Medical Center inquired about the status of the paper and any potential press release, he was told the journal could no longer publish it, out of concern they would be taken to court.

Suba told us that, when he learned the paper would be pulled:

I was outraged. During [a May 26] conference call, my response to BMJ Associate Editor Henry Spilberg was “Welcome to the wrong side of history.”

Here is the email Suba received, informing him the paper wouldn’t be published:

Following extensive legal review of your paper, we have reached the conclusion that BMJ Global Health will be unable to proceed with publication.

The nature and severity of the allegations in the paper are such that if the journal were to publish it, BMJ would be at risk of legal action for defamation in the English courts from any of the parties accused of misconduct. We therefore have to follow the advice of our lawyer and decline to publish.

The article, “Unethical randomised controlled trial of cervical screening in India: US Freedom of Information Act disclosures,” was published online April 26. It describes a randomized controlled trial conducted in Mumbai that compared the effects of screening versus no screening on cervical cancer rates. Suba and his co-authors allege that the researchers used screening methods that had been deemed “unsatisfactory for cancer control” before the trial began, and thus were denying women in both the treatment and control groups access to potentially life-saving tests.

On May 18, Suba received this email from the associate publisher:

 …[I] am writing regarding the above paper which was accepted for publication in the journal and for which the BMJ media office are planning to write a press release. The media officer highlighted that the press release should be reviewed by our legal adviser before publication and asked me whether the paper itself had been legally reviewed. It had not, although it had undergone two rounds of peer review. I therefore took the precaution of sending it to our pre-publication legal adviser yesterday; he is going to review the paper and will send me his response shortly.

On May 24, Suba told the associate publisher a media representative had told him there would no longer be a press release for the paper. The publisher confirmed that was the case, and informed him the paper would not be published, “following extensive legal review.”

The associate publisher Henry Spilberg confirmed that sequence of events to us, noting that the journal considers this to be a “withdrawal,” not a retraction:

It’s not a retraction per se, on the basis of the content of the paper. It’s simply a withdrawal based on the advice that we received that we couldn’t proceed with publication…It’s not a retraction because it was not intended to be published in the first place. If everything had worked correctly, it would be still in the pre-publication phase.

Spilberg explained that the paper shouldn’t have appeared online, since it should have first received a legal review, and also was intended to be included in a press release, which would have been embargoed:

It was a production error, essentially.

Suba told us:

Obviously, I wish to emphasize that BMJ Global Health had no issues with the factual and scientific basis of our paper, which critiqued an 18-year randomized controlled trial conducted in Mumbai, funded by the U.S. National Cancer Institute (NCI), and involving more than 151,000 low-income women of color as trial subjects. The Mumbai RCT compared cervical cancer death rates among women offered cervical screening to cervical cancer death rates among women offered no screening whatsoever. In 2012, the Mumbai RCT was determined to be unethical by the U.S. Office for Human Research Protections.

Our paper included evidence we had obtained through the U.S. Freedom of Information Act (FOIA). Documents that we obtained through FOIA included clear evidence of egregious scientific misconduct. We included that evidence in our paper. Documents that we obtained through FOIA also included clear evidence that NCI leaders had made false and misleading statements to U.S. Congressional oversight staff in order to avoid accountability.

On May 28, Suba wrote to the Chair of the BMJ ethics committee to appeal the withdrawal:

On behalf of my co-authors, I strongly protest BMJ’s retraction of our paper.

We believe it is inappropriate to retract scientifically valid papers out of concerns for subsequent litigation. Such policy places scientific literature on a slippery slope. We also believe it is unrealistic to believe that those whom our paper criticizes would respond to such criticism with litigation, rather than scholarly debate.

We appeal to you to reverse BMJ’s decision to retract our paper.

Spilberg said the journal plans to post an “editor’s note” shortly:

…noting that the paper has been withdrawn, that it was inadvertently posted online and has now been withdrawn following legal advice.

Suba has long criticized cervical cancer studies in India, even comparing them to the infamous Tuskegee study that withheld treatment from low-income African-American patients with syphilis.

Suba told us he plans to submit the paper elsewhere.

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16 thoughts on “BMJ journal yanks paper on cancer screening in India for fear of legal action”

  1. This is bad lawyering as well as bad policy. The UK has an exception to libel that more or less grants immunity to publishers of science if the article has been peer reviewed and editor approved.

  2. In the newsy article published in Alabama Media in June 2015 ( Dr Suba claims that 254 women in the control unscreened group of 138 624 have died of cervical cancer (duration of follow up not stated). However he gives no number for the number dying of cervical cancer in the screened group of 224 929 women. Does anyone have access to the numbers given in the retracted submission ?

      1. Thanks Eric. While I appreciate your criticisms of the Indian studies funded by US sources, it still seems surprising that the reduction in mortality in these three large trials only ranged from 29-43%. As you have argued elsewhere, perhaps the screening methods used were in truth relatively ineffective.

  3. While sharing the general sense of at least initial outrage, I can see where the BMJ is coming from. Getting involved in long and costly litigation can distract, apart from the financial consequences. However if what Mr David Egilman says is correct, the BMJ need to get another lawyer.

  4. The title itsel invited legal opinion .Thereis nothingwrongin withdrawing.Can we have access to peer review reports as it is already published.

  5. Good to see this item and discussion on it.
    Eric Suba first wrote a paper on this subject in the Indian Journal of Medical Ethics in 2014. See:
    The paper was responded to by researchers and there is intense discussion, including a public lecture by Suba in Mumbai at the KEM Hospital/GS Medical College where the researchers were also invited and allowed to intervene.

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