One of the most highly-cited journals in cardiology has retracted a paper less than a month after publishing it in response to criticism first posted on Twitter.
The article, “Short-term and long-term effects of a loading dose of atorvastatin before percutaneous coronary intervention on major adverse cardiovascular events in patients with acute coronary syndrome: a meta-analysis of 13 randomized controlled trials,” was published online January 3 in the European Heart Journal (EHJ). Its authors purported to analyze clinical trials of patients who were given a loading dose of atorvastatin, a cholesterol medication, before undergoing cardiac catheterization.
How closely the study authors adhered to their own methods came under question on January 8, when Ricky Turgeon, a cardiology pharmacist, posted a series of tweets in which he claimed some of the studies included in the analysis either did not test the drug in patients undergoing the procedure — referred to as PCI — or patients had not all been diagnosed with acute coronary syndrome, commonly known as a heart attack. With many of the trials included in the analysis not abiding by the predefined inclusion criteria, the study’s conclusions are unreliable, argued Turgeon.
Turgeon, who works in the Department of Pharmacy at Vancouver General Hospital in Canada, told Retraction Watch that one trial included in the analysis — MIRACL — “is fairly well known for having excluded patients who underwent or were planned to undergo PCI.” This prompted him to further examine the trials analyzed in the EHJ study. Turgeon says that by his count seven of the thirteen studies analyzed “did not meet their own inclusion criteria,” including one study that was actually observational rather than being a “randomized controlled trial” as suggested in the study title. One clinical trial was inadvertently counted twice in the analysis.
After Turgeon posted his critique on Twitter, an editor at the journal contacted him, asking him to submit a letter to the editor explaining his findings. Turgeon and Andrew Althouse, a statistician at the University of Pittsburgh, did so on January 15, after which the journal put together an ethics committee to look at the case. The original study authors were given an opportunity to reply to the concerns, abiding by Committee on Publication Ethics (COPE) guidelines, according to the journal.
The journal retracted the paper on January 30, a response Turgeon says is “without a doubt” appropriate. “Fixing the multiple mistakes identified here fundamentally change the results.”
Turgeon and Althouse were not formally credited in the notice, nor were the specific discrepancies explained:
This paper has been retracted due to discrepancies identified by a reader as regards the adherence to the predefined inclusion criteria in a significant number of the considered studies. After editorial investigation and consultation with the authors, the authors apologized and confirmed errors in their work. The editors therefore agreed with the ESC Publications Ethics Committee that the paper should be retracted. The editors apologize to the readers for the inconvenience caused by this publication.
After the retraction, Althouse replied to the journal’s social media account asking whether Turgeon would be credited in the notice. (This is a question we’ve seen raised before, as retraction notices often simply refer to “a reader” or no one at all.) Turgeon says that the journal has informed him they still plan to publish his letter describing the errors. Publishing the letter alongside the uncredited retraction notice, he said, “does speak to the journal editors’ interest in owning up to the error and correcting the record.”
Asked why the retraction notice did not credit Turgeon by name, the journal told Retraction Watch that they “invite readers who raise concerns with the interpretation of data of published papers to submit a Discussion Forum contribution” and that they “also thank critical readers in our correspondence for alerting us to any issues.” (Tell us what you think about such credit for sleuths, by taking our poll below.)
Despite three rounds of peer review, the reviewers did not identify the meta-analysis’ errors before publication. One way to prevent these types of fundamental errors from slipping through the cracks in the future, said Turgeon, is for journals to provide reviewers more detail about the underlying studies incorporated into a meta-analysis, potentially even making the full text of the source reports easily available to peer reviewers.
Regarding the use of social media to review published studies, Turgeon, who has never used Twitter before for this purpose, feels that “it’s not a great mechanism to identify issues” because these discussions are not easily found without prominent scientists or users with many followers amplifying the message.
The study authors did not respond to an email request for comment.
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