BMJ journal retracts, replaces study on chronic fatigue in children

A BMJ journal has retracted and replaced a paper on chronic fatigue in children after admitting that it misrepresented the nature of the research in the editing process. But the article has drawn scrutiny beyond merely the characterization of the analysis.

The paper, “Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study,” appeared in early April in BMJ Paediatrics Open, and was written by a group in Norway. The paper is technically not about chronic fatigue syndrome (CFS), but in the introduction the authors write:

If accompanied by other symptoms, such as exertion intolerance, chronic pain and cognitive impairments, the patient might fulfil one of the diagnostic criteria for chronic fatigue syndrome (CFS).

Despite the title, however, the study was not, in fact, a feasibility analysis. Rather, it was a randomized controlled trial, a fact that somehow got garbled during editing. 

The discrepancy was flagged in a comment which the journal published in May — a comment that raised several more issues than the trial design, as did several users of social media.  

Writing on Virology Blog, David Tuller, of UC Berkeley, who has spent years critiquing studies of chronic fatigue syndrome, posted several times on his concerns about the article. In addition to trial design, Tuller and several colleagues noted several other red flags, such as changing the outcomes of interest when the preregistered primary outcome was disappointing. They also blasted the journal for shoddy peer review: 

An examination of the peer review history also raises questions about the rigor of BMJ Paediatrics Open’s editorial stewardship. Although one reviewer stated flatly that he had not read “beyond the abstract,” the acknowledgement apparently did not present an obstacle to publication in BMJ Paediatrics Open. Does the journal consider a peer review of an abstract to be a robust substitute for a peer review of a full paper?

According to the retraction notice [BMJ tells us the links to the notice and the new version of the paper will be live tomorrow, Thursday]: 

On April ninth 2020 BMJ Paediatrics Open published the paper “Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study” online. On May 19th, the journal published a letter to the Editor from a reader drawing our attention to how this trial was reported, noting that the study was presented as a feasibility study when the original trial design was for a fully powered trial. 

We undertook a thorough internal review of the original manuscript, the peer review and the editorial process to understand whether and how this had happened. We identified a mistake in the editorial process which led to this misrepresentation of the research that was undertaken. Unfortunately, editorial errors in judgement happen. We wish to transparently acknowledge our error, to correct the scientific record fully and thank the correspondent for bringing this to our attention. We now retract this paper. 

We acknowledge that this was not due to error on behalf of the authors. In line with the Committee on Publication Ethics’ Retraction Guidelines we decided to pursue the option to retract and republish. With the authors’ agreement, we invited the authors to resubmit their research written up as originally undertaken. This has undergone editorial and peer review as a new submission. It has been published with the DOI http://dx., and clearly links back to this retracted version so that the history of the paper can be seen.

In a statement provided by the journal, editor Imti Choonara of the University of Nottingham said:

I want to thank the correspondent for bringing this issue to the journal’s attention. It has prompted a review of editorial processes, as a result of which, we have introduced further editorial checks and statistical reviews.

I want to make it clear that the authors were not responsible for this error. Chronic fatigue syndrome is still not fully understood and dogged by controversy, so it’s important to add to the knowledge base, hence the decision to invite the authors to resubmit their original study.

The journal said:

More broadly, BMJ is developing further resources to support specialist journal editors and is extending the scope of research integrity training, not only for journal editors, but also for associate editors and the wider team.

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