A public-health journal has retracted a study from Ethiopia that made unlicensed use of a questionnaire developed by a U.S. researcher known to aggressively protect his intellectual property.
This time, he didn’t have to: The journal’s publisher flagged the copyright infringement itself, Renee Hoch, managing editor at PLOS Publication Ethics, told Retraction Watch:
PLOS Global Public Health decided to retract the article because the authors did not have a license to use the MMAS-8 scale and the MMAS-8 data were essential in supporting the article’s conclusions. This decision is supported by the PLOS Licenses and Copyright policy and the COPE Retraction Guidelines.
The study found that people with diabetes who had a glucometer at home were more likely to take their medicine as prescribed. It has been cited three times since it was published last year, according to Clarivate’s Web of Science, including once by a paper in PLOS ONE by the same group.
The Morisky Medication Adherence Scales (MMAS)-8 survey used in the study was first described in a 2008 publication by Donald Morisky of the University of California, Los Angeles. Since then, Morisky has demanded steep payments from hundreds of researchers using the questionnaire, causing some who couldn’t pay to retract their work, as we reported in 2017 in partnership with Science.
Morisky registered the copyright for the MMAS-8 scale in 2018 and trademarked it the following year. Philip Morisky, managing partner of Donald Morisky, told us:
I am not familiar with the article in question. Copyright exists automatically in an original work of authorship once it is fixed, but a copyright owner can take steps to enhance the protections.
He did not comment on the chilling effect such steps could have on public-health research, particularly in poorer countries. But Hoch said:
As an Open Access publisher, we regret that license fees and other restrictions can create barriers to utilization of resources such as the MMAS-8, thereby creating inequities within the research community and impeding the advancement of research. Nevertheless, work published in PLOS must meet all applicable ethical and legal requirements, and we will take editorial action as needed if authors did not have requisite permissions or licenses for use of a third party resource.
Hoch added:
Of note, this type of issue can arise due to honest error if researchers are unaware of the applicable license requirements.
Neither the corresponding author nor the second author of the paper responded to our requests for comment.
In its May 10 retraction notice for the study, titled “Medication adherence and its associated factors among type 2 diabetic patients in Ethiopian General Hospital, 2019: Institutional based cross-sectional study,” the journal states that the issue regarding permission to use the questionnaire could not be resolved during discussions with the authors, adding:
Considering the nature of the concerns in this case, the article contents were removed from the journal’s website at the time of retraction.
The authors did not reply or could not be reached to comment on the retraction decision.
Update, 6/9/23, 1115 UTC: Sofonyas A. Tiruneh, the second author of the paper, tells us:
All the authors are from a developing country, and honestly, we were not aware that the Donald Morisky medication adherence tool required a fee to use. When we received the retraction notice, we attempted to contact Morisky, but unfortunately, no one responded to our emails before the retraction was initiated by the journal.
We are extremely disappointed with the situation, as it will have a negative impact on our professional profiles moving forward. We are uncertain about how we can reverse the retraction at this point, but we are willing to take any necessary steps if there is a possibility to do so.
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“unlicensed use of questionnaire”
So,
1. was it enough to give proper and clear citation to the source of survery form?
2. what could be the case if the authors had used a modified version of the questionnaire before use while giving clear citation?
1. Nope.
2. This is complicated. The problem is that you need to use a validated metric, which is why you don’t want to test a new questionnaire unless doing so is the entire purpose of your study. How can you show the modified questionnaire taps into the intended content areas effectively and accurately if you hadn’t thoroughly validated its use? If you don’t change it enough, it’s plagiarism and remains a copyright violation; if you change it enough to avoid this then you’re using an untested metric. It’s a no-win scenario if there aren’t effective alternate testing metrics available.
The solution is to validate another tool that accomplishes the same task so these leeches can’t extort so much money, but people at wealthy institutions aren’t going to want to use the less-tested tool when it’s reasonable for their budgets to simply pay the fee. This leads to significant inequity for researchers with less access to funding.
None that Philip’s apparent mote of concern for research equity is belied by the fact he says absolutely nothing about providing the licence for reduced cost for poor institutions and researchers. Neither does he suggest any potential remedy. These people simply don’t care about research process nor equity. They care about extracting as much money as they can possibly get away with, and it’s easier to screw over the disadvantaged than to modify pricing structure (even if the concern is financial rather than ethical–which it is).
The remedy is right there on the Morisky Scale website:
“RETROACTIVE LICENSE PRICING
Retroactive licenses is required when the MMAS scale was used without a license. The cost of the retroactive license is a flat fee of $6,000 per study. ”
https://www.moriskyscale.com/mmas-license-pricing.html#/
The issue with Mr. Morisky’s business akumen has popped up in these pages more than once. What prevents the researchers in need for such a tool from developing their own? Organize a conference that adresses exactly what the new tool needs to accomplish how it should look, who develops it and who tests and evaluates it. Conferences for the resolution of less weighty issues are organized all the time. Sometimes even scientists have to venture into the world of business competition to circumvent the machinations of a greedy peer.
Well said Sir/Ma! That is the way to go. If the researchers are content experts in their field of study, then they should be able to develop & validate their tools locally. Such validation in Africa of even validation done outside Africa is even a biological as well as psycho-social necessity. So, all these overdependence & eternal subjugation to these external folks must start decreasing, please!
1. No. This is about copyright, not simple plagiarism.
2. No. It will still breach copyright. Modifying a copyrighted material should be licensed by the copyright owner.
You would think that at this point anyone looking up and considering the Morisky scale would find the reports that it’s booby trapped. Morisky declared no conflicts of interest in his 2008 Journal of Hypertension. Most medical journals had COI policies by 2008, maybe time for the editors to look back at at whether a retraction is warranted there
How would COI be relevant? AFAIK, it’s never been in dispute that Morisky owned the Intellectual property and was free to license it.
The other article by the same authors, published in BMC Research Notes, doesn’t even include a citation for MMAS-8 in the reference list. Yet MMAS-8 is the only data collection instrument. What on earth were the peer-reviewers and editors doing when they reviewed this?
They were probably busy looking for their own minutely relevant or even irrelevant, parasitic articles to be implanted (ie, as coercive citations) into the reviewed manuscript!
There are influx of papers retracted from various Ethiopian Universities, particularly by Hindawi in 2022 and 2023….
Was it done with the tacit consent of higher ups
I wonder why Ethiopian Universities turned blind to these unpleasant events…