Two journals have retracted papers this year for unauthorized use of a controversial scale whose creator has been known to license use of the questionnaire for six-figure sums – and to aggressively pursue those payments from researchers he claims have misused the instrument without prior approval.
The Morisky Medication Adherence Scale (MMAS) is named for its creator, Donald Morisky, now a professor emeritus in community health at UCLA. As the name implies, the measure allows researchers to assess patients’ adherence to drug regimens.
Morisky made a business out of licensing the scale and demanding steep fees for researchers who failed to obtain the proper permissions, as we reported in Science in 2017. Researchers who cannot afford the payments Morisky and his business associate demand have been forced to retract their work.
The tool initially involved four questions but in 2008 expanded to eight. But the paper describing the longer questionnaire was retracted in 2023 after one critic claimed the scale was no more accurate than flipping a coin.
In May, the authors of a September 2024 paper in Cureus on medication adherence for patients with cardiovascular disease requested the retraction of their paper for “use of a copyrighted scale without the necessary permissions,” according to the notice.
The corresponding author did not respond to our request for comment, but a representative from Cureus confirmed the retraction notice referred to the MMAS. The journal was “contacted by a representative for the scale owner who alerted us to its use in this paper without the necessary permissions,” and after speaking with them, the authors requested the retraction. The representative didn’t respond to our follow-up request regarding the identity of the person who raised the issue. Cureus did not answer our question regarding how much the authors were asked to pay.
A 2023 paper from Journal of Arrhythmia was withdrawn in July “because the authors had not obtained permission to use the MMAS-8 scale reported in the article,” according to the notice. The paper, which describes disease awareness and medication adherence in patients undergoing atrial fibrillation ablation, has been cited once, according to Clarivate’s Web of Science.
The journal acknowledged our request for comment but did not answer our questions regarding how they were alerted to misuse of the scale. Nihon Medical School, where the study took place, also did not respond to our email request for comment.
By our count, there have been at least nine retractions for licensing issues related to the MMAS. But not all retractions of papers that use the scale explicitly cite a reason in the notice, so the number is likely higher.
Morisky also has been known to demand researchers who license his scale make changes to publications after they appear – as was this case in this 2018 article by Adrienne Casebeer and her colleagues in Population Health Management, which was retracted several months after it appeared in print. According to the notice:
Dr. Casebeer’s team obtained a license to use the MMAS-8 scale from Dr. Morisky prior to conducting the study. Nevertheless, after publication of a separate article in the Journal of Patient-Reported Outcomes that also cited the MMAS-8, as the lead author, Dr. Casebeer was contacted by Dr. Morisky who requested that a number of changes be made to the article. Dr. Casebeer and her team have no desire to engage in a dispute with Dr. Morisky and therefore proactively contacted the Editor of Population Health Management and requested that the scale be removed from her published paper.
In 2023, we wrote about researchers who “were not aware that the Donald Morisky medication adherence tool required a fee to use.” When they attempted to reach out to Morisky, he didn’t respond, and their paper was retracted by the journal.
Steve Trubow, Morisky’s former business partner, told us he is currently policing the use of the scale after a lengthy legal struggle between the two.
Morisky, his family and Trubow have been playing tug-of-war over the scale – and a related “widget,” which belongs to Trubow’s company called MMAS Research LLC – for years. In 2020, the pair faced off in court over ownership of the scale, a battle which Trubow told us ended in a settlement.
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Nothing for free. Business is everywhere 😔
It is amazing that authors researching drug compliance and become aware of Morisky’s questionnaire, aren’t aware of all the highly publicized bad outcomes for researchers of doing so. This is the first I’d heard of the Casebeer case with him going after someone who had gone to the trouble of licensing it. It’s a freakin’ questionnaire.
I have developed five measures that have been used and cited in over 3700 papers. I did this work because I love health research. If these creeps wanted to make money, they should have done so in real-estate and stocks, not in academic research. Moreover, this measure is not very impressive. Researchers in this field must be pretty dumb if they think this measure is special. The measure is easy to fake and game, but then agoan, the authors are not academics, more like junk removal company.