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 But the paper describing the longer questionnaire was retracted in 2023 after one critic claimed the scale was no more accurate than flipping a coin.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A 2023 paper from Journal of Arrhythmia was withdrawn in July “because the authors had not obtained permission to use the MMAS-8 scale reported in the article,” according to the notice.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 😔
Business is one thing. Morality and ethics are more important
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.
Oh no, is this John Girrado another pen name like we have seen many times in the past? I can’t find any info in Google Scholar, Pubmed, or Research Gate. Also, someone should investigate this Steve Trubow character who claims that he owns an interest in these stupid tools. If you were to look up Copyright Circular 14 here: https://www.copyright.gov/circs/circ14.pdf
copyright does not extend to the creator of the derivative work. So, if Morisky developed the original scales, then Trubow would have no legal interest them and what is policing, the widget software? Is anyone using the widget program? Sounds like a money grab to unsuspecting parties.
Copyright can be transferred or partly transferred to other people or companies.
I can do you one better: “In no case does copyright protection for an original work of authorship extend to any idea, procedure, process, system, method of operation, concept, principle, or discovery, regardless of the form in which it is described, explained, illustrated, or embodied in such work.” (17 U.S.C. § 102(b))
What amazes me is that a dozen other researchers haven’t produced their own scales.
Considering the known unreliability of self-report surveys, it’s surprising that journals even publish papers that involve these type of survey “tools”. But I guess the fields that employ them aren’t doing real science anyway, so they call that standards of practice I suppose.
Short answer: it isn’t trivial to do that.
Something becomes a standard in a domain of research, and then its use may become almost a requirement if you want people to pay attention to your research. This is one reason researchers aren’t making their own scales, but it’s not the biggest reason.
The biggest reason: producing a scale requires a lot of time, effort, and money and you have to publish studies showing how accurate it is before its use in a large study can be justified. You aren’t likely to easily secure funding for a study that reinvents a scale, even if it will save everypony money in the long term.
If you mean, “why aren’t researchers doing this to make the kind of money he’s been making”, this is why many scales in psychology require licensing fees. If your fees are modest then this isn’t a problem, but if you try to make a ton of money you’re no better than Professor Emeritus Asshat. In addition, if you try to charge any fee whatsoever for a similar scale, I guarantee PEA will sue as much as he possibly can over copyright infringement. He has an obvious personal stake in the outcome (the outcome is his income). Even if his claim is meritless, it could be caught up in courts for a year or two.
So you don’t have a lot of good options. If you want a respected scale, you need the money to develop and test it on a very large sample of control and test subjects. You’re not likely to see grant funding for this, if you try to charge a fee you will end up in court, and any research you try to publish on the scale will not be publishable for a substantial run-up of time. And, ironically enough, the only institutions who desperately need a lower-cost scale are smaller research groups who can’t afford to run a study that produces and norms a new metric.
The two largest problems is that these smaller research institutions cannot afford the ridiculous fee, and researchers are not made aware in advance that a fee is required. PEA wants people to find out after the fact that they owe him money because they’re more likely to pay that way, so there is no motivation for him to tell people in advance apart from ethics (and I think we can safely assume that’s not a part of this equation).
Even though measurement scales are expensive to produce, perhaps there should be a cap on fees with price reduction for institutions that are impoverished, maybe by limiting the maximum fee to no more than 5% of the amount of money spent on the production of the article that references it or something like that. But it really shouldn’t be legal to do what he’s doing. It stifles and destroys research for no reason other than to give a steady river of money to one greedy little former academic whose scale isn’t even of particularly high quality.
JMIR Publications has an ongoing call for papers to replace these scales and does not publish articles that use MMAS. Time to come up with an open tool. https://support.jmir.org/hc/en-us/articles/360000547811-What-is-your-policy-regarding-access-to-critical-research-tools-and-instruments-eg-questionnaires
RIP scientific research! People now want to earn money from anything and everything, including a scale. Shame on you, Dr. Morisky! There are more widely used scales all around us that we (practising clinicians) use on a daily basis (in both clinical practice & research) without even thinking about licensing: NRS pain scale, VAS pain scale, CHADS2 score (or CHA2DS2VASc), Child-Turcotte-Pugh class (or MELD-Na score), BMI, PESI (PE Severity Index), ESC (European Society of Cardiologists) risk class, Pneumonia Severity Index (PSI), CURB-65 (for pneumonia), ASA (American Society of Anesthesiologists) class, RCRI (Revised Cardiac Risk Index), Duke Treadmill Score and numerous others! Just imagine if we start reaping profit from every inch of clinical practice & academic research; it’s just disgusting in my opinion.
A couple of thoughts. Firstly, I am surprised that copyright protection applies to non-commercial activities. Secondly, I am concerned when copyright protection is applied to assessments of the value or accuracy of something. Such an application could be used to suppress information that the copyright owner deemed undesirable — not something we expect from both research and copyright protection.
The idea that you have to pay more than once, and in this instance that’s daft too, to use a measuring tool of any kind is absolutely absurd.
I know this is the least important thing about the situation, but also they use Grok AI images for the moriskyscale blog. At least use a “respectable” AI when making knockoff stock images (ironically, likely to avoid paying for licensing).