Are Medical journals dead?
Summary
'A repórter médica investigativa Maryanne Demasi aborda os principais problemas na publicação científica, incluindo questões com 'Peer Review' e pre-prints, politização de revistas científicas, censura científica e diminuição da confiança dos leitores. Demasi destaca argumentos de vários críticos, como o ex-editor do British Medical Journal, Richard Smith, que propõe que a 'Peer Review' muitas vezes ignora a pesquisa inovadora e regularmente falha em detectar fraude. Smith reconhece que as revistas estabelecidas têm influência, particularmente para pesquisadores juniores que procuram construir suas carreiras acadêmicas. Embora Smith ainda veja necessidade de revistas médicas, ele defende métodos de publicação alternativos, como Substack. Alguns especialistas, como John Ioannidis, estão preocupados com a potencial fragmentação da literatura científica com esses novos modelos de publicação emergentes. Ioannidis e advoga por um corpo unificado e abrangente de pesquisa. . A discussão também revela preocupações sobre a confiança decrescente nas revistas médicas e na medicina em geral nos últimos anos, devido a fatores como a politização da ciência e censura científica durante a pandemia do Covid-19. Ioannidis aponta a possibilidade de inaccuracy de muitas descobertas de pesquisa publicadas, a pressa descuidada de grande parte da pesquisa inicial sobre o Covid-19, e a propagação de informações errôneas e desinformação. Embora ambos os métodos de publicação, tradicional e auto-publicação, tenham seus apoiadores e detratores, a questão central gira em torno do aprimoramento da credibilidade, integridade e acessibilidade da pesquisa médica. Indo adiante, a comunidade de pesquisa científica precisa avaliar como identificar e comunicar melhor as descobertas científicas ao público de maneira precisa e eficaz.'
'Muitos cientistas estão pensando em como a pesquisa é verificada e compartilhada com o mundo. Neste artigo, ouvimos de editores de revistas científicas, também conhecidos como as pessoas que decidem o que entra nas revistas de pesquisa. As revistas de pesquisa são meio que como jornais ou revistas, mas em vez de compartilhar histórias, compartilham novas descobertas. As descobertas são comprovadas com experimentos, observações e informações coletadas. Também ouvimos dos pesquisadores, as pessoas que fazem essas descobertas, que enviam seu trabalho para as revistas e esperam ser publicados. Quando a pesquisa é publicada, é levada mais a sério. Richard Smith, que costumava editar uma revista de topo, aponta que as etapas necessárias para a pesquisa ser publicada nem sempre fazem sentido. Às vezes, os verificadores ignoram estudos que são realmente bons. Outras vezes, eles perdem erros graves na pesquisa e essas descobertas incorretas ainda chegam às mãos do público. Isso pode causar problemas graves, especialmente quando os leitores dependem de revistas de pesquisa para tomar decisões sobre que comida comem, que remédios tomam e outras escolhas de estilo de vida. Alguns críticos de revistas estão preocupados com a censura. A censura é quando certas pessoas ou grupos têm controle sobre que conhecimento é compartilhado e propositalmente mantêm algumas delas escondidas - mesmo que a informação seja 100% correta. Muitas vezes, isso ocorre porque os censores não concordam com as informações por motivos políticos ou sociais. Durante a pandemia, vimos isso acontecer com um estudo sobre vacinas que foi retirado depois de ter sido compartilhado. Isso fez com que algumas pessoas perguntassem se as grandes revistas médicas estavam escondendo algum trabalho. Cientistas famosos, como Carl Heneghan e Tom Jefferson, optaram por pular grandes revistas e compartilhar seu trabalho em revistas menos conhecidas e online, porque acham que é mais rápido e fácil. Mas, pessoas como John Ioannidis, um pesquisador, estão preocupadas que isso possa bagunçar como os livros científicos são escritos. Ioannidis acredita que a pesquisa médica deve permanecer unida para que as pessoas possam ver o quadro completo, em vez de ter pesquisa importante em lugares que as pessoas podem não conhecer. Um ex-editor de pesquisa, no entanto, apoia os pesquisadores compartilhando seu próprio trabalho porque acha que o processo de verificação é muito lento e muitas vezes impede que as ideias do pesquisador venham à tona. Outro editor de pesquisa está preocupado que as pessoas estão começando a perder a confiança nas revistas médicas e nos médicos e na medicina em geral. Ela está triste que a ciência, como muitos argumentos durante a pandemia, se tornou política. Ioannidis também fala sobre a perda de confiança e acredita que muitos dos resultados compartilhados na pesquisa podem estar errados. Esta conversa mostra a luta entre a maneira antiga de verificar estudos e a nova maneira onde qualquer pessoa pode acessar estudos. Embora a maneira antiga ainda seja a maneira principal de se sair bem no trabalho de um cientista, o possível segredo e esconderijo fez com que as pessoas ficassem infelizes. A luta principal é tornar a pesquisa médica mais confiável e fácil de obter. Todos querem garantir que todos os outros obtenham informações científicas precisas e úteis.'
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'Nos últimos anos, um novo debate surgiu na comunidade científica sobre a forma como a pesquisa é verificada e publicada. Neste artigo, pesquisadores e editores de revistas de ciência discutem os principais problemas dentro da publicação científica, incluindo como esses problemas impactam os cientistas individuais e o público em geral. Richard Smith, ex-editor do British Medical Journal, expõe suas preocupações com o peer review. O processo de peer review serve como a espinha dorsal do processo de verificação de fatos das revistas de ciência. Antes de serem publicados em uma revista de ciências, os estudos são analisados por outros cientistas. Na maior parte do tempo, os revisores por pares são escolhidos porque estão fazendo pesquisas semelhantes, o que pode criar um tipo de viés, especialmente em campos onde existem poucas pessoas fazendo esse tipo de trabalho porque torna muito fácil saber quem são os revisores e pode levar a um ambiente de "um arranha as minhas costas eu arranho as suas". Isso pode criar um viés. Smith argumenta que "peer review é baseada na fé e não na evidência", apontando que alguns estudos previamente rejeitados pelos revisores por pares passam a ser partes altamente consideradas da ciência. Ele também faz o ponto de que erros regularmente passam pelo peer review. Críticos de revistas importantes estão preocupados com a censura. Durante a pandemia, vimos exemplos desse tipo de debate, incluindo um artigo sobre vacinas de mRNA que foi retirado depois de ser publicado. Isso fez algumas pessoas questionarem se grandes revistas médicas estavam censurando certos trabalhos. Alguns cientistas conhecidos, como Carl Heneghan e Tom Jefferson, decidiram pular as grandes revistas e publicar seus trabalhos em revistas menores, especializadas e em plataformas online como Substack, porque eles acreditam que é mais rápido e menos complicado. Mas outros, como o pesquisador John Ioannidis, temem que isso possa distorcer a literatura científica. Ioannidis acha que precisamos manter a pesquisa médica unificada e equilibrada. Smith apoia a autopublicação porque acha o processo tradicional muito lento e acredita que muitas vezes sufoca a voz do autor. Ele também reconhece que as grandes revistas detêm muita influência, especialmente para jovens pesquisadores que procuram construir suas carreiras. A ex-editora do JAMA Internal Medicine, Rita Redberg, está preocupada com a diminuição da confiança nas revistas médicas e no campo médico em geral. Ela está chateada com a forma como discussões científicas, como o debate sobre máscaras durante a pandemia, se tornaram políticas. Ioannidis também menciona a perda de confiança do público, apontando para o seu próprio trabalho que mostra que muitos resultados de pesquisas publicados podem ser falsos. Esta discussão mostra as visões conflitantes em torno da publicação tradicional, revisada por pares, e dos métodos mais novos e de acesso aberto. Embora o método antigo ainda seja o principal marcador de sucesso profissional, o potencial sigilo e censura levou a uma crescente insatisfação. Plataformas como Substack oferecem mais controle para os autores e acesso mais rápido para os leitores, mas enfrentam críticas por possivelmente prejudicar a literatura científica e dividir a ciência. No geral, ambos os métodos têm seus apoiadores e críticos, o ponto central do debate é sobre melhorar a confiabilidade e a acessibilidade da pesquisa médica. Todo mundo quer garantir que o público receba informações científicas precisas e eficazes.'
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Former editor of The BMJ says, “It's interesting to me in a way that journals are still alive, because I think there's a lot of reasons why they should be dead.”
Problems that have plagued medical journals for decades include the failure of peer review, replication crisis, ghost-writing, and the influence of Big Pharma.
In 2004, Richard Horton, editor of the Lancet wrote, “Journals have devolved into information laundering operations for the pharmaceutical industry.”
More recently, Peter Gøtzsche, one of the founding fathers of the Cochrane Collaboration said, “The medical publishing system is broken. It doesn’t ensure that solid research which goes against financial interests can get published without any major obstacles.”
Scientific publishing is now one of the most profitable businesses. Elsevier, for example, made $2.9 billion in annual revenue with a profit margin approaching 40%, rivalling that of Apple and Google.
But despite these impressive numbers, trust in medical journals has diminished, and this has only been exacerbated by the covid-19 pandemic.
Peer review fail
Former editor of The BMJ Richard Smith once famously wrote; “Peer review is faith not evidence based, but most scientists believe in it as some people believe in the Loch Ness monster.”
In a recent conversation with Richard Smith, he explained why.
“Peer review was thought to be at the heart of science – that is, who gets a grant or who gets a Nobel Prize – and I suppose it wasn’t until the 80s and 90s that somebody actually examined it – it was just sort of assumed to be a good thing,” said Smith.
“Then people began a series of experiments – there was a Cochrane review – looking at the evidence to see if peer-review was beneficial. And actually, what they found was that there was really no evidence,” he said.
Smith, who worked at The BMJ for 25 years said the peer-review process is slow, it’s expensive, and it stifles the publication of innovative ideas.
“There are lots of examples of ground-breaking work that were rejected by peer-reviewers but go on to win Nobel Prizes. Is the work crazy? Or is it truly genius? Peer review is not good at deciding that,” he said.
Peer review also fails to detect fraud. The recent Surgisphere scandal is a case in point.
Lancet and New England Journal of Medicine were forced to retract studies after researchers reported a link between treatment with hydroxychloroquine and increased death of hospitalised covid patients.
Glaring discrepancies were found in the database underpinning the studies, but were not detected in the peer-review process.
“If researchers say there were 200 patients in the study, then you assume there were. But we have increasing evidence that that’s not the case – there are a lot of zombie trials that never happened or have been manipulated in some way,” said Smith.
“So, in a nutshell, we have lots and lots of evidence of the downside of peer review and really no convincing evidence of its upside,” he added.
Rita Redberg, a cardiologist at the University of California San Francisco, who recently stepped down after 14 years as chief editor of JAMA Internal Medicine, concedes that peer-review is “not perfect”.
“You always assume that what the authors are telling you is true. The process depends on the honesty of the authors, and yes, people can be dishonest. But we’re doctors, we’re not investigators with the resources of the FBI. Of course, when any potential dishonesty comes to our attention, we will investigate,” said Redberg.
“It has its problems, but what’s the alternative? No peer-review? In general, I think peer review is much better than a system without peer review,” added Redberg.
Politicisation of journals
During the pandemic, some journal editors became increasingly politicised.
Editors at the New England Journal of Medicine, for example, took the rare step of writing an editorial in 2020, urging American voters to oust the sitting President. It was a controversial move.
John Ioannidis, Professor of Medicine at Stanford University, and the most cited scientist in the world, said he is not in favour of the politicisation of medical journals.
“The message it sends is that scientific journals are just another arm of the political propaganda machine,” said Ioannidis.
“That’s not to say that scientific journals shouldn’t take stances on important issues that are decided by politicians like climate change, regulation of industry, and environmental pollution. I just think the editorials were very poor choices and not for the pages of the journals,” he said.
Ioannidis is not convinced that these political statements swayed anyone to cross the political aisle, and thinks the editorials should be retracted.
“To be honest, the editors who made these statements should retract their own editorials on these political issues. Editors can keep their political orientation and still cover all the big important medical issues,” he added.
Emergence of pre-prints
Pre-prints are non-peer-reviewed articles posted on servers such as medRxiv and bioRxiv, that allow thousands of people to view the research. Many see this as a double-edged sword.
It enables faster data sharing in an emergency and quick feedback, but it also opens the door to sloppy science that can be widely disseminated by the public and the media.
Redberg’s personal view is that pre-prints, which have not undergone peer-review, are potentially harmful.
“I think there’s a danger of putting out information that’s not accurate. For approval of drugs and devices, it’s worth taking the time to get things right. I feel much more confident that you’re going to get it right if it’s undergone peer review,” said Redberg.
“I think it started with very good intentions – people sharing their work and getting comments – but the articles stay up there even after they’re published in journals, and having an older, different–and possibly inaccurate–version remaining in the public sphere may inadvertently disseminate incorrect information,” added Redberg.
Ioannidis, on the other hand, says he is in favour of pre-prints because “they offer more transparency in the system, and they allow for some earlier dissemination of work,”.
But he warned it can be a battlefield citing experiences where some of his pre-prints would receive more than 1000 peer reviews within a day of release.
“A few were very, very helpful. Hundreds of them were just abuse. It was a very traumatic experience. If you separate what is the good contribution versus the abuse, then I think that they’re useful,” said Ioannidis.
Smith argues that pre-prints actually prove his point about the failure of peer-review. “If you look at what eventually appears in journals, it’s usually very similar to the original pre-print. So, it’s evidence that peer review has not made much of a difference,” said Smith.
“What I argue is that the peer review should not be three or four selected people looking at something before it’s published, but where the ideas are available to everybody. That’s the real peer review,” he said.
Scientific censorship
Publishing articles in medical journals during the pandemic, especially research that was critical of vaccine safety, was sometimes censored or retracted for no good reason.
For example, a peer-reviewed paper linking the mRNA vaccines with myocarditis, authored by doctors Jessica Rose and Peter McCullough, was suddenly withdrawn with insufficient cause.
Some high-profile scientists have decided that the time burden and logistical intensity of publishing in the major medical journals is simply not worth it.
Carl Heneghan and Tom Jefferson, for example, two of the most reputable researchers in the world, say they’ll only publish in specialised journals that have peer-reviewers with the right expertise.
Otherwise, the bulk of their work is published on the writing platform, Substack (Trust The Evidence).
“I do worry about that,” says Ioannidis. “We need the voices of people like Carl Heneghan and Tom Jefferson and others in the mix. I suppose if they’ve been thwarted, then there must be some venue where that missing part can appear, and perhaps Substack caters to that need.”
“I do wish that we get them back into the traditional type of medical journals though. If the classical literature is missing a very key perspective like theirs, then the distortion becomes bigger,” he said.
“It makes it more difficult to balance the literature when knowledgeable, critical voices are missing. I know I may sound like I’m willing to stick to that sinking ship. But I would prefer to not fragment science into medical journals, and Substack and who knows where else,” added Ioannidis.
Smith on the other hand, is more enthusiastic about self-publishing.
“I’m in favour of getting it out there. Let the world decide. It makes a lot of sense to me,” says Smith citing his own challenges with publishing in medical journals.
“Recently, I submitted a piece to the Lancet – a book review – and there was the hassle of all the forms you have to fill in, all the comments from the editors, which I mean – maybe it’s arrogance on my part – but didn’t seem to make things much better,” said Smith in a perturbed tone.
“You’ve got a particular voice, and they disrupt it to some extent. So, it ends up much messier. Doesn’t feel to me like there’s a lot of value added in that process,” he said.
Smith says self-publishing is more of a problem if you are a junior researcher and want to rise in the academic arena.
“You need to publish in these journals because that’s how you’re judged. If you’ve published in the New England Journal of Medicine, it’s assumed to be a very significant piece of research. I mean, it’s completely unscientific to use the place you publish as a surrogate for the value of the research, but that’s what continues to happen,” said Smith.
Diminished trust
Redberg says it’s not just medical journals that lost trust.
“I think people’s trust in medicine and public health diminished in general in the last few years. The sad part to me is that science became political – whether you wore a mask or not became a political statement – It’s not a political question. It’s a scientific question,” said Redberg.
Ioannidis who famously authored the paper, “Why Most Published Research Findings Are False” said, “I think that we are losing…well, we have already lost the trust of a major part of the population.”
“Covid created a lot of extra stress on the system. People wanted to publish papers very quickly, by now it’s almost a million papers. We’ve looked at the covid literature and most of it was very sloppy, corners were cut, probably worse than usual,” said Ioannidis.
“The frontier of science is broken at the moment. If we do not acknowledge that we have a problem – and make no mistake – we have a very serious problem, then it will be difficult to defend against conspiracy theories or against people who just want to make money by spreading misinformation or disinformation,” he added.
So, are medical journals dead?
“I don’t think medical journals are dead, no. I feel like they’re busier and more important than ever, because there’s so much innovation and I think that disseminating it through a high-quality, peer-review process is the best way to go,” said Redberg.
Ioannidis is quick to acknowledge there is a problem with medical journals. “They are very sick, and they suffer from all sorts of diseases, but I just don’t want to say that I’m giving up on them. They need to transform. I hope that they get better. But I don’t want to proclaim them dead yet.”
Smith agrees that there’s a role for medical journals, but he seems less invested.
“It’s interesting to me in a way that journals are still alive, because I think there’s a lot of reasons why they should be dead,” said Smith.
Maryanne Demasi, PhD
2 Comments
Comments are closed.
Peter Shaw
Obviously a massive problem that science has become a business…
The idea of peer review has good intentions, but it is only as good as the reviewer is honest and has the resources to sift through the bullshit.
Ultimately, I think, the solution starts with education and a culture change. That is why the Broken Science Initiative is so powerful. If those who lead the way have a deeper understanding of what science is, and really care about the Truth, the process fixes itself.
Like Greg says – Any man, but not every man, will learn this.
…My hope is that enough learn to hold a dim light at the end of the dark mainstream tunnel.
Brad Jones
Thank you for the article Maryanne. One important thing to mention regarding journals is the paywall that keeps researchers away from information. Science isn’t being shared openly. Perhaps, the model could quickly fall apart with a peer reviewed “wiki-medical journal”.