The editor of Indian Journal of Medical Ethics (IJME), Amar Jesani, has written some comments on my blog post “Deception, distrust and disrespect”. Read my response below:

Ole Petter Otterson’s blog contains few inaccuracies and moralistic sermons – I hope they are not wilful/deliberate.

1. Before publishing in the IJME. Lars Andersson published in the Journal of Internal Medicine with Wiley as publisher. His three pieces appeared in 2014, 15 and 17 – three consecutive yearsII He wrote on equally sensitive issue – vaccine and indulged in debate with other authors. All the while he showed his affiliation with the Kerolinska Institute (KI). The KI never protested. Even today, his affiliation is shown as that of the KI on the website of the JOIM. This blog does not say that the KI has drawn attention of the JOIM as they did with the IJME.

2. The IJME decided not to retract the said paper. The paper is using publicly accessible data and uses a very simple analysis which could be done by anybody. His inferences and conclusions, whether “premature” or “half-baked”, are open to challenge by experts. He did not carry out any experiment for which one may need to go to his laboratory to find out whether it was real of fake. I would urge you to read material in question and not to use unnecessary generalisation or be moralistic about the issue.

3. Why should an author not have a right to remain anonymous? There are circumstances where some may need protection of anonymity. For instance, would you expect a doctor in occupied territory anywhere in the world write about his/her experience or do analysis of cases of torture perpetrated by occupier using his/her real name? That is the reason why nobody with some ethics grounding would agree to a blanket rule that all authors must identify in public. Such rule would not be ethics, but the luxury of those researcher protected in the cocoons of developed countries. The author in question has, after first deceiving us, identified to the editor – that is it, and should be sufficient. If he wants to identify in public, he will do it.

4. Lastly, yes, Lars Andersson did deceive us and we admitted it. But he seems to have deceived the KI too, and that since 2014. Why are you not talking about the flaws in the way the KI is run? By the way, the KI is not immune to ethics scandals – we need not bring them here.

5. Lastly, the right way to question us is to analyse whether in the present melieu the medicine and science are treating vaccine as sacred / holy cow or any such animal and creating such fear complex that even those who support vaccine and vaccination but at the same time want to do scientific critical thinking are afraid of coming out in open. Better to work for more tolerance for genuine vaccine critics than condemning them.

Amar Jesani, Editor, IJME

 

Dear Mr. Jesani,

Thank you for your comments. Here is my response:

1  The journals are the first line of contact with the authors and with this comes a responsibility to confirm the authors’ identity and affiliation and to safeguard the quality of the manuscript. The universities are not set up to police the journals and their editorial practices. Indeed the relationship between journals and universities should be based on trust – as should the relationship between journals and the society at large. Lax editorial policies serve to erode trust, as in the case at hand.

Universities – on their side – have a responsibility to act swiftly when deceit is brought to their attention – but their responsibility does not extend to monitoring the quality of the editorial process. Had we been alerted about Lars Andersson’s false affiliation in the Journal of Internal Medicine we would have acted as swiftly as in the case of the current publication in the Indian Journal of Medical Ethics.

Let me add: To any editor it should have served as a warning sign when a lone author submits a paper on a sensitive issue with an email address that has no connect to the purported affiliation. We have alerted the other journals that the link between the name “Lars Andersson” and KI must be removed. One of the journals has already promised to comply.  

2  We have never been moralistic, but reassert that any journal – and not least a journal which carries the term “ethics” in its name – should be attentive to a basic principle in medical publishing, or in any scientific publishing for that matter, namely that experiments must be open to reinterpretation and – in the case of the present paper – that arguments must be open to debate and counterarguments.  Such debates are thwarted by anonymity and false affiliations.

Any paper on a medical issue may impact people’s health, be it through prevention, diagnosis or treatment. With this comes the need to hold authors to account for what they publish.

In my former blog post, I first and foremost discussed the need to avoid fraud and false affiliations. I did not discuss the conclusions made by “Lars Andersson”, nor did I demand a retraction of the article. Let me add, though, that our own researchers in this field publicly and with force dismiss “Lars Anderssons” theories about a possible link between HPV vaccination and an increased incidence of cervical cancer in Sweden.

3  This argument (about being anonymous) is not valid. The editor refers to an extreme case that is not representative of the case at hand. However, we agree that in rare and exceptional cases it could well be that authors are in need of protection through anonymity. But right to anonymity does not imply right to false affiliation. If anonymity should be required, then the journal should state this explicitly on the title page. The author should then be listed as “anonymous”, and not with a fake name and a fake affiliation. This is basic procedure, and this is transparency.

4  We are working proactively when it comes to ethics in medical research and our firm response to this deceit is a case in point.  We are transparent when it comes to our own shortcomings but these do not absolve the journals from their responsibility to uphold sound editorial procedures.

5  I refer to my previous blog: “Authors must be allowed to challenge accepted wisdom and dogma – obviously this is of utmost importance for scientific progress and for trust in research – but soundness in scientific approach must be a conditio sine qua non.”

  1. sandhya srinivasan says:

    Prof Ottersen has raised important issues on the role of journals and of research institutions in ensuring ethical research and informing medical practice. However, his attack on The Indian Journal of Medical Ethics in the name of publication ethics is flawed, and indicates a reluctance to engage in discussion on the scientific issues. He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.

    Good editorial practice: While journals should make every effort to confirm the author’s identity and affiliation, this is not routine editorial practice even among well-established journals. The Journal of Internal Medicine (published by Wiley) and Vaccine (published by Elsevier) have carried material by “Lars Andersson”, without checking his institutional affiliation and despite his use of a non-institutional id.

    Editors’ accountability: The comment by “Lars Andersson” ( http://ijme.in/articles/increased-incidence-of-cervical-cancer-in-sweden-possible-link-with-hpv-vaccination/ ) was reviewed by an external, international subject expert, an external statistician, a working editor with expertise in research methodology (Mala Ramanathan) and the manuscript editor (Sandhya Srinivasan) before being accepted for publication. When we were notified of the deception regarding the author’s identity and affiliation, we immediately removed the KI affiliation from the journal. We have explained our justification ( http://ijme.in/articles/statement-on-corrections/?galley=html ) for retaining the article on our website, and maintaining the author’s anonymity.

    The need to enable scientific debate: Prof Ottersen does not explain how anonymity prevents scientific debate on an analysis of publicly available data. And he does not explain how “false affiliation” is relevant in the context of the IJME article which no longer carries any affiliation. He says that “leading researchers with intimate knowledge of the vaccination field have identified serious flaws in the published report and its conclusion, thus questioning the quality of the review process”. However, neither he nor these unnamed researchers have stated what those flaws are. The attack on IJME for maintaining the author’s anonymity
    appears to be to avoid scientific debate. We invite critical commentaries on the paper by “Lars Andersson” towards advancing the scientific debate on the issue at hand.

    The suggestion that false affiliation and anonymity are preventing scientific debate is a red herring. Does Prof Ottersen’s indignation comes from his inability to personally target the person questioning the HPV vaccine?

    The need for institutional accountability: We suspect that, in addition to using the author’s anonymity as a red herring to prevent scientific debate on the article, KI has reasons to whip up sentiments against IJME to hide glaring failures of governance in the institute in relation to “Lars Andersson”.

    Between 2014 and 2017, two internationally reputed journals, JoIM and Vaccine, published correspondence from “Lars Andersson” who reported affiliation to KI. The letters in JoIM were in response to a paper in the same journal. A perusal of the JoIM articles shows that “Lars Andersson” had filed a complaint of research misconduct in 2016 against six authors of this paper, five of them affiliated to KI. The complaint was with KI for about a year, after which it investigated these allegations without confirming the identity of the complainant. Let alone a journal published from India, KI did not verify, on its own, the existence of a person on whose complaint it was acting. It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation. In this background, and with KI providing legitimacy to “Lars Andersson”, how could JoIM and Vaccine have suspected that “Lars Andersson” did not exist in KI? And how could this question have ever occurred to IJME?

    The prevention of deception by an author on the name or affiliation requires the joint efforts of many stakeholders, including journals. While IJME has taken full responsibility for what has happened, the attacks on it in the name of publication ethics cannot wish away the ongoing governance failure in the KI, and cannot be used to prevent scientific debate on an article which nobody has proved to be unscientific, except by innuendo.

    Dr Sunita V S Bandewar, PhD, MHSc (Bioethics), Independent Senior Research Professional; Working Editor, IJME. Email: sunita.bandewar@gmail.com
    Dr Rakhi Ghoshal, PhD, Assistant Professor, United World School of Law, Gandhinagar INDIA; Consultant Researcher, King’s College, London, UK; Working Editor, IJME. Email: rakhi.ghoshal@gmail.com
    Vijayaprasad Gopichandran, MD, PhD, Primary Care Physician, Reproductive Health Clinic, Rural Women’s Social Education Centre, Kancheepuram District, Tamil Nadu; Assistant Professor, Department of Community Medicine, ESIC Medical College and PGIMSR, Chennai INDIA; Working Editor, IJME. Email: vijay.gopichandran@gmail.com
    Sanjay A Pai, MD, Working Editor, IJME. Email: sanjayapai@gmail.com
    Mala Ramanathan, MSc, PhD, MA; Working Editor, IJME. malaramanath@gmail.com
    Sandhya Srinivasan, MA, MPH, Independent Journalist, Mumbai; Consulting Editor, IJME. Email: sandhya199@gmail.com

    • Ole Petter Ottersen says:

      The editor now raises several issues that serve to divert attention from the main point: lax editorial procedures that led the Indian Journal of Medical Ethics to publish an article under a false name and false affiliation. The editor’s reference to lax editorial procedures in other journals does not clear the editor and journal of blame but rather underscores the need to act.

      The Editor writes: “While journals should make every effort to confirm the author’s identity and affiliation, this is not routine editorial practice even among well-established journals.” It is surprising and disappointing that the editor and journal take this stance. This does not bode well for the future of medical publishing, nor for the reputation of the Indian Journal of Medical Ethics.

      • Dr Peter Flegg says:

        It is extremely worrying that a journal of medical ethics should take this stance, and casts considerable doubt upon their entire raison d’etre.
        It is also of great concern that the major scientific flaws in the article in question, which are readily identifiable even to those with a limited expertise in epidemiology, should have escaped the notice of the journal’s supposedly expert review panel.

  2. Pravir Chatterjee says:

    In short “Lars” deceit has been admitted and the wrong attribution corrected by the journal. That, along with an apology and criticism of the act of deception is about all the journal can do. It was done promptly. Other journal should do the same.

  3. David Lawrence says:

    The staff of the IJME defend their lack of rigor by building a strawman and engaging in whataboutism. That KI didn’t object to the false affiliation before it was made aware of the problem is nonsensical. Saying that KI should have questioned the legitimacy of the false name then the anonymous author filed actions against KI is without merit. Does the editor know that KI didn’t discover this fraud during an investigation ofthe complaint.

    We have journals accepting and publishing a manuscript not from an author who for political reasons wishes to be anonymous but from someone who lies about their name and university affiliation. We have an article that through questionable selection of cases introduces potential biases to conclude that immunizations are hazardous. After the Andrew Wakefield debacle, if I was a journal editor, I would have closely vetted the presenter of findings that have such an important implication for public health. Indeed, as an editor I might wonder why such an important article was submitted to my journal instead of to a more prestigious one.

    The journal tries to counter the questions concerning reproducibility by saying that the research didn’t arise from a lab but from public information. Yet, the article’s methodology section doesn’t provide sufficient information to counter concerns that the data could have undergone selective manipulation to achive a desired result.

    As I commented in the other forum (before I read this thread) this is a major problem for the credibility of published research. When I read an article published in a journal I expect that the author is a real person who has the claimed credentials and affiliation. If a journal will publish a manuscript by anyone without a verification that the author has a real name, an earned credential, and a true affiliation then what is left of the trust we have given journal publication. Journal publishing should be the
    ultimate scientific communication. If a journal editor is unwilling to carefully serve in a gatekeeper role, then nothing published there has and credibility.

    A scientific journal should have a mechanism to identify and reject claptrap. Else, I could manipulate some dairy marketing data and population prevalence data to suggest that eating vanilla ice cream leads to, what, yes, presbyopia that a good idea. I would be sure to use a pseudonym and to claim an affiliation with an institution I would like to disparage.

  4. David Lawrence says:

    Today, I noticed that the journal, IJME, has retracted the article but within the retraction defends the author’s methods and findings.

    http://ijme.in/articles/increased-incidence-of-cervical-cancer-in-sweden-possible-link-with-hpv-vaccination/?galley=html#comments

    I cannot find any plausible mechanism that the author’s methods could have demonstrated a cause and effect (HPV vaccination causing cervical cancer). The weak association that was identified by selective manipulation of the data is on its face impossible because of what is known about the disease progression of cervical cancer. 15 to 20 years is the development time. HPV vaccine was first developed in 2006-2007 and not widely distributed in Sweden until 2010. If the pseudonymous author’s findings are to be believed, the vaccine would also need to be classed as a powerful cancer promoter and accelerant via some yet-to-be identified biological process.

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