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By Charles Piller
This story was supported by the Science Fund for investigation reports. Please help Science pursue ambitious journalism projects.
In June 2020, in the biggest research scandal of the pandemic to date, two of the most important medical journals each retracted a high-level study of patients with COVID-19. Thousands of news articles, tweets, and academic commentary shed light on the scandal, but many researchers apparently failed to notice. In a review of the 200 most recent academic papers published in 2020 that cite these papers, Science found that more than half – many of them in leading journals – used dishonored articles to substantiate scientific findings and failed to note retractions.
COVID-19 “is such a hot topic that editors are willing to publish without proper verification” even in the face of the retractions that have made global headlines, says Elizabeth Suelzer, reference librarian at the Medical College of Wisconsin who wrote on problematic citations to a retracted 1998 study The Lancet falsely linking vaccination to autism.
The two retracted COVID-19 papers, one in The New England Journal of Medicine (NEJM) and the other in The Lancet, were based on what appeared to be a huge database of patient records compiled from hospitals around the world by Surgisphere, a small company run by vascular surgeon Sapan Desai, co-author of each article. May 22, 2020 Lancet The article ostensibly showed that hydroxychloroquine, an antimalarial drug promoted by President Donald Trump and others, could harm rather than help patients with COVID-19. Its publication led to a temporary halt of a major clinical trial and ignited an already controversial debate over the drug, which has been found not to help against COVID-19. May 1 NEJM The article corroborated other evidence that people already taking certain blood pressure medications were not at greater risk of death if they developed COVID-19.
Questions have arisen about the validity, if not existence, of the Surgisphere database, however, and retractions followed on June 4. But out of the 200 articles reviewed by Science—All published after the retractions – 105 incorrectly cited one of the disgraced studies. In several cases, this was a primary source for a meta-analysis combining several studies to draw overall conclusions. In most cases, the studies were cited as scientific support or background. Science also found a handful of articles that uncritically cited an influential April pre-print based on the same Surgisphere data set, which described the pest control drug ivermectin as beneficial in critical cases of COVID-19. (There is no standard way to remove pre-prints, however.)
Ivan Oransky, co-founder of the Retraction Watch website, says such errors happen because “people don’t willingly or negligently check references.” Many writers copy and paste lists of seemingly relevant quotes from similar articles without reading them, he says. “It’s scary. It’s terrible, but common.
Many tainted citations have appeared in articles published by little-known journals, but at least a dozen have found their way into major publications. For example, three articles in PLOS ONE, the leading open-access journal, cited the retracted articles during discussions of pandemic conditions in Europe. An article from December 28 in the Proceedings of the National Academy of Sciences (PNAS) – one of the most influential journals – discussed the risks and benefits of drugs to treat COVID-19 and noted the Lancet retraction in his quotes, but the text simply noted the conclusions of the article on hydroxychloroquine as “controversial.”
The editors of these two publications said they would correct the references and take steps to avoid such problems in the future. Renee Hoch, a PLOS ONE editor and responsible for publication ethics, wrote in an email that the publication relied on the authors and its external contributors, volunteer editors to verify citations, and was taken by surprise when has been contacted by Science. “We are currently monitoring this issue with high priority in light of the implications for public health and ongoing research into COVID-19,” she wrote.
Hoch added that reliance on retracted work, “either directly or in the form of supporting references”, can be detrimental. “[W]here, retracted labor has clinical implications, which can lead to direct risks to patients.
In a written response to questions on the quote from Lancet paper, May Berenbaum, editor-in-chief of PNAS, said: “The authors really should have either removed the quote, added more text explaining why they included it, or cited the notice of withdrawal itself.” Since no editor or reviewer spotted the problem, she said, “I plan to discuss with the staff how to integrate such a selection into the manuscript processing.” A co-author of the article, biostatistician Clelia Di Serio of Vita-Salute San Raffaele University, later said the reference to the Lancet the paper would be erased.
Some journal editors noted mitigating factors. In Stroke, a leading medical journal, a December article on ischemic stroke in COVID-19 patients referenced the NEJM paper without mentioning the withdrawal. Stroke Editor-in-chief Ralph Sacco wrote in an email that the retraction took place after the article was initially received. However, a review of the article was resubmitted months after the event, according to the newspaper itself. Sacco said he would not issue any corrections because the retraction “is not important to the findings.”
A December 16 article on the genetics of SARS-CoV-2 Nature communications, another high-profile review, also cited the NEJM article without reference to the withdrawal. Elisa De Ranieri, editor-in-chief of the newspaper, said Science his journal does not systematically look for “retractions or other post-publication updates.” A lead author of the article, biomathematician Maik Pietzner of the University of Cambridge, said that although the article was submitted after the retractions, it was written in advance and that “the current pandemic requires immediate response ”. However, the article was published 4 months after its submission.
Suelzer says inappropriate quotes from retracted articles are hard to excuse. Retraction Watch publishes a free retraction database that has been integrated into a number of automated services to verify citations, including scite.ai, Zotero and RedacTek. Failure to use such tools “is a disservice to readers and researchers,” Suelzer says. “These are pretty low bars.”
Yet Oransky estimates that in biomedicine, up to 90% of citations to retracted articles do not mention their disgrace. “Half the time [as seen with the Surgisphere papers] is an improvement. This is what is shocking about it.
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