White Paper

Rising tide of plagiarismand misconduct inmedical research
Plagiarism and other forms of misconduct are a growing problem in research. Whenfactored for the increase in articles published, there has been a 10 fold increase in therate of article retraction over the past 20 years. A quarter of those retractions are due toplagiarism and duplication, often referred to as self-plagiarism, and a larger portion ofretractions are fraudulent or fabricated work.
Unfortunately, this rise in unethical research is having severe consequences on the
medical profession. Not only is money and time being wasted trying to replicate
questionable research, precious publication space is also wasted on duplicative papers.
More importantly, the ethical issues are beginning to increasingly impact the level oftrust that the public puts into the medical profession. Even worse, patients sometimes
receive ineffective or harmful treatments based on poor or unethical research.
Although there are many potential solutions, there is no single floodgate to restraining
misconduct in medical research. Stemming the tide of bad research will require aconcerted effort at all levels and roles in the field of medical research—from theresearchers that pen new papers to the journals themselves and even the doctors who
receive the final publications. Without addressing the issue directly and broadly, theissue and its consequences are only likely to grow.

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Contents

Introduction: The rise of plagiarism		
3
Retractions: Solution to a growing problem?		
4
Reputations marred across medical research		
5Conclusion		
9

Works cited 		
10

White Paper | Rising tide of plagiarism and misconduct in medical research2Introduction: The rise of plagiarism
In December 2010 issue of the journal Anesthesia and Analgesia, the editor of the publication posted a notice ofretraction, stating that they had become aware that a recently published manuscript entitled “The effect of celiac plexus
block in critically ill patients intolerant of enteral nutrition: a randomized, placebo controlled study” had portions of it
found to be plagiarized from five other manuscripts. The retraction would have been fairly mundane, if still somewhat
disappointing, if it had not been for a separate request for retraction in the same issue. In that request for retraction, anIndian physician requested that a manuscript he had contributed be retracted due to the discovery of plagiarized material
inside it. That, too, would be uninteresting if it weren’t for the fact that the Indian paper was one of the five papers citedin the retraction for the first. Meaning that the first paper was retracted, in part, for plagiarizing from a paper that was
retracted for plagiarism.1
However, such is the nature of medical research as plagiarism continues to grow as a problem. Increasingly questionable
research is being built upon other faulty research. While this creates a serious problem for journal editors, it can create
bigger problems for doctors working in the field and patients who may be receiving faulty treatment.

White Paper | Rising tide of plagiarism and misconduct in medical research3Retractions: Solution to a growing problem?
A 2009 analysis of the Thomson Scientific Web of Science database for the Times Higher Education revealed that, when
adjusted for the increase in published papers, the rate of retractions has increased 10 fold in the past 20 years.2
And while the number of retractions is still fairly low—95 out of more than 1.4 million published papers— many experts
have expressed concern that this represents only a small fraction of the problem. James Parry, the chief executive of UK
Research Integrity Office said in an interview with the Times Higher Education that, “Even on a conservative estimate of one
percent misconduct, we might expect 15,000 retractions a year, but we have a lot less.”
These findings are mirrored closely by Grant Steen, the author of a 2010 paper in the Journal of Medical Ethics that lookedat the number of retractions in the PubMed database from 2000 to 2010.3
In an interview with Retraction Watch, Steen said that “the rate of retraction definitely increased year-by-year over the period
I evaluated.” Steen also noted that the rise in retractions could be caused by a variety of factors, including increased use ofplagiarism detection tools and publishers retracting farther and farther back to purge their databases of “false science.” 4
However, retractions only tell a part of the story, as only published posts are retracted. According to Kim Mitchell, theJournal Publications Director at Landes Bioscience, a firm that publishes over 40 journals, just one of the company’s
journals, “Cancer Biology & Therapy”, rejected 221 article submissions for plagiarism in 2012.
Mitchell stated that among those articles rejected, 43 had more than 40 percent of the content similar to another paper.
Half of those cases were matters of self-plagiarism, and the other half involved more traditional plagiarism.
However, the journal has not yet had to retract any submitted articles due to plagiarism because of its diligent filtering,which prevents plagiarized papers from running in the company’s publications. “We haven’t had to retract anything since westarted using iThenticate and CrossCheck,” Mitchell said.
Mitchell isn’t the only one working to filter out plagiarized submissions before publication. The problem became so
serious for the Singapore Medical Journal and the Medical Journal of Malaysia that the two publications released a jointstatement in 2008 reminding researchers of the ethical issues surrounding plagiarism and reminding them not to use
unattributed works in their papers.5
Finally, and most seriously, there’s the issue of known plagiarism appearing in a work, but it not being retracted.
Retraction Watch cited a recent report for the Serbian science ministry by the Center for Evaluation in Education andScience (CEON/CEES) which found that, across all fields including medicine, 11 percent of scientific journal articles
published in English in Serbian journals contained plagiarism.6 However, there were only six retractions despite over
123,000 articles published since 2000.
In short, plagiarism, as well as misconduct in general, is a growing problem for the medical field and it’s one thatjeopardizes both the reputation of the field and, ultimately, the health of patients.

White Paper | Rising tide of plagiarism and misconduct in medical research4Reputations marred across medical research
The impact of plagiarism and misconduct is significant and broadly felt. Unethical behavior, for example, slows the paceof new research and innovation by causing researchers to duplicate efforts and attempt to replicate flawed studies.
According to Kim Mitchell, these delays have been felt sharply at her journals. Though Landes Bioscience makes a great
deal of effort to quickly reach decisions on submitted papers, the delay caused by dealing with plagiarism and otherethical issues has doubled the time it takes to reach a decision on a manuscript.
“Initially, from submission to first decision was 30-35 days. Now, after the influx of plagiarized papers, it takes a month just to go
through the papers and send them back for review. It now takes about 60 days to first decision,” Mitchell said.
This delay keeps critical research out of the hands of colleagues and practitioners that may need the information to help
patients or advance their research.
Further, misconduct creates an issue of trust, especially with the general public. Patients need to feel certain that theirdoctors have both the correct information to treat them and that they are being cared for by people with their bestinterest at heart. Scientific misconduct, however, can make this very difficult.
Brain research
For example, in 2010 the UK medical journal, The Lancet, retracted a controversial 1998 report by Dr. Andrew Wakefieldthat seemingly showed a link between the MMR vaccine and autism. The move came after an article by reporter Brian
Deer identified undisclosed financial conflicts of interest in the work, prompting the British General Medical Council toinvestigate Wakefield and find 36 counts of proven misconduct.
However, largely because of Wakefield, many members of the public grew to distrust the MMR vaccine and, as recently as
2009, one study found that as many as a quarter of parents believed vaccines can cause autism.7
Cancer research
Earlier this year, an editorial by French cancer researchers was retracted from the Journal of Clinical Oncology overallegations of plagiarism.8 According to the retraction, the editorial contained uncited material from six other works,
including content published between 2007-2011.
The retraction would have been unremarkable except one of the physicians who had signed the editorial was Dr. David
Khayat, a prominent French oncologist who has routinely been involved in his country’s policies on cancer research,
including convincing the government to increase spending on research and treatment.
According to the authors of the paper, the work was a commentary piece and the first author did not properly citematerials in lines over two pages of commentary. Though it seems likely to have been a simple but avoidable mistake,it cast a black mark on the reputation of a physician who has been crucial in advocating for government investment toadvance cancer research.

White Paper | Rising tide of plagiarism and misconduct in medical research5Medical psychology
The field of psychology, an area already struggling to build a positive image with the public, has been hit hard byallegations of plagiarism and misconduct.
In 2008, one of the UK’s best-known psychiatrists, Dr. Raj Persaud, was suspended from practice for three months by thenation’s General Medical Council after he admitted to nine counts of plagiarism. Dr. Persaud, who was a media celebrity
in the country, blamed the plagiarism, in part, on his hectic schedule and said that he never intended to deceive.8
However, the GMC disagreed saying that they were, “in no doubt that your (Dr. Persaud’s) dishonest conduct and plagiarisingother people’s work on multiple occasions represents a serious breach of the principles that are central to good medical
practice.”
Dr. Persaud not only lost many of his media positions after the scandal but also resigned as a consultant for a London
hospital, South London and Maudsley NHS Foundation Trust.9
Unfortunately, that would not be the only ethics scandal psychiatry and psychology would face.
In 2011, Danish social psychologist Diederik Alexander Stapel was found to have fabricated data in some 30 papers, all ofwhich were retracted,10 and soon thereafter, another social psychologist, Dirk Smeesters, was found to have fabricateddata in two papers, both of which were retracted.11
The result of these scandals was not just research time and money wasted on flimsy and fraudulent results, but theharm to the public’s trust and perception. This mistrust is summarized in a 2009 paper published in World Psychologythat found perceptions of psychiatry in the news media are largely negative and quoted an earlier study focusing on
the media’s coverage of the John Hinckley trial by saying that psychiatry is seen as “a discipline without true scholarship,
scientific methods, or effective treatment techniques.” 12
While clearly the mistrust of the field began well before the recent scandals, the Drs. Persaud, Stapel and Smeesters
scandals certainly haven’t helped. The authors of the World Psychiatry paper recommend that psychiatrists “strictly
observe ethical rules in the practice of psychiatry and to maintain professional competence” as a means to prevent thestigmatization of the field.

Growing need for prevention
Practitioners in the medical field involved with medical research and students looking to enter the medical field are
directly impacted by these issues. Ethical issues, such as the ones listed above, not only waste time and money that could
be spent on quality research, but also harm the reputations of their fields and destroy careers of potentially promisingphysicians and researchers. Maintaining high integrity standards and ethical research practices is key to the success ofthe medical research community.
Medical researchers
For medical researchers, maintaining good ethical practices is paramount. This means, among other things, notfabricating or altering data, not deliberately plagiarizing work and checking work thoroughly.
Also, although medical writers are often touted as a means of preventing plagiarism13, there have been incidents of
misconduct.14 This makes it crucial for researchers to check papers rigorously, especially if additional writers wereinvolved.

White Paper | Rising tide of plagiarism and misconduct in medical research

6Doctors, physicians and healthcare practitioners
Doctors, as the users of the research others produce, are on the front lines when bad information is published. It’s
important for doctors to be critical of the work they read and raise suspicions when they feel something is amiss.
For example, the inconsistencies in Smeesters’ work were first noticed by an associate professor at the University ofPennsylvania, Uri Simonsoh, who, in turn, alerted Smeesters’ university.15
With the tools for checking for ethical violations, and for plagiarism in particular, so broadly available, those who arereading the published data can often catch issues that are overlooked during the peer review process.
Medical professors and students
It is the responsibility of educators at medical institutions and departments to teach their students about writing ethics
and best practices. In turn, medical students need to abide by their instructors’ and institutions’ integrity policies, andensure that both their coursework and any research they assist in is up to the highest standards. As with researchers,
students need to work to avoid both intentional ethical issues and mistakes.
Being involved in unethical research, especially at a graduate level, can severely harm career prospects, so students are
urged to ensure that everything they author or contribute to is of the highest quality and standards.
Medical journals
Unfortunately for medical journals, not only are the number of retractions on the rise, but the vast majority of thoseretractions are caused by fraud, including 25 percent of which are due to plagiarism or duplication.16
To reduce retractions and improve the quality of research, it’s critical for publishing organizations to strengthen thereview process, and thoroughly examine submitted works prior to publication. Editors may decide to check submissions
at different points during the review process, but nearly all agree to do it before publication. According to a survey of 129
editors conducted by iThenticate in December 2012, 97 percent believe that it is best to check work for plagiarism before
publication.17
iThenticate, leading plagiarism detection software for researchers, and CrossRef, a not-for-profit membership associationof scholarly publishers, encourage their members to publicize their use of the service in their submission systems and intheir author instructions communications to actively deter authors from submitting plagiarized or duplicate work as earlyin the process as possible.
Other publishers, like the British Medical Journals (BMJ), have come out publicly to let authors know they will screen
papers at the point of acceptance.
Kim Mitchell has found that the best time to check a work for plagiarism is shortly after it’s submitted and before it is sentout for peer review. This way, the reviewers’ time is not wasted examining manuscripts that will ultimately be pulled fromconsideration and potential issues with a paper can be resolved quickly.

White Paper | Rising tide of plagiarism and misconduct in medical research7Mitchell has also determined that technology can help with this process greatly: “If you’re not using a plagiarism detection
system, put one in place.” Though Mitchell said her company doesn’t check every paper, they do run a plagiarism scan on
the discussion section of original research papers and, “if we get a high result on the discussion we run the entire paper,”she said.
A recent survey by CrossRef suggests that Similarity Check members are taking a variety of approaches to plagiarism
screening such as ones that screen all manuscripts on submission (like Anesthesia & Analgesia18) and those who do sofor all accepted papers, like the BMJ Group. “Many take Landes Bioscience’s approach and do some triage based on sectionsof text or a subsection of papers, which can be useful, depending on the volume of submissions and available resources,” stated
Rachael Lammey at CrossRef.
Detecting flawed research early, using a system like Landes Bioscience, not only helps prevent retractions, maintain the
reputation of the journal and make room for better research to be published, but it also enables researchers to edit
minor errors to be edited from otherwise solid work and resubmit the paper for publication.

White Paper | Rising tide of plagiarism and misconduct in medical research

8Conclusion
The importance of dealing with misconduct in medical research cannot be understated. Poor quality and unethicalresearch not only wastes time and money that could be spent on more significant and impactful projects, but faulty
research also helps foster a distrust of the medical field, an area where trust is especially important, and can even resultin patients receiving harmful treatments.
In order to reduce the amount of poor quality research that is published, including both retracted and un-retracted
articles, there needs to be a concerted effort from all involved in the medical field, including researchers, journals andhealthcare practitioners.
“The problem of plagiarism is a growing one. The only way that it’s going to be solved, as an ethical problem, is to have a lot
more retraining both here and abroad,”
Kim Mitchell said. It is only through a broad, concerted effort to reduce unethical research that the pace and quality ofgood research be increased and the public’s trust in the profession and its advancements be restored. Such efforts will
only serve to improve the quality of care for patients and the general health of the public.

White Paper | Rising tide of plagiarism and misconduct in medical research

9Works cited1.

Das, Natasha and Panjabi, Monica. “Plagiarism: why is it such a big issue for medical writers?” National Center for
Biotechnology Information, U.S. National Library of Medicine. Apr-Jun 2011. http://www.ncbi.nlm.nih.gov/pmc/ articles/
PMC3121267

2.

Corbyn, Zoe. “Retractions up tenfold” The Times Higher Education. August 20, 2009.
http://www. timeshighereducation.co.uk/story.asp?storycode=407838

3.

Steen, Grant R. “Retractions in the scientific literature: do authors deliberately commit research fraud?” BMJ Publishing GroupLtd & Institute of Medical Ethics. November 15, 2010. http://jme.bmj.com/content/ early/2010/10/18/jme.2010.038125.abstract

4.

Oransky, Ivan. “So how many retractions are there every year anyway?” Retraction Watch. November 16, 2010.
http://retractionwatch.wordpress.com/2010/11/16/so-how-many-retractions-are-there-every-year-anyway/

5.

Peh WCG, Arokiasamy J. “Plagiarism: a joint statement from the Singapore Medical Journal and the Medical Journal of
Malaysia” Singapore Med. 2008. http://smj.sma.org.sg/4912/4912e1.pdf

6.

Oransky, Ivan. “A tsunami of plagiarism in Serbia, but hardly any retractions” Retraction Watch. January 3, 2012.
http://retractionwatch.wordpress.com/2012/01/03/a-tsunami-of-plagiarism-in-serbia-but-hardly-any-retractions/7.

Harmon, Katherine. “Impact Factor: Can a Scientific Retraction Change Public Opinion?” Scientific American. March 4, 2010.
http://www.scientificamerican.com/article.cfm?id=retraction-impact-lancet

8.

Oransky, Ivan. “Plagiarism leads to retraction of liver cancer paper” Retraction Watch. July 12, 2012.
http:// retractionwatch.wordpress.com/2012/07/12/plagiarism-leads-to-retraction-of-liver-cancer-paper/

8 (2).

Wainwright, Martin. “Persaud suspended from practice for three months over plagiarism” The Guardian. June 20, 2008.
http://www.guardian.co.uk/society/2008/jun/21/mentalhealth.health9.

Wainwright, Martin. “Disgraced Raj Persaud quits as consultant at leading hospital” The Guardian. October 23, 2008.
http://www.guardian.co.uk/lifeandstyle/2008/oct/24/raj-persaud-psychiatry-maudsley

10.

Carey, Benedict. “Fraud Case Seen as a Red Flag for Psychology Research” The New York Times. November 2, 2011. http://
www.nytimes.com/2011/11/03/health/research/noted-dutch-psychologist-stapel-accused-of-researchfraud. html?_
r=1&ref=research

11.

Oransky, Ivan. “Following investigation Erusmus social phychology professor retracts two studies, resigns” Retraction Watch.
June 25, 2012. http://retractionwatch.wordpress.com/2012/06/25/following-investigationerasmus- social-psychologyprofessor-retracts-two-studies-resigns

12.

Sartorius, Norman et al. “WPA guidance on how to combat stigmatization of psychiatry and psychiatrists” World Psychiatry.
October 9, 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948719

13.

Woolley, Karen L et al. “Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for
misconduct: a systematic, controlled, retrospetive study” Informa Healthcare. June 2011. http:// informahealthcare.com/doi/
abs/10.1185/03007995.2011.573546

14.

Oransky, Ivan. “Yes, Virginia medical writers really do commit plagiarism says a surgery retraction” Retraction Watch. May 12,
2011. http://retractionwatch.wordpress.com/2011/05/12/yes-virginia-medical-writers-really-do-commitplagiarism- says-asurgery-retraction/

15.

Jha, Alok. “False positives: fraud and misconduct are threatening scientific research” The Guardian. September 13, 2012.
http://www.guardian.co.uk/science/2012/sep/13/scientific-research-fraud-bad-practice

16.

Fang, Ferric C et al. “Misconduct accounts for the majority of retracted scientific publications” PNAS Online. September 9,2012.
http://www.pnas.org/content/early/2012/09/27/1212247109

17.

“Survey Shows Plagiarism a Regular Problem in Scholarly Research, Publishing, But Action to Prevent Falls Short” iThenticate
Survey. December 5, 2012. http://www.ithenticate.com/plagiarism-detection-blog/bid/89411/Survey- Editors-See-RampantPlagiarism-vs-Writers-Think-Work-is-Original

18.

“Anesthesia & Analgesia Announces Use of CrossCheck on All Article Submissions” Newswise. February 12, 2011. http://www.
newswise.com/articles/anesthesia-analgesia-announces-use-of-crosscheck-on-all-article-submissions

White Paper | Rising tide of plagiarism and misconduct in medical research

10About iThenticate
iThenticate is the premier tool for researchers and professional writers to check their original works
for potential plagiarism. With an easy-to-use submission process that checks for similarity against
the world’s top published works, researchers and institutions can feel confident that their academic
reputation will be protected.
iThenticate provides faculty, researchers, grant writers, and graduate or doctoral students witha comparison database for the evaluation of academic research papers and journal articles.
Throughout the granting, researching and writing phases iThenticate can provide valuable support toensure your work is free from suspicion.

About CrossCheck
CrossCheck powered by iThenticate is an initiative between CrossRef® and iThenticate® established
to help publishers prevent professional plagiarism and other forms of scholarly misconduct.
www.crossref.com/crosscheck

About Turnitin
Turnitin is your partner in fostering original thinking and supporting authentic learning. Turnitin
solutions promote academic integrity, streamline grading and feedback, and improve outcomes
across educational levels and content areas. Turnitin leverages cutting-edge technology to provide
tools that prevent plagiarism, deliver formative and summative feedback, surface actionable
reporting, and investigate academic misconduct. Growing from one million student paper
submissions in 2002 to one billion in 2018, Turnitin serves over 15,000 institutions globally and isheadquartered in Oakland, Calif., with international offices in the U.K., Netherlands, Australia, Korea,
India, and throughout Latin America.

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of plagiarism and misconduct in medical research11