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Undeclared conflict of interest


A paper on a controversial topic from three authors was published. All three authors completed forms to say that they did not have competing interests. This was stated at the end of the paper. A reader subsequently contacted the journal to say that she had clear evidence that one of the authors did have competing interests. He had, she said, been involved in legal cases and received substantial payments for his work. The article related to these legal cases.


The wrong standard deviations, the over stringent selection criteria, and the overt attempt at advertising


A randomised controlled trial raised three aspects of concern: 1. The participants’ physical characteristics at entry to the study were listed in a table. For the two groups—intervention and control—one physical characteristic was given as a mean ± the standard deviations (SDs). However, the SDs for both groups were much smaller than they should have been. 2. The inclusion criteria were unusual. These excluded half of the eligible population. 3.


The hazardous drug used in an unlicensed way


The author (a clinician) sent in a case series, involving two patients. Both patients presented with severe pain, which was resistant to strong analgesics. The author then gave them a drug with potentially very serious sideeffects, including a small risk of disability or death. This drug is only licensed for a small number of indications. Neither of these two patients met the clinical criteria for its use, yet the author gave it to them in a quasi-experimental way.


The study that may or may not already have been published


A study purported to have been stimulated by a systematic review that had already been published in the journal. The new study included 15 patients who had been treated in one arm of a study and 15 who had been treated in another arm. The peer reviewers noticed that the original systematic review included 31 patients from the same authors. The editor contacted the authors asking them to make clear whether this was a new study or a presentation of existing data.


A paper describing a case of possible medical negligence


A paper was submitted, describing a doctor who had given an injection of a drug (actually a herbal/homeopathic remedy) to a patient who had already experienced recurrent swelling when given previous injections of the drug. The patient suffered a severe anaphylactic reaction, but survived. The reviewer suggests that it was negligent to give such an injection. It seems at least plausible that this was negligence, and the question for the journal is whether any action should be taken.


The unacceptable use of a placebo


This was a small randomised controlled trial of a medication for an active inflammatory condition. The trial was unnecessary, as several large trials and a recent non-systematic review had shown that the medication was beneficial for flare-ups of the condition. In this case, all patients were taken off non-steroidal anti-inflammatory drugs (NSAIDs) and then they were randomly allocated to receive the medication or an inert placebo.


Paper submitted by a PR company without the knowledge of the authors


A paper was submitted for which there were seven contributors, but no corresponding author. The only identification of who had sent the paper was an accompanying e-mail from a public relations company. When contacted by the editorial office, the PR company confirmed that the paper was to be considered for possible publication.


Duplicate publication based on government data


A group of researchers from departments of psychology and public health submitted a paper based on a survey that had been commissioned by the NHS Executive. The paper was received at Journal A on 14 May 1998 and a decision to offer publication of a revised version was made on 25 June 1998. Over a year elapsed between this offer and the resubmission of a revised version of the paper due to illness and a change of job, on the part of the corresponding author.


The single author, randomised controlled trial


After a randomised controlled trial from a single author had been published, a letter was received in which the correspondent suggested that the original trial might be fraudulent. Firstly, the writer claimed that it was highly unlikely that just one author could perform a prospective, randomised, double blind, placebo controlled trial, especially in a small district hospital. The correspondent was also worried that there was no mention of other standard treatments.


Editorial compliance with duplicate publication


An editorial that was very close to a paper that had already been published in another journal was submitted for publication. The authors did not make clear that the editorial was essentially the same as the one already published, but this was discovered during the peer review process. Nevertheless, the journal went ahead and published the editorial without disclosing that it was very similar to the one that had already been published. Copyright was not obtained from the author.