An article describing three similar cases was submitted to Journal A. The author was asked to provide evidence of the patients’ consent for their details to be used in the paper. The author replied that all the patients’ personal details in the report had been anonymised and that signed consent would destroy this. Also, two of the three patients had since died and correspondence could be distressing for the relatives. The editor explained the importance of consent and that she would be happy to accept a signed letter from the author confirming that consent had been obtained for publication of all three cases. The author had obtained permission from the living patient and also from the relatives of one of the patients who had recently died. The relatives of the other patient could not be traced. The patient’s wife had also died and there were no children. The editors accepted this explanation and peer reviewed the article for possible publication.
_ Legally, permission is required from the living unless they are under 16 or incapacitated. _ Relatives have no place in giving permission on behalf of deceased patients. _ The explanation from the authors was, however, deemed acceptable as it was agreed that they had gone as far as possible and had acted courteously.
An author wrote to the editor of a specialist journal, indicating that a paper had been published without appropriate recognition of himself as an author. In his letter he stated that he had contributed more than 50% of the cases reported. The first author had “not only stolen my data and published it without my consent, but also omitted my name. ” The editor has written to the authors of the paper asking for further information, but should any further action be taken?
_ Under the Vancouver guidelines, simply providing cases does not constitute authorship. _ The onus was on the journal to pursue this because the paper had now been published. _ The editor should contact the head of department, but if the institution is unwilling to look at it, then it should be left as an unresolved case. _ First of all, request an explanation from the authors.
A specialist society wishes to post “case of the month” on the society website. The society is not proposing to obtain patient consent from all patients, but will anonymise the case reports instead. It has been suggested a case might be anonymised by changing details including age, occupation, or gender. It has also suggested that there is often much to learn from patients who have died, from whom consent would not be possible. Is this approach reasonable?
To do this would be in breach of the UK General Medical Council guidelines.
Rendering the patients anonymous is not enough.
If a patient has died, permission is not required, but should be obtained from the next of kin as a courtesy.
The facts regarding age, occupation and gender could not be altered.
The editor was advised that patient consent must be obtained, and that patient details must not be modified in an attempt to provide anonymity. The specialist society will inform authors that they must obtain signed patient consent before cases can be published.
An author requested advice about reporting unusual ocular manifestations of a patient who died from a fatal injury. The author sought the permission of the family to report the case, but they also requested that the patient’s name be added to the report in her memory. The author has proposed to add the following in the acknowledgement section: “The authors are grateful to the family of forename/surname for their permission to publish this case report, and at their request, have named the deceased, in memoriam.” What does the committee think?
_ If the deceased patient is identifiable, then there is a breach of confidence, and confidence survives death. _ The family cannot absolve this, but if it is in the public interest, then the name could be provided. _ The editor has to be satisfied that the dead patient would not have objected to any publicity, and that no other person(s) can be hurt or harmed by the publication of her name. _ If these criteria can be satisfied then a redrafted form of words could be published—for example: “The authors are grateful to the family of forename/surname for their cooperation in the publication of this case report, and at their request have identified her as the deceased, as a memorial to her.”
An article was published with three authors’ names. Not all of the authors’ signatures had been included on the original submission letter. A complaint was lodged by Y, who said that X had submitted the paper without either his or Z’s consent or knowledge, and that there were several specific errors and omissions. Y then submitted a statement for publication in the journal dissociating himself from the published article. The statement was copied with Y’s approval to the corresponding author, X, to give him the opportunity to respond. X responded and arranged for two colleagues, A and B, to submit statements about the research work in question. Y (the complainant) also submitted further information about the research work. This correspondence spawned a series of allegations, denials, explanations and counter-allegations. Although the journal feels it should publish Y’s dissociation from the article in the journal, would it be wise to publish this without anything from X? Additionally, if the editors are sure that X submitted the article without the approval of his supposed co-authors, should action be taken against him, such as barring him from publishing in the journal for a period of time?
_ The corresponding author should have the right to reply. _ There had been a clear breach of publication ethics as not all the authors signed the original agreement on submission. _ It probably is not enough to publish a statement and the matter should be referred to the head of the institution for an investigation, after which the journal should publish the consequences. _ A representative from the other institution—that of author X’s—should also have the right of reply, and the editor would also need to comment on the issue. _ Institutions can hide behind confidentiality agreements and there is evidence that internal enquiries are not always useful. _ The heads of the institutions of all the authors should be informed and the journal should not make any public statement until the responses had been received.
A letter of dissociation from the author was published by the journal. The heads of the institutions were not contacted.
Three papers concerning one hospital problem had been submitted to three different journals. Before publication the three editors of the journals became aware of the three different papers and the substantial overlap between them. The three editors communicated with each other and realised that they had four concerns: 1. There was very considerable overlap among the three papers. There didn’t seem to be any justification for publishing three papers rather than one or two. 2. The authors of the papers had not disclosed the existence of the other papers to any of the editors. 3. The three papers all had different sets of authors, and it seemed most unlikely that all authors met the definition of authorship devised by the International Committee of Medical Journal Editors. It also subsequently emerged that at least one author was unaware that he had been listed as an author on one of these papers. 4. There were inconsistencies among the papers. One particular patient was described in all three papers, and there were inconsistencies in the nationality of the patient, the readmission date, the results of a particular test, and the final diagnosis. The three editors took a very long time to decide what action to take, and in the end differed in their responses. One editor decided simply to notify the authors that she would not publish the paper and that she was concerned about the circumstances of the paper. The two other editors decided to ask for an investigation. One editor wrote to the chief executive of the institution where the authors had worked some ten months ago, but no explanation of what happened had been received. What should the editor do now?
_ The chief executive has now responded and agreed there were problems with redundant publication and as a result they will be revising their policies. Reasonable answers had been given that explained the discrepancies raised. _ A letter should be published in all of the journals regarding the redundant publication. _ A common agreement between all of the editors should be obtained, noting that it could be a prolonged procedure.
The matter was investigated by the chief executive, who agreed that the overlap was evident on re-review. But he believed there was no deliberate intention to deceive.
A paper containing three case reports of the same disease was accepted for publication. The disease reported is fairly rare. The parents of one of the cases consented to publication on condition that their daughter was referred to in the paper by her first name rather than as a case number. This particular case has been discussed in the course of a national inquiry, but it is not clear whether the other two cases were discussed. If the editor publishes this paper, the identity of the other two cases might be revealed if he respects the wishes of the parents. What does COPE advise?
Informed consent must be sought from the relatives of the other two cases. The editor should approach the authors to this effect. _ The fact that a national inquiry is under way is not relevant. _ The authors should also inform patients that the journal has a website and that there are regular press releases, so the case might receive wide dissemination.
The other two families had already given their consent. The authors contacted them again to alert them to possible press coverage. No objections were raised so the article was published with the patient’s name in full, as requested by the parents.
A paper was submitted in which a young surgeon described five patients who died over six months under the care of one surgeon. The author suggested that the surgeon was dangerous and that something should have been done. Nothing was done and the surgeon has since retired. The paper, a very personal one, provides an interesting insight into the difficulties that doctors have dealing with problem colleagues. Should the editors: _ attempt to get consent from the patients’ relatives? _ worry about the fact that somebody, somewhere, is likely to be able to identify the surgeon, particularly if the article is signed rather than published anonymously?
_ This case had already been published in a journal the preceding year. _ The system has changed in the past 10 years since these issues first arose, but the committee felt that the information could be published as a source of interest on what used to happen. _ It was suggested that the article be re-published, accompanied by five people’s responses as to what would happen now.
I analysed the results of a randomised controlled trial that had just been completed by some of my colleagues. The trial compared an oxygen radical scavenger with a placebo in patients with acute myocardial infarction. One of the major outcome measures included infarct size,as measured by nuclear imaging. My analysis showed that there was no significant difference between groups for either of these parameters, but statisticians from the pharmaceutical company involved concluded that the treatment provided significant clinical benefit. The main difference was that they had performed within-group analyses,which showed a significant reduction in infarct size in the treatment group. The study had already been presented at conventions using this analysis. I maintained that the within-group analysis was not only inappropriate,but misleading,and even unethical. I suggested that because of the small sample size (around 60 patients), they should be happy that the results leant towards a benefit for treatment, and what they really needed was a larger trial. Unfortunately, the study contract forbade publication without the drug manufacturer’s permission. I contented myself with the thought that I had prevented the publication of wrongful claims, and we continued to lecture that there was insuf?cient evidence for the use of this drug in coronary artery disease. To date, the drug continues to be a best seller. The story then hit the headlines, when it was published in a journal. The concession to its publication had been the inclusion of some statements pointing out that the conclusion was based on within-group analysis. I was appalled. How could they purposely publish a misleading claim, and ignore all references to alternative analyses? The problem is compounded by the following: The principal instigator is a senior cardiologist,professor emeritus in our college,and a leading figure in heart associations. He sits on many committees that approve funding for projects (some of which are mine). He has lectured far and wide that the drug is actually effective. The editor is a good friend of his. What should I do?
This is not within COPE’s remit as the case was not submitted by an editor. Suggest that the complainant submit a letter to the editor of the journal concerned. A systematic review of published studies would expose the flaws.
A paper was published in January 1998,and seven authors were credited. B was thanked for his contribution in the acknowledgements section. One year later B wrote to the editor, outlining two alleged incidents related to this paper. First, the cohort reported in the January 1998 paper was one that B had been working on since the early 1990s. In 1992–3 he sought collaboration with another research group. A grant was applied for and granted. At that time B, who was a co-signatory on the grant application, moved abroad but the grant specifically included money for him to travel back to his home country to continue the collaboration. Moreover, all the collaborators agreed that he would be a co-author of all subsequent papers. As the collaboration proceeded, B felt he was being edged out of the group. A senior colleague in his home country felt the same way and eventually resigned from the collaboration. B was unaware that a paper was being prepared for publication from this study. The first time that he saw the paper was after publication. He only contacted the editor after several colleagues urged him to bring the matter out into the open. Not only was he not included as a full author on the paper, but his permission had not been sought for acknowledgement, in direct contravention of the Vancouver Group guidelines. The second allegation concerning this paper is that the hypothesis subtly shifted between the grant application and the published paper. The hypothesis as stated in the grant application is different in an important way from that stated in the introduction to the paper. The results of the research support the hypothesis as cited in the paper,but directly contradict the hypothesis as cited in the grant application. B alleges that the research group concerned has indulged in post hoc hypothesis generation so that the results reflect their beliefs about the meaning of the data rather than their pre-specifed hypothesis. Another paper from this research group,in which B is cited as an author, again without his permission, is currently being held by the editor of a specialist journal pending the outcome of this particular case. All of the co-signatories and collaborators on the original grant application have been asked (with B’s permission) for their view on the allegations. A further complication is that although the grant awarding body has a procedure for dealing with allegations of misconduct, one of the authors of the paper is one of their unit directors.
The editor was advised to inform the grant awarding body of this case and tell them that he had referred the matter to COPE. The editor should also urge the grant awarding body to act with some urgency and, that given the circumstances, the initial investigation cannot be referred to the unit director. The editor should await responses from all collaborators and authors and then show them to B. It was agreed that editors should not get involved when authors fall out but the fact that the paper is published has involved the editor.
The editor heard from all of the authors that the individual making the allegation knew about the work all along and they refute his allegations. Their response to the editor’s challenge about the hypothesis change was that that was the nature of scienti?c progress. However, from the responses,it is clear that there has been a major falling out between the two sides of the collaboration. However,this team did not agree with the allegations either. The senior author now feels that the editor is “destroying”the collaboration and that all parties should get together and discuss. In addition the editor has now been contacted by an editor of another journal who has received a paper from the same stable which has problems around authorship.
Advice on follow up:
COPE advises that the editor should now: Go back to the person who made the original allegations and get his response to the above. Discuss this with the grant awarding body. Involve the journal ombudsman. Invite a representative of the grant awarding body to attend a COPE meeting so that the case can be considered in its entirety. Inform authors and heads of institutions and research council that COPE are considering this case. This gives a line of accountability. The journal ombudsman felt that there was nothing further the journal could do. Two representatives of the grant awarding body attended a COPE meeting. They agreed to instigate an investigation and to raise additional questions about the change in hypothesis with the authors. The grant awarding body has clear procedures and guidelines for research misconduct and they will be revising these to clarify the issues of authorship.