Author: Eemaan Kaur Thind, MPH(c) Western University, Canada
A summary of Epidemic Ethics’s sixth seminar
Professor Ross Upshur - Head, Division of Clinical Public Health at the Dalla Lana School of Public Health, Toronto, Canada
Dr. Ezekiel J. Emanuel - Professor of Health Care Management and Professor of Medical Ethics and Health Policy in the Perelman School of Medicine
Dr. Laragh Gollogly - Editor, Bulletin of the World Health Organisation and Member of the International Committee of Medical Journal Ethics (ICMJE)
With the increasing incidence of retracted COVID-19 studies, particularly those published in the world’s leading journals, the scientific publication process is currently under high-level scrutiny. The desire for rapid data sharing amidst a pandemic is certainly understandable and necessary. But how can publishing models balance rapidity with reliability? How can the perils of “publication by press release” be mitigated? This blogpost contains a summary of Epidemic Ethics’s sixth seminar on publication ethics in public health emergencies.
Dr. Emanuel discusses three problems within the publication process during the COVID-19 pandemic: (1) rapid retractions and mistakes due to inadequate peer review in the rapid publication process; (2) data withholding; and (3) not sharing underlying data during “publication by press release.” These issues are contributing to study retractions, which not only tarnish the integrity of the researchers and the journals, they can have catastrophic long-term effects on public trust in science. Dr. Emanuel calls on researchers, journal editors, non-biomedical journals, and social media to reform the publication process by balancing rapidity in publication with aspirations for truth. He argues for a more precise identification of the type, quality and thoroughness of peer review using a grading system: (1) an editorial without a peer review; (2) a rapid peer review that did not meet normal peer review standards; and (3) a complete peer review. Editors of leading journals should act collectively and refuse to publish findings if they have already been shared publicly before the editorial and peer review process. Researchers may choose between holding a press release for the general media (unrelated to a scientific conference), and forgoing the opportunity for a publication—or—waiting (for a few weeks in the COVID-era) for the editorial review, a rapid peer review, and the publication. The associated trade-offs (e.g., delay in getting potentially life-saving treatments to COVID-positive patients) must be acknowledged and weighed against the harms of retracted publications, unverified and incorrect claims, made through “publication by press releases.”
Building on Clay Shirky’s “filter failure” hypothesis, Dr. Gollogly argues that “information overload,” due to rapid publishing in the age of COVID-19, is not the problem—“filter failure” is. Our traditional means of publication and review are simply ill-suited to the realities of a pandemic response. She identifies some of the prime consequences of filter failure as: inadequate information retrieval systems for point-of-care settings, problems identifying relevant information from a massive pool of resources, lack of health literacy, and public mistrust in science amidst a pandemic. She recommends the creation of “new filters” and an enhanced focus on upstream approaches: innovative methods of knowledge translation, better information systems, and the promotion of health literacy. The perspective of those impacted by information overload and the publication system (e.g., patients, families, healthcare workers, policymakers, and systematic reviewers) should inform the framework for publication ethics during public health emergencies. From the publishers’ perspective, the marginal material costs of publishing studies are negligible, especially when compared to the intangible costs of attention and care; Dr. Gollogly submits that the ethical duty to balance these costs rests with the publishers.
In response to Dr. Emanuel’s suggestion to create a grading system for greater clarity on the nature of the peer review, Dr. Gollogly argues that one is already in place (e.g., pre-prints are not peer reviewed before public release). Typically, progressive ranking of journals serves as a proxy for the quality of peer review. She warns that all journals might not agree to make comparable statements about the quality of peer review that took place.
Q1. How do we manage publication issues that relate to standards of clinical care that may have issues related to liability?Dr. Gollogly says, “working mechanisms for liability cannot currently cope with the volume” of publications. If the scientific community as a whole supports the need for open archives, she does as well.Dr. Emanuel argues for spending “slightly more time” on a quality peer review in exchange for increased reliability.
Q2: “How do you set up systems so that scientists do not feel pressured by their institutions to conduct “publication by press releases”?“Sticks”: Sanctions for institutions (e.g., moratoria for publishing in leading journals for a period of time, withdrawal of research funding). Leading journals and funding agencies should agree. “Carrots”: Rewards/grading for researchers who conduct ethical research.
Q3: What are your thoughts on social media as an emerging actor in the information ecosystem?Dr. Emanuel and Dr. Gollogly believe that Twitter is not an adequate peer review mechanism. There are deep concerns about the quality of scientific discussion over this media.
Q4: Could the WHO be more proactive in setting standards for journals?As an organisation, WHO does not have the capacity to conduct peer reviews. They work with the ICMJE and advocate for publication quality standards.
Resources on this topic can be found by searching for "research dissemination & publication" in the Epidemic Ethics database.
Dr. Maxwell Smith, Prof. Ross Upshur & Dr. Ezekiel Emanuel recently published an article titled “Publication Ethics During Public Health Emergencies Such as the COVID-19 Pandemic.”
Continuing the conversationWe welcome you to continue this discussion in the comments section below. In addition, if there are other relevant resources you would like to share, please note these in your comments or submit the resource so our team can add it to the Epidemic Ethics database.