More evidence that the manuscript peer review process is broken

To the surprise of almost no one, asking authors of research papers to submit names of potential peer reviewers for their manuscripts turns out to be a bad idea.

According to a recent New England Journal of Medicine article by Dr. Charlotte J. Haug, a number of research papers have been retracted because reviews were fabricated. Email addresses of suggested peer reviewers were not legitimate. The bogus email addresses were almost all created by authors of papers who then reviewed their own work favorably using fake identities. 

More about the problem can be found on the blog Retraction Watch.

This type of fraud is simple to do because anyone can set up an email address on Gmail or Yahoo mail using any name. Unless a reviewer has an academic email address, proving legitimacy is impossible.

However even if a reviewer has an “edu” address, how would an editor know that a suggested reviewer is not the author’s sister-in-law or a former mentor?

Every medical student who applies for residency knows that you don’t ask someone for a letter of recommendation unless you are sure that it will be favorable. Why would an author take a chance on recommending someone to review a paper without knowing that the review would be a good one?

I agree with the Dr. Haug that soliciting the names of possible reviewers from authors can save editors time and bother. Having spent three years as an associate journal editor, I have experienced the frustration of trying to find high quality reviewers or even a warm body of any quality to do the job.

I also agree with her that a root cause of this problem is the pressure on faculty to publish.

Another problem is that there are too many journals. In 2014, well over 5000 journals and 760,000 papers were included in Medline. The combination of “publish or perish” and superfluous journals leads to the proliferation of marginal papers.

The problem is not simply fake reviews. Since journal reviewers are not paid and have many other responsibilities, they may not thoroughly read papers or provide useful comments about manuscripts.

Some have suggested paying peer reviewers, but who would pay them? Certainly not publishers, even though they make tons of money. And paying might attract unqualified people looking to make a little extra cash.

What about post-publication peer review? It is already happening on blogs, on sites like PubPeer, and even on PubMed. However, the volume of papers published in medicine alone certainly precludes post-publication review of all of them.

Maybe it doesn’t matter. New journals are appearing every day. Most are “open access” and the charge authors “processing fees.” For many of these publications, processing fees do not include even a cursory manuscripts peer review.

With so many journals publishing just about anything for the right price, readers will have to do their own peer reviewing. Be skeptical my friends. 

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A medical riddle Where do incident reports go

Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have.

Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all.

In fact, I don’t even know where they went or who dealt with them. When I was a department chairman, I sat on quality assurance and risk management committees. Yet we never discussed individual incident reports.

The original intent of incident reports was to identify patient harms and increase patient safety.

According to a 2009 post by patient safety expert Dr. Bob Wachter, hospital incident reports are a spinoff from the Aviation Safety Reporting System which had successfully used them for identifying potential safety issues such as near misses.

At Dr. Wachters hospital, San Francisco General, about 20,000 incident reports were filed every year. That is about half of what the Aviation Safety Reporting System receives per year, and San Francisco General Is only one of about 6000 hospitals in the United States.

Dr. Wachter feels that analyzing incident reports is not worth it. He estimates that each incident report creates about 80 minutes of work times 20,000 reports, which equals about 26,600 hours of wasted time. He also estimated that about one fourth of US hospitals do nothing with incident reports. That saves time but renders the reports useless.

He says an even bigger problem is that incident reports in his hospital fail to capture most events that harm patients.

That has also been my experience. I think most incident reports were filed by people wanting to "cover their asses" and most of the reported incidents were minor. A reference in Wachters article states that most incident reports are submitted by nurses with only about 2% by doctors.

Incident reports can backfire too. From a 2002 Medscape article: "In some states, under certain conditions, the incident report is considered confidential and cannot be used against the nurse practitioner in a lawsuit. However, if copies are made or the chart reflects that an incident report was completed, the incident report can then be subpoenaed by the patient and used against the defendants in court."

And from the Louisiana State University School of Law: "The nonjudgmental nature of an incident report is very important because in most cases the incident report will be discoverable in litigation. An accusatory remark in an incident report may gain unintended weight in a legal proceeding."

Since incident reports generate a massive amount of wasted time, fail to identify most events that harm patients, are frequently ignored, and can possibly have a negative effect on lawsuits, why are they still being filled out by the thousands?

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Court dismisses Metuhs suit trying to stop his trial

The Fundamental Rights Enforcement suit filed against the EFCC by the National spokesperson of PDP, Olisa Metuh, has been dismissed by Justice Okon Abang of the Federal High Court, Abuja.

The judge dismissed the suit at its hearing this morning March 9th. Metuh had filed the suit challenging his arrest and detention by EFCC over his alleged involvement in the $2.1 billion arms deal scandal.

Metuh asked the court to make a declaration that his arrest on January 5th was unlawful as there was no warrant of arrest issued by any court. Metuh also argued that his detention by EFCC for 10 days without being charged to court violated his rights. He asked the court to stop EFCC from further arresting him.

Dismissing Metuhs suit, the presiding judge, Justice Abang held that EFCC had the constitutional powers to arrest and detain him. Justice Abang stressed that his arrest was lawful as it was granted by a Chief Magistrate court. He thereafter dismissed the suit for lacking in merit and awarded a cost of N15, 000 against Metuh.

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