Hope Springs Eternal in the Human Breast; Man never Is, but always To be best.
— Alexander Pope
Primum non nocere is our primary mantra but "staying current" is no stepchild. The internet was predicted to be a vehicle to facilitate our staying current. Instead, the internet has made currency more difficult by allowing every nimrod a voice with wide dissemination of information including fake news. Not only has fake news been empowered by the fringe, their message often overshadows truth and makes sifting through the chaff more difficult, especially for the ill-informed. Fake news has always been around but was easier to identify before. Now, the internet makes fake news omnipresent, sometimes omnipotent, and incredible people spread dubious stories.
"Prestigious journals," traditionally our main source for staying current, may make errors but usually not egregiously. By the end of April, The Wall Street Journal, via the CDC, reported 704 cases of confirmed measles in 22 states. This is the worst year for measles in the U.S. in 25 years. Infected travelers, unvaccinated foreign nationals or Americans traveling abroad who become infected, spread the disease to the unvaccinated citizenry. Even though the U.S. is nearly 95 percent vaccinated (95 percent is necessary to prevent outbreaks), pockets of the unvaccinated place certain communities at risk.
New York City officials decreed a public-health emergency by making mandatory measles-mumps-rubella (MMR) vaccinations and fines for noncompliance in specific ZIP Codes in Brooklyn, areas of a measles flare-up which began in the fall of 2018. By April 2019, 285 people (including 246 children) had developed measles with 21 hospitalizations, including five in intensive care.
In 1963, measles annually infected four million people. The standalone measles vaccination was introduced that year. By 2000, measles was eliminated in the U.S. Vaccines are safe and one of our most studied medically manufactured products.
What Happened?
In 1998, lead author Andrew Wakefield, M.D. published a series of 12 cases in the prestigious Lancet which suggested that the MMR vaccine might make children susceptible to behavioral regression and pervasive developmental disorder (autism). Within a year, two (1, 2) Lancet articles refuted the claims. A small retraction article in Lancet by 10 of the 12 authors stated that no causal link had been made. The controversy continued and Lancet retracted the article. The damage had been done; many parents stopped vaccinating their children out of fear of autism from a minor paper in a prestigious journal. This generation, born circa 1998, is now called the “Wakefield Generation.”
The Lancet article gave rise to the anti-vaccination movement and the internet enabled global reach which was responsible for a 20 year high of measles in Europe (2018). Although internet missives are often harmless banter, they infect, literally and figuratively, many in our populations. Through viewership numbers they gain stature and easily squelch or drown out the truth.
Wakefield’s study had severe repercussions by linking his actions to various epidemics and deaths. The British General Medical Council found he acted dishonestly and irresponsibly. On May 24, 2010, he was removed from the UK medical register and barred from practicing medicine in the UK. He now lives in the U.S. and continues his anti-vaccination propaganda which includes writing a book, "Callous Disregard: Autism and Vaccines: The Truth Behind a Tragedy" (2010) and producing a movie, "Vaxxed: From Cover-Up to Catastrophe."
Prestigious Universities May Also Make Mistakes
Prestigious publications may not escape the intricate web of fake news. A False Aim Act was filed against Duke University in 2013. The suit claimed that Duke knew about faked data when grants were submitted to the Environmental Protection Agency and the National Institutes of Health worth at least $200 million. In 2017, after the usual circuitous path, a researcher admitted to faking data, which was used to secure federal grants. In March 2019, Duke settled with the government for $112.5 million and acknowledged 17 retractions. Some articles likely went into prestigious publications and may have become foundations for future studies.
The Internet
The internet gave rise to the open access (OA) journal and dissemination of medical information was forever changed. Open access means anyone with a computer and an internet connection may freely access the article. The prestigious journals charge a subscription fee and non-members may only access the abstract. Most specialists do not take all the journals within their specialty, especially subspecialty journals.This limits their access to some of their specialty information. Abstracts are teasers and may even lead to confirmation bias. They are no substitute for reading an entire article. The OA journal has the potential to change that.
The OA journals are circulated worldwide. Another advantage for the author as well is wider viewership of e-journals and the potential for more citations. More citations, which in the past was linked to publication in prestigious journals, lead to higher rankings in the algorithm of Google Scholar even though these articles may be of less significance (or even fake). Higher rankings often lead to even more citations.
The Rise of the Predatory Publisher and Journal
Jeffrey Beall, MSc in library science, was the Scholarly Communications Librarian at the University of Colorado Denver. In 2009, he began to receive spam emails from previously unknown publishers. In this instance, the author paid to have his article published which is also called the gold OA. He felt this was perverse in that the more authors who signed on, the more the publisher profited. The potential for profit, potentially, could trump truth. In 2010, he coined the term “predatory publisher” (a term I do not necessarily agree with) and published his first list of less than 20 potentially sham publishers (obtained from his spam emails) on a blog which was widely disregarded.
In 2011, Beall defined the predatory publisher “as those that unprofessionally abuse the author — pays publishing model for their own profit” and published a second list of abusers. In 2012, he started a new blog, scholarlyoa.com, with contributions and suggestions from readers. Beall insists these publishers care more about the authors (payor) than the readers, which may lead to fake news. Updates of questionable publishers and stand alone journals occurred a couple of times a year.
In 2014, a website, scholarlyoa.net, was created by librarians worldwide. The site analyzes Beall’s blog site. Beall himself has been labeled a “predatory blogger” and received death threats. This website was at least partially responsible for Beall discontinuing his list and taking his website down in 2017.
Dr. Adam Clapper, a pathologist from Columbia, Missouri, read a profile on Elizabeth Holmes (founder of Theranos) in The New Yorker “Blood, Simpler” (The New Yorker’s moniker is “Fighting fake stories with real ones”). Dr. Clapper did not believe what he read. He detailed his beliefs in his blog, Pathology Blawg. His blog brought him into contact with people who shared his disbelief. He referred the information to John Carreyrou, an investigative reporter for the Wall Street Journal. Carreyrou’s investigations and articles resulted in the downfall of Theranos.
How Do We Stay Current?
"Staying current" has become our own swamp. Prestigious journals think they are infallible and that we should believe everything they say. This is just not true. We may trust but we also must verify. Anyone with a website may become an e-journal. Although the e-journal model seems to be the future, the rise of the predatory publisher has made it less than desirable and tainted the whole group. Both are quandaries for the us. Google info adds a whole new level. Dr. Haider Warraich (cardiologist) warned us in her article “Dr. Google is a Liar” in The New York Times.
Perhaps the best scientific model will become an e-journal with excellent peer review, as much data as necessary to verify the conclusion, automated reference linking and comments at the end of the paper providing immediate feedback for verification and rebuttal. Paid advertisements could remove the perverse burden of the doctor paying to publish. Quoting or blind belief in an abstract of a prestigious journal without reading the entire paper can be as risky as believing articles in a predatory journal.
Dr. Garland is an orthopedic surgeon retired from private practice. He has no conflicts of interest.
Image by Teguh Jati Prasetyo / Shutterstock
