Adventures in Ethics and Science

By email, following on the heels of my post about the Merck-commissioned, Elsevier-published fake journal Australasian Journal of Bone and Joint Medicine, a reader asked whether the Journal of American Physicians and Surgeons (JPandS) also counts as a fake journal.

I have the distinct impression that folks around these parts do not hold JPandS in high esteem. However, it seems like there’s an important distinction between a fake journal and a bad one.

Kathleen Seidel of the Neurodiversity Weblog wrote a meticulous examination of JPandS and of the professional society, the Association of American Physicians and Surgeons (AAPS), whose journal it is. While you should read the whole thing, here I’m going to focus on just a few sections of her post that I think are germane to the question of whether JPandS is a real medical journal (albeit perhaps one with a quality control problem) or a fake one.

First, about the Association of American Physicians and Surgeons:

A political advocacy organization comprised of doctors, lawyers and others who support free markets and limited government, the Association of American Physicians and Surgeons defines itself as:

…a national association of physicians dedicated to preserving freedom in the one-on-one patient-physician relationship. AAPS members believe this patient-physician relationship must be protected from all forms of third-party intervention. Since its founding in 1943, AAPS has been the only national organization consistently supporting the principles of the free market in medical practice.

Some of the consequences of the organization’s commitment to free-market principles and to the primacy of the patient-physician relationship are not obvious at first:

AAPS opposes the concept of evidence-based medicine, warning its members that:

Physicians must beware of accepting the concept of a standard of care that is itself evidence-based, threatening the autonomy of physicians and subjugating the patient’s interest to that of the collective. (AAPS Newsletter)

[Evidence-based guidelines] are a divisive force, creating uncertainty and mistrust, and undermining confidence in physicians and our medical system. EBGs can be used either to accuse physicians of withholding therapy, or of prescribing unnecessary or unproven treatments. Behind the fa├žade of EBGs, [managed care organizations] can determine medical policy with impunity. (Norman Latov MD)

Practice guidelines and treatment protocols are regarded as impediments to the unfettered practice of medicine.

There is a lot of pressure to restrict physicians’ treatments to practice guidelines and to methods that have been shown to be both safe and effective in double-blind controlled trials. If we were to insist on this across the board, a huge number of medical treatments that physicians rely on would be ruled out… If everything can be done with treatment protocols, then perhaps we should do without physicians altogether. Of course, we recognize that there are varying abilities, but I think it is a mistake to say that one small group, politically appointed, can sit in infallible judgment on just who the real physicians might be…. (Jane Orient, MD, Executive Director, AAPS)

That a professional organization would take political positions is not in itself problematic.

When the profession being organized is one like medicine, where there is supposed to be some involvement of the scientific method in generating the knowledge that guides practice, political lobbying may raise concerns if it is not kept distinct from the process of generating and evaluating knowledge.

This is where the journal comes in.

The original publication of the AAPS was Medical Sentinel. From the looks of it, Medical Sentinel was always presented as an outlet for AAPS positions rather than a disinterested collection of articles reporting medical findings.

Medical Sentinel contained a preponderance of political commentary on issues pertaining to medical practice. In 2002, AAPS decided to revamp their journal — giving it a new name, a more professional appearance, and shifting its editorial focus from political commentary to “more articles of a scientific nature, particularly if they are relevant to contemporary policy debates.” Sporting a new masthead, AAPS would devote an increasing amount of space to scientific articles reflecting the organization’s politics and philosophy.

The refurbished publication — Journal of American Physicians and Surgeons — was unveiled in March 2003. JPandS promptly distinguished itself for featuring articles offering scientific justification for the AAPS opposition to abortion. Assertions made in Karen Malec’s The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent, Brent Rooney’s Induced Abortion and Risk of Later Premature Births and Joel Brind’s Induced Abortion as an Individual Risk Factor for Breast Cancer have since have been disputed by numerous cancer researchers. JPandS continues Medical Sentinel‘s tradition of conservative political commentary on medical topics, and has also published articles on hyperbaric oxygen therapy, including its controversial use in the treatment of multiple sclerosis; pain management, opioids, and physician prosecutions; hospital pricing transparency; sham peer review; nutritional treatments for ADHD and herpes; low dose radiation therapy for cancer; and the effects of diagnostic and environmental radiation.

Looking to science for findings that might have relevance to policy debates is, one would think, a good thing — a step forward from latching onto particular policy decisions regardless of whether they are supported or undermined by out best scientific knowledge.

However, to Seidel’s eye, JPandS has a striking lack of articles with results that might complicate AAPS policy positions or call them into question.

Another pattern that Seidel notes is that JPandS authors and JPandS articles played prominent roles in litigation which turned on the question of whether there was a good scientific basis for claims of causation. Indeed, some JPandS authors were already involved in litigation when their articles were received; meanwhile, that an article was published in JPandS (a peer-reviewed medical journal) was used as a basis for asserting its credibility as a source of scientific evidence in a court of law. Seidel points out this tangle of agendas as it plays out in litigation around autism:

Initiation of legal action against pharmaceutical companies and government agencies in the absence of conclusive scientific evidence to support a causal connection between vaccines and autism — in the words of Mark Blaxill –

puts the blame game before the scientific inquiry…

The blame game continues, as does the scientific inquiry. Numerous large-scale epidemiological studies have dismissed a causal connection between autism and vaccines. Clinicians with expertise in autism and toxicology have clearly distinguished between symptoms of autism and those of mercury toxicity. Concurrently, parent-advocates and sympathetic scientists under pressure to present legal proof of “general causation” — proof that did not exist at the time that any now-suspect vaccines were administered — have produced a multitude of articles positing a connection between autism and vaccine injury, for use as evidence in an adversarial judicial process, and have disputed any evidence that would undermine the attainment of their litigation agenda. An aggressive public relations campaign is also underway aimed at cultivating widespread public belief that autism is a consequence of poisoning, and thereby gaining political support for litigants.

AAPS has wholeheartedly facilitated this activity, which furthers its longstanding political agenda of undermining support for public health programs and promoting suspicion of vaccines. In the three years since its refurbishment in 2003, JPandS has published 21 articles promoting a link between vaccines and autism or death, some heralded by press releases widely-distributed by the AAPS and other organizations.

While there seems to be no shortage of scientific findings that challenge the hypothesis that autism is caused by vaccines or by mercury, there is a shortage of such findings published in JPandS. (One also gets the impression that there is a shortage of papers whose conclusions agree with those appearing in JPandS published in “mainstream” medical and scientific journals; I leave it to those with a better familiarity with this literature to chime in about whether this impression is correct or mistaken.) And, strikingly, the use of results published in JPandS in litigation, if successful, would further the AAPS political agenda. Meanwhile, the JPandS articles did not disclose the potential conflict of authors who were also litigants or paid expert witnesses.

Indeed, JPandS even published an article arguing that the law might be better the scientific method for the purposes of evaluating knowledge claims:

In their article, On Evidence, Medical and Legal Dr. Donald Miller and lawyer Clifford Miller (an active participant in the MMR controversy in the U.K.) assert the superiority of legal standards of proof over evidence-based standards of proof, causation, efficacy and practice generally accepted in medicine and science. They seem to imply that a single case study should be sufficient to prove causation of harm — and, by extension, legal liability — in cases involving many thousands of claimants with widely varying circumstances and documentation.

…scientific standards of proof are not uniform and well defined, in contrast to legal standards. Standards of measurement, ways of reporting and evaluating results, and particular types of experimental practices vary. As a result, there is no simple and reducible algorithm against which “good” science can be evaluated. There is another aspect of the scientific standard of proof that particularly impacts medicine. Science’s quest for objective certainty admits only a narrow range of evidence… With regard to uncommonly occurring and rare events like adverse drug reactions and vaccine-induced autism, judges need to realize that a CDR [child death review] case report and CD case series alone can prove causation to a very high standard… medicine needs to develop a better understanding of the nature of evidence and of evidentiary proof, by emulating law’s approach to evidence. Law in turn needs a better understanding of the shortcomings of medicine’s current approach to evidence….

Relaxed editorial standards and the haste to produce “science” that supports predetermined conclusions and offers a scientific rationale for a political and legal agenda, have been accompanied by some notable irregularities in articles published in JPandS.

At this point, let’s pull back from Seidel’s examination of JPandS and lay out our expectations for scientific and medical journals. (I understand that some will argue that medical research ought to be bound by somewhat different standards than scientific research, but I think it requires a positive argument to support the assertion that medical research shouldn’t live up to something like scientific standards of evidence and reasoning.)

  1. Manuscripts are subjected to peer review to ensure that the research reported was guided by sound scientific methodology. Minimally, this means that manuscripts include information about how the experiments were conducted (and how they might be reproduced by other researchers), a consideration of potential sources of error and a discussion of how these were dealt with, and probably some discussion about how the results fit into (or change our understanding of) the existing body of knowledge in the field.
  2. Serious efforts are made to identify, disclose, and/or manage potential sources of bias by the researchers (and the peer-reviewers), whether these stem from financial or other considerations.
  3. There is documentation that any research with human subjects or non-human animals was conducted according to recognized ethical standards and prevailing laws and regulation. (Among other things, this means that the IRB or IACUC at the researchers’ institution has approved the protocol and oversaw the research.)
  4. The journal’s policy with regard to which submissions are accepted for publication reflects a commitment to follow the evidence, even of that evidence should pull in the opposite direction from political ideology or standing policy recommendations.

There’s another expectation that I think is implicit: a good scientific journal will provide a good microcosm of the knowledge built by the scientific community in the particular area the journal takes as its focus. This means that if a matter is a source of legitimate controversy for scientists committed to using scientific methodology to understand it, the articles appearing in the journal will reflect this controversy. If, on the other hand, the scientific community reaches a point where a scientific matter is essentially settled (except for some of the details around the edges, perhaps), the articles in the journal will reflect that consensus.

Does JPandS live up to these expectations?

While articles accepted by JPandS undergo peer review, Kathleen Seidel and Orac have noted serious methodological shortcoming in them. If the peer review is not focused on the scientific quality of the manuscripts under review, on what basis are the peer reviewers evaluating the manuscripts?

To the extent that peer review is supposed to provide a level of scientific quality control, if the way it is implemented by JPandS fails to provide that quality control, there might as well not be peer review. Broken peer review can break the whole medical journal.

The failure of JPandS authors and editors to disclose potential conflicts of interest might lead the casual reader believing that JPandS articles are more objective and disinterested than they really are. This is at least misleading, if not outright deceptive.

Finally, the range of articles included in JPandS strongly suggests that submissions are subjected to an ideological filter that plays a significant role in which will be published. The microcosm of scientific knowledge presented in the pages of JPandS departs significantly from that presented by other medical journals. However, it closely tracks the preexisting ideological commitments of AAPS.

On this basis, it certainly looks like the credibility of JPandS, and of the articles published within it, is very shaky.

Operationally, I’m inclined to say that this makes JPandS no better than a fake journal. However, I can’t help but wonder if the people editing JPandS and submitting articles to it realize that this credibility gap exists.

If they are completely committed to a particular view of the world, fully expect that the evidence will support that view, and blame mistaken methodology for results that don’t support that view — indeed, to the point of openly rejecting evidence-based medicine and scientific standards of proof — the problem isn’t one of lying so much as arguing for a different standard of credibility.

The danger is that the outward appearance of JPandS might not alert the casual reader that this journal does not accept the standards that other medical and scientific journals try to set for themselves. If AAPS knowingly trades on this confusion to get unearned credibility, I think the case can be made for fakery. But even if no conscious effort is made to fool the reader, the outwards similarities may be enough to do harm.

Comments

  1. #1 Lawrence
    May 6, 2009

    The problems re the whole MMR thimeresol vaccine-autism link controversy (whether valid or not) I don’t think can be done justice in a single posting, it needs a massive book – that is the evidence for and against. It is not so simple, and I think it has been grossly oversimplified and the very debate entirely misrepresented by the medical industry. However whilst the position of JPandS may be suspect here (and regarding their anti-abortion papers especially) this kind of misses the point.

    My point being, when it comes to vaccines in toto and the efficacy and safety of many drugs for that matter, the bias and really big money interests runs the other way – with the mainstream journals which are increasingly corrupted by multibillion dollar BigPharma interests. The red flags go up with so many so-called findings re the efficacy and safety of vaccines and prescription drugs in studies even part-financed by BioTech and BigPharma. These so-called evidence based findings have been written up in med journals which have become, in the words of Richard Smith, former editor at the BMJ “an extension of the Marketing Arm of Pharmaceutical Companies”.

    All the so-called prestigious medical journals (esp in the US) are suspect in this particular way, only industry insiders and their obedient unthinking yes-men take them very seriously (and the know-nothing doctors) in this regard. Their self-censorship (ie what they don’t publish), and I do mean quality evidence-based medicine that is critical of many chemical drugs and vaccines is very telling, and it doesn’t count in favour of the
    “prestigious’ journals like NEJM, Lancet, and for that matter Nature, Science etc.

  2. #2 Robert Bird
    May 6, 2009

    1) I don’t know how much different fake and bad journals are in this case – both want to profit from the assumption that readers are likely to make that the material withing is independently peer-reviewed and thus that the contents are (within the ability of the reviewers to know) true. Rather than reporting what they find, they report what they wish to find and claim that the appearance of their desires in print makes them real. They are also intended to deceive people who don’t know the internal workings (or, in Merck’s/Elsevier’s case, the lack thereof) of the journals into accepting their “facts” as real. Since the intent to deceive is the same, they deserve to wear the same mantle of moral bankruptcy. (JAPS has some basic peer-review, even if it’s poliitically motivated, so the chance that they would find something true and accurate is higher than that of AJBJM.)

    2) Lawrence – in order to support the idea that BigPharma, etc. are suppressing bad data on vaccines, don’t you have to have evidence that there are real effects of vaccines which are being suppressed? Data talks, everything else walks.

  3. #3 Pat Cahalan
    May 6, 2009

    > I can’t help but wonder if the people editing
    > JPandS and submitting articles to it realize
    > that this credibility gap exists.

    In the first case, they probably don’t recognize it as a credibility gap at all. The second is a real problem.

    We’ve been discussing “rating journals” in our latest class, and the problem is really complicated in the IS field. There are so many publications that it’s almost impossible to use the title of the publication as any sort of credibility measure (with a half-dozen exceptions); not to mention the fact that the publication cycle time means that if you’re doing anything even close to the edge of a field, you’re stuck in conference proceedings land anyway.

    I don’t have a really good answer at this point; scientific publication has a number of huge foundational problems. Time to publish. Time to review. Method of review. Page count (seriously, this is a problem?) of a particular issue. Lack of oversight standards; who gets to call themselves a “scientific journal”?

  4. #4 Lawrence
    May 6, 2009

    Robert Bird, before I mention vaccines, we must not ignore the RELATED controversy on adverse drug side-effects. There is certainly plenty of evidence that adverse side-effects of drugs are downplayed, ignored, not properly acknowledged, and then when they no longer can be, it’s all wilfully swept under the carpet until the next time..Nothing is ever learned and the same mistakes are made again and again. The evidence for this actually fills whole books, it simply cannot be disputed.

    As far as vaccines go, what I write above re drugs means that we have to be very cautious when the topic turns to vaccines, because it is very much a related topic to adverse effects of prescription drugs. Vaccines cannot be seen in isolation, is what I am getting at. The same profit-driven Biotech/BigPharma industry, the same health beauracracies, the same medical scientists, the same yes-men drugsalesmen and women ie doctors at the bottom of the food chain, the same checkered history of iatrogenic illnesses (even fatalities), and the same sweep it under the carpet attitude prevails. And medical textbook publishers connive in the whitewashing of the history of vaccine-induced iatrogenic ailments and fatalities. Gee I wonder why?

    Look here is a very pertinent example, given the swine flu pandemic we are all hearing so much about. In 1976 there was a disastrous swine flu vaccine fiasco in the US (after fears of an epidemic that never materialised) that saw two dozen people die, paralysis and brain damage (Guillame-Barre syndrome) in at least 500 cases. The FDA and the NIH admitted it! The federal government would pay more than $400 million in damages to syndrome victims and their families…in 1976. It was one of the most successful and largest class action suits against the US government in history! The govt had planned a nation-wide innoculation that was unprecedented in its planned scope. This fiasco was recognised as such by the NIH and the government and the media (after of course initially selling the vaccines to a panicky American public). Yet where do you hear about any of this NOW, from the NIH and the clueless know-nothing media?

    It wasn’t that long ago, I was a kid in 1976, and I’m not old, yet it is like it never happened. The present silence of this fairly recent and absolutely disastrous vaccine fiasco speaks volumes and I will tell you why. There are already some biotechs talking about developing new swine flu vaccines (naturally) as quickly as they can, they certainly don’t want the public having second thoughts if they are made to remember a previous swine flue vaccine from not so long ago that was in fact one of the darkest chapters in the history of modern medicine (never mind vaccines)! How would they sell their vaccine to the public so easily and make their money? this is not a conspiracy, it’s just a vested interest.

    Another aspect to this fiasco is that the US government had to pay out the civil lawsuits, not the vaccine makers. The government had promised the vaccine manufacturers it would take the litigous risk for them if anything went wrong, after they got nervous and sensed something was wrong with their vaccines and passed the buck to the government/taxpayers who duly agreed to it! So at the end of the day US taxpayers paid out hundreds of millions of dollars for the disastrous and even deadly consequences of a dangerous vaccine blunder sold to the public by the NIH.

    Data and facts talk, everything else walks…

    That was just swine flu vaccine, there is plenty more where that came from. One wonders if history is going to repeat itself here.

  5. #5 Robert Bird
    May 7, 2009

    Howe exactly did you find that out? (I should have remembered it – it was described in The Coming Plague as well.) No one hid it – the smae people you claim are hiding stuff now were the ones who found and dealt with it. So, while they screwed up, they also dealt with it and didn’t hide it, which was your presumption.

    To argue that evidence is being suppressed by established authorities, you need not only evidence of bad news but also evidence of suppression. Since the people who caused the effects also revealed them, I don’t think that works out for you.

  6. #6 Lawrence
    May 8, 2009

    Bird when you write “.. were the ones who found and dealt with it. So, while they screwed up, they also dealt with it and didn’t hide it, which was your presumption”, it is rather shocking, but not really surprising. You are basically saying the same people who permanently paralysed and even killed those they innoculated (what you euphemistically call “screwing up”) dealt with the problem of you know the paralysis and deaths they caused. How did they deal with the problem? By admitting it, Bird tell us!

    How is that “dealing with the problem” they caused? Oh they paralysed hundreds of people with G-B syndrome and killed a couple of others, but hey presto, they “dealt with it” by admitting it! Oh that’s ok then I guess. They didn’t hide what they did, simply because they couldn’t – the scale of the vaccine blunder was too massive for them to hide it. Gettit? Like Nixon couldn’t hide Watergate, it got too big. Must we commend Nixon because his crimes became public knowledge and he didn’t succeed in covering them up?

    Hey believe what you want, hear no evil see no evil. I’m certainly not going to get you to change your mind and I can’t be bothered to bang my head against brick walls. Since you engage in blatant apologetics regarding the massive number of cases of iatrogenic paralysis and even iatrogenic deaths in a disastrous scandal in US medical history, well you certainly are not going to steer even one millimeter off the rails of medical mainstream orthodoxy here re vaccines.

    Do you work for the NIH Bird or the FDA or in BioTech? Or are you just a doctor?

    There is btw considerable evidence of suppression and censorship and misrepresentation of vaccine-induced adverse iatrogenic ailments by the med journals and the medical orthodoxy as a whole, over the decades. If you insist as you do, that I am basically making this up, then you really simply can’t be bothered to do even cursory research here. You simply don’t want to know, and so you don’t. And no matter what evidence I could bring up here, you would simply rubbish it, or engage in apologetics like you did with the ’76 swine flu vaccine. So why bother?

    I mean if you aren’t willing to look a little further and a little deeper than whatever the editors at Nature and NEJM etc tell their readers to think, then nothing I can write up is going to change your thinking in this regard.

  7. #7 Robert Bird
    May 8, 2009

    1) Have your alternatives done anything effective? (It’s easy not to fail if you don’t actually ever do anything.)

    2) Can you actually tell if your alternatives failed? The point (which in the midst of your hysteria you seem to have missed) is that the outcomes of the Swine Flu vaccinations were found by the people that did them. They can’t undo reality (if you have suggestions for this, I’m sure someone would listen) but they could actually tell both when their treatments worked and when they failed. You aren’t relying on some other group (outside the NEJM/AMA/blahblahblah junta) to show that information and bring it to the attention of the proper people. Having an alternative way to get reliable information on the outcomes of treatment would be helpful, but the only source of such information you’ve given in your rant is the one you claim to be untrustworthy.

    So you have 1) no way to get information about the outcomes of either standard treatments (other than, well, the people you claim are untrustworthy), and 2) no treatments (again, it’s easy not to fail if you don’t do anything). So you have lots of smack, but no logic and no methods to do what you claim to desire (improve health outside the realm of peer-reviewd medicine). Buh-bye.

  8. #8 Diggitt
    May 13, 2009

    Here are Lawrence’s words: In 1976 there was a disastrous swine flu vaccine fiasco in the US … that saw two dozen people die, paralysis and brain damage (Guillame-Barre syndrome) in at least 500 cases. The FDA and the NIH admitted it! The federal government would pay more than $400 million in damages to syndrome victims and their families…in 1976. It was one of the most successful and largest class action suits against the US government in history!

    Lawrence, how do you see “the most successful and largest class action suits against the US government in history” as suppression?

    In terms of “dealing with the problem” is your outrage at what happened, or at the language used to describe it? Nobody can bring the dead back to life or reverse medical disorders induced by the vaccine. But payment of “more than $400 million in damages [in 1976 dollars] to syndrome victims and their families” does in fact deal with the immediate problem — the injured and dead — about as well as can be done.

    In terms of having the same people involved: who do you want developing vaccines, soup salesmen? If immunologists, biochemists, and other scientists developed vaccines before 1976, they will be the people who have been doing it ever since.

    If you believe that vaccines should not be developed, you’re in the same position as people who think cloning shouldn’t happen. It’s going to happen. The question is whether it will be overseen and regulated by educated people working with a societal consensus — or done by cowboys in a black market world. You cannot regulate what you don’t acknowledge! And most people want any immunizations they can get.

  9. #9 A Moss
    June 21, 2009

    What a disgusting blog you have here.

    You compare a deliberately fraudulent journal from Merck and Elsevier with the journal of a bona fide medical association which refuses to take drug company advertising.

    That tells us everything we need to know about Janet D. Stemwedel’s scientific ability.

    I see you have not taken down the New England Journal of Medicine which has been caught so many times publishing papers with faked data on psychiatric drugs that it is not possible to trust what it publishes.

  10. #10 red rabbit
    August 16, 2009

    Lawrence: people who are interested in vaccines one way or another in general know about the 1976 flu vaccine. It’s not widely publicised by other than the fringe media currently due to 1. having been dealt with both medically and via the courts, and 2. not having recurred.

    Another vaccine injury issue that most interested in vaccines, in particular those developing vaccines, also learn about was the Dengue issue, wherein there was an unforseen effect which turned out to be a learning point for the difference between Dengue fever and Breakbone fever. Very scary stuff at the time.

    (Essentially, those who got infected primarily got a mild illness called Dengue fever. Those who got infected by the same strain a second time were immune. Those who got infected by a related but not identical strain got Dengue hemorrhagic fever, or Breakbone fever. We did not know this until the vaccine trials, when vaccinated people infected with related but non-identical strains of Degue all got Breakbone fever.)

    It goes to show that there is a lot of care put into the development of vaccines in order to ensure that they are maximally safe and effective, and that it is always a learning process.

    PS: Guillain-Barre syndrome =/= brain damage

  11. #11 Petre Dini
    September 21, 2009

    While browsing the net, I found two more fake journals in Computer Science:

    (1) International Journal of Computer Science and Information Security (IJCSIS) (http://sites.google.com/site/ijcsis/contact-ijcsis)

    (2) International Journal of Computer and Network Security (IJCNS) (http://www.ijcns.org/)

  12. #12 Reviewer IJCNS
    October 14, 2009

    International Journal of Computer and Network Security (IJCNS) is free journal and author pay the fees for paper print journal only, accepting paper is difficult may be your paper is not accepted and you said fake.

    Reviewer IJCNS
    (http://www.ijcns.org/)

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