By Grant Jacobs 28/05/2018 7


‘Fake author’ papers opposing HPV vaccine by ‘Lars Andersson’ are being retracted. The editor of one of the papers has offered an extraordinary defence, railing at the Karolinska Institute.

Earlier this month I wrote about a research opinion piece claiming that the HPV vaccine increases cervical cancer in some patients. Among the faults of the comment article were that the sole author faked their name and institution, and that the people it pointed to were almost entirely not vaccinated.

I’ve just been alerted that the publisher of this paper, the Indian Journal of Medical Ethics (IJME), has retracted the paper.*

According to Retraction Watch three more ‘Lars Andersson’ papers in the Journal of Internal Medicine are also to be retracted. (In a twist of fate perhaps, the editor of this journal is a professor at the Karolinska Institute that the author offered as his faked address.)

The ‘Lars Andersson’ publication in Vaccine is yet to be resolved, but Retraction Watch has previously noted that they are investigating it.

These papers have a small number of citations. I’m curious as to what actions authors who have cited papers that are retracted take. I can’t say I’ve ever been in the position.

An extraordinary response by the editor

I was writing that’s a relief to see the IJME has decided that ‘wearing’ the deception was the wrong decision, but in my mind this is almost completely undone by the extraordinary response of the editor of the ‘Lars Andersson’ article on the blog of Ole Petter Otterson, the president of the Karolinska Institute.

So extraordinary it is, I am copying it below in it’s entirety, then offering a few thoughts on parts of it. While this response is ‘out there’ the IJME has a long way to go yet in resolving this issue.

Prof Ottersen has raised important issues on the role of journals and of research institutions in ensuring ethical research and informing medical practice. However, his attack on The Indian Journal of Medical Ethics in the name of publication ethics is flawed, and indicates a reluctance to engage in discussion on the scientific issues. He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.

Good editorial practice: While journals should make every effort to confirm the author’s identity and affiliation, this is not routine editorial practice even among well-established journals. The Journal of Internal Medicine (published by Wiley) and Vaccine (published by Elsevier) have carried material by “Lars Andersson”, without checking his institutional affiliation and despite his use of a non-institutional id.

Editors’ accountability: The comment by “Lars Andersson” ( http://ijme.in/articles/increased-incidence-of-cervical-cancer-in-sweden-possible-link-with-hpv-vaccination/ ) was reviewed by an external, international subject expert, an external statistician, a working editor with expertise in research methodology (Mala Ramanathan) and the manuscript editor (Sandhya Srinivasan) before being accepted for publication. When we were notified of the deception regarding the author’s identity and affiliation, we immediately removed the KI affiliation from the journal. We have explained our justification ( http://ijme.in/articles/statement-on-corrections/?galley=html ) for retaining the article on our website, and maintaining the author’s anonymity.

The need to enable scientific debate: Prof Ottersen does not explain how anonymity prevents scientific debate on an analysis of publicly available data. And he does not explain how “false affiliation” is relevant in the context of the IJME article which no longer carries any affiliation. He says that “leading researchers with intimate knowledge of the vaccination field have identified serious flaws in the published report and its conclusion, thus questioning the quality of the review process”. However, neither he nor these unnamed researchers have stated what those flaws are. The attack on IJME for maintaining the author’s anonymity
appears to be to avoid scientific debate. We invite critical commentaries on the paper by “Lars Andersson” towards advancing the scientific debate on the issue at hand.

The suggestion that false affiliation and anonymity are preventing scientific debate is a red herring. Does Prof Ottersen’s indignation comes from his inability to personally target the person questioning the HPV vaccine?

The need for institutional accountability: We suspect that, in addition to using the author’s anonymity as a red herring to prevent scientific debate on the article, KI has reasons to whip up sentiments against IJME to hide glaring failures of governance in the institute in relation to “Lars Andersson”.

Between 2014 and 2017, two internationally reputed journals, JoIM and Vaccine, published correspondence from “Lars Andersson” who reported affiliation to KI. The letters in JoIM were in response to a paper in the same journal. A perusal of the JoIM articles shows that “Lars Andersson” had filed a complaint of research misconduct in 2016 against six authors of this paper, five of them affiliated to KI. The complaint was with KI for about a year, after which it investigated these allegations without confirming the identity of the complainant. Let alone a journal published from India, KI did not verify, on its own, the existence of a person on whose complaint it was acting. It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation. In this background, and with KI providing legitimacy to “Lars Andersson”, how could JoIM and Vaccine have suspected that “Lars Andersson” did not exist in KI? And how could this question have ever occurred to IJME?

The prevention of deception by an author on the name or affiliation requires the joint efforts of many stakeholders, including journals. While IJME has taken full responsibility for what has happened, the attacks on it in the name of publication ethics cannot wish away the ongoing governance failure in the KI, and cannot be used to prevent scientific debate on an article which nobody has proved to be unscientific, except by innuendo.

Dr Sunita V S Bandewar, PhD, MHSc (Bioethics), Independent Senior Research Professional; Working Editor, IJME. Email: sunita.bandewar@gmail.com
Dr Rakhi Ghoshal, PhD, Assistant Professor, United World School of Law, Gandhinagar INDIA; Consultant Researcher, King’s College, London, UK; Working Editor, IJME. Email: rakhi.ghoshal@gmail.com
Vijayaprasad Gopichandran, MD, PhD, Primary Care Physician, Reproductive Health Clinic, Rural Women’s Social Education Centre, Kancheepuram District, Tamil Nadu; Assistant Professor, Department of Community Medicine, ESIC Medical College and PGIMSR, Chennai INDIA; Working Editor, IJME. Email: vijay.gopichandran@gmail.com
Sanjay A Pai, MD, Working Editor, IJME. Email: sanjayapai@gmail.com
Mala Ramanathan, MSc, PhD, MA; Working Editor, IJME. malaramanath@gmail.com
Sandhya Srinivasan, MA, MPH, Independent Journalist, Mumbai; Consulting Editor, IJME. Email: sandhya199@gmail.com

Addressing the editor’s response

Earlier in the act, I wrote to the editor who wrote the response quoted above, asking for the basis of the review of this paper. She never responded. It’s a pity she hadn’t simply referred me to what she wrote above.

Let me comment on a little of this. I have noted some of my concerns earlier. Many more are noted by Prof. Munthe, whose response can be found on Justin Weinberg’s blog.

Much of the editor’s defence involves pointing at others, but this doesn’t exonerate the IJME. To avoid repetition, I’m not going to cover each time this is raised.

Prof Ottersen has raised important issues on the role of journals and of research institutions in ensuring ethical research and informing medical practice. However, his attack on The Indian Journal of Medical Ethics in the name of publication ethics is flawed, and indicates a reluctance to engage in discussion on the scientific issues. He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.

The last sentence in particular is unwarranted at best; pointing fingers is unhelpful. It’s easy to say this from a distance, but it’s better to accept the (deserved) criticism, and just move forward. The conspiratorial tone also reads awfully similar to what we’ve come to expect from those opposed to vaccines.

 

Editors’ accountability: The comment by “Lars Andersson” ( http://ijme.in/articles/increased-incidence-of-cervical-cancer-in-sweden-possible-link-with-hpv-vaccination/ ) was reviewed by an external, international subject expert, an external statistician, a working editor with expertise in research methodology (Mala Ramanathan) and the manuscript editor (Sandhya Srinivasan) before being accepted for publication. When we were notified of the deception regarding the author’s identity and affiliation, we immediately removed the KI affiliation from the journal. We have explained our justification ( http://ijme.in/articles/statement-on-corrections/?galley=html ) for retaining the article on our website, and maintaining the author’s anonymity.

I find it exceptionally hard to believe this has been reviewed soundly. It does not take deep expertise to see the basic errors made, and these errors were widely noted by others. On a scale of errors, they amount to errors in arithmetic. Almost all of the people used in the argument were not vaccinated, and too few people were involved to make meaningful statements. (Furthermore, it’s possible that none of these women were vaccinated once you consider that not all younger women in the population were vaccinated. This would be consistent with the very high rate of prevented of cervical cancer that recent results observe.)

I noted in my earlier piece, as Prof Munthe also did, that the paper falls outside the remit of the journal, and so should have been excused,

The journal is a medical ethics journal, not a medicine journal. Despite this we see several papers on HPV that don’t look (to me) like ethics papers. Why are they publishing these? Most journals reject papers outside of the scope they cover, and quite firmly. One reason is to match papers to their peer review and editor’s expertise. If it was reviewed it’d be interesting to know who reviewed this paper,[7] and what their expertise was.

I guess I now have my answer to my latter question. Of the reviewers listed by the editor only one might have relevant expertise, but the vague “international subject expert” is not encouraging: specifically what subject?

The editor continues,

The attack on IJME for maintaining the author’s anonymity appears to be to avoid scientific debate. We invite critical commentaries on the paper by “Lars Andersson” towards advancing the scientific debate on the issue at hand.

As I noted in my earlier piece I’ve never heard of anonymity used in scientific publishing. When you publish in science it is to present an argument for a case, with the understanding that you publish your argument for all to critique.

Is the IJME editor is unaware of, or ignoring, the publicly-reported criticism of ‘Lars Andersson’s claims?

You also need to take care to distinguish criticism of anonymity from criticism of accepting the deceit (as the IJME initially did).

There is (paraphrasing) no ‘avoiding scientific debate’—it was widely criticised at several sources.

On a practical note, while they “invite critical commentaries” this might be moot if the paper has been retracted.

Does Prof Ottersen’s indignation comes from his inability to personally target the person questioning the HPV vaccine?

Conspiratorial, and ad hominem (and possibly distracting from the issues at hand).

The prevention of deception by an author on the name or affiliation requires the joint efforts of many stakeholders, including journals. While IJME has taken full responsibility for what has happened, the attacks on it in the name of publication ethics cannot wish away the ongoing governance failure in the KI, and cannot be used to prevent scientific debate on an article which nobody has proved to be unscientific, except by innuendo.

Cooperation among journals, etc., might help, but doesn’t immediately turning around and pointing fingers undo that, or make it rather hard to achieve?

No-one is preventing ‘scientific debate’, but that cannot work under deceit, and basic standards should be kept. The argument offered by ‘Lars Andersson’ is too poor to have been published, irrespective of the deceit played by it’s author.

Other articles on Code for life

A few vaccine resources (mostly for those wanting shorter overviews)

Sources for medical information for non-medics and non-scientists (for those wanted more detailed information)

If presenting a claim on a popular issue… “… consider testing if your idea is sound first” – some thoughts and advice on checking stuff out

Sources for medical information for non-medics and non-scientists (a resource page)

Fact or fallacy, a survey of immunisation statements in the print media (at the time I wrote that the media unfortunately get things wrong, which can be confusing if you’re new to the topic, but I have to say the NZ media is doing better of late — keep it up!)

The Panic Virus (a review of a book examining parents’ concerns about vaccines)

Thoughts on, and for, those trying to choose to vaccinate or not (Some thoughts on some aspects of parent trying to find sound information.)

Immunisation then and now (a peek at history)

Rubella, not a benign disease if experienced during early pregnancy (including rubella in New Zealand – I’m a rubella kid)

Footnotes

* Thanks to ‘Rosewind’ on Twitter.

About the featured image

The quadrivalent HPV vaccine, targeting HPV type 6, 11, 16 and 18. Sourced from Wikimedia, Creative Commons Attribution-Share Alike 2.0 license.

Being a quick piece, I’ve re-used the feature image from the original article about the ‘Lars Andersson’ paper in IJME. (Finding these images takes time!)

Electron micrograph of human papilloma virus. Public domain image, source Wikimedia. The virus particle is negatively-stained; the background is stained not the specimen. The result is an image that looks a bit like the film negatives of film era photography. (Film photography is still around, but now only practiced by enthusiasts.)


7 Responses to “‘Fake author’ papers opposing HPV vaccine retracted, editor’s defence”

  • The editor is arguing that it is the Karolinska Institute’s responsibility to scrutinise every published paper in every journal, vigilantly checking for authors who claim a KI affiliation, so their failures to notice the fraudulent “Lars Andersson” in ‘Vaccine’ and ‘JIM’ were “glaring failures of governance”.

    “He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.”

    I think that refers to “Lars Andersson”‘s letters to the JIM, which questioned the claims reported in an earlier paper in that journal, by KI researchers:
    For clarification, I have the following three questions to the six authors of the article
    Those authors dutifully answered the questions, but “Lars” was unsatisfied. In the mind of the IJME editor, this is tantamount to “fil[ing] a complaint of research misconduct in 2016 against six authors of this paper”. Also, those authors’ response proved that KI “investigated these allegations”. From this imagined investigation of imagined allegations / questions, “It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation.”

    To sum up my attempt to reconstruct the editor’s fantasy: there was an imaginary investigation of an imaginary allegation, thereby
    (1) establishing the prima-facie validity of that imaginary allegation,
    (2) proving that KI researchers are guilty of misconduct
    (3) also proving that KI were just as negligent as the IJM, since they should have checked Lars Andersson’s affiliation in the process.

    This goes beyond “incompetence” and “no idea of ethics”. The editor’s argument is not even sane.

    “The comment … was reviewed by … the manuscript editor (Sandhya Srinivasan) before being accepted for publication.”
    Srinivasan seemed to have never heard of it when contacted by Twitter.

  • Hi Alison,

    I can’t see how the KI could be expected to take responsibility for “Lars Andersson” when he didn’t work there anyway!

    I can’t either!

  • Hi herr doktor bimler,

    The editor is arguing that it is the Karolinska Institute’s responsibility to scrutinise every published paper in every journal, vigilantly checking for authors who claim a KI affiliation, so their failures to notice the fraudulent “Lars Andersson” in ‘Vaccine’ and ‘JIM’ were “glaring failures of governance”.

    It’s not institutes’ responsibility anyway. They’re claims made elsewhere, and not their claims to defend as it were.

    Purely for academic-style rumination, it seems to me that the only way to implement this is development a sort 0f global academic police state where only pre-approved people are ‘allowed’ to write papers. (Hmm. Good sci-fi plot…)

    “He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.”

    I think that refers to “Lars Andersson”‘s letters to the JIM, which questioned the claims reported in an earlier paper in that journal, by KI researchers:

    For clarification, I have the following three questions to the six authors of the article

    Those authors dutifully answered the questions, but “Lars” was unsatisfied. In the mind of the IJME editor, this is tantamount to “fil[ing] a complaint of research misconduct in 2016 against six authors of this paper”. Also, those authors’ response proved that KI “investigated these allegations”. From this imagined investigation of imagined allegations / questions, “It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation.”

    I thought it referred to the same letter. Good point about it being academic correspondence rather than an ‘investigation’ by KI. You’d wish an editor distinguished these; they’re quite different.

    “The comment … was reviewed by … the manuscript editor (Sandhya Srinivasan) before being accepted for publication.”
    Srinivasan seemed to have never heard of it when contacted by Twitter.

    She gave the paper a shout-out on April 30th: https://twitter.com/sandhya19910/status/990915707784388608 It any event her name is given at the bottom of the paper noting her as the editor for that paper.

  • For people who were so concerned for the reputation and the career of the pseudonymous contributor, the IJME editors are working very hard to attack the reputations of KI researchers:
    “the Karolinska Institutet’s own role in permitting misconduct by its researchers.

    The evidence for this “misconduct” is (1) a troll accused them of concealing evidence, and (2) they took the troll’s complaints seriously enough to reply. In the editors’ minds, this becomes an admission of guilt, in turn proving the “ongoing governance failure”.

    I hope they don’t pretend to be experts on medical ethics.

  • Another thought that has been suggested elsewhere is that the “external, international subject expert” may prove to be one of small number of people with ‘sympathetic’ views.

    Whatever the case, this is where stronger journals use several expert reviewers. One day I must write about peer review. It seems widely misunderstood, even by those reporting on science in the media.

    Off-topic: ODG. I’ve just learnt that there is a (parody) twitter account, Reviewer Number 3. What next?