Features
The evil impact of medical research misconduct
BY Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed),
MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
The scholarly eye-opening article ‘Retracted research ~ 1’ by Amal Mandal, a former Associate Professor of Political Science from West Bengal, India, published in The Island Newspaper on 01-03-2024, and the follow-up article ‘Retracted research ~ 2’ by the same author, published on the following day, would have sent shock-waves and shivers down the spines of all involved in scientific publishing. Those newspaper items were primarily based on an index article titled “More than 10,000 research papers were retracted in 2023 — a new record.” published in the reputed scientific journal Nature on 12th December 2023(1). It reported on the unbelievable and gut-wrenching situation in 2023 when implausible numbers of so-called original research articles published in many journals, including those of tremendous pedagogic repute, were retracted (withdrawn) following publication, for a variety of reasons.
Amongst the whys and wherefores for retractions, academic research misconduct comes up pretty high in the ranking order. It has been known for quite a while but now it has really been put out into the open and the cat is most definitely out of the bag. As reproduced almost verbatim here from a communique from Imperial College London, UK(2), “research misconduct has been characterised as actions or questionable research practices that fall short of the standards of ethics, research and scholarship required to ensure that the integrity of research is upheld. It can cause harm to people and the environment, waste resources, undermine the research record and damage the credibility of research. It is often defined by ‘falsification, fabrication and plagiarism’ and can include making up data or results, incorrectly attributing authorship, gift authorship, manipulating research data, materials, equipment, or processes, or changing or omitting data, graphs, images, or results.”
In the main, many of those papers that have been retracted have published results and material that are not perfectly authentic and tenable from the point of view of a rigorous scientific appraisal. In other words, to put it in perspective and even to state rather bluntly, they are fraudulent attempts at securing scientific publications, even at the price of sacrificing intellectual honesty. All kinds of misdemeanours are known to occur in the many strata of people involved in the scholastic publishing industry. Amongst these, unscrupulous authors of so-called original research articles, which are of doubtful validity, take pride of place; certainly not a situation to be proud of, but only fit to be relegated into a contemptible bin of disgrace. The main worry of all these aspects is the fact that the inadequacy of scientific precision in many of these articles has been detected only after they had been accepted and published in the journals concerned. The articles had got into the published public record by the time the problems had been detected.
Bio-medical scientific publications are so very important because they attempt to provide the precise technical basis and erudite reasons for the causation of, as well as the accepted management strategies for human disease. Medical journals have an abiding impact on the diagnosis and treatment of human illnesses and the way we provide essential healthcare to unfortunate patients. They are the pivotal foundations of current knowledge on which up-to-date treatment of diseases and disorders affecting humans are based.
There is no room for two words or give-and-take provisions in that endeavour. Medicine and healthcare that are evidence-based should undoubtedly be the cardinal principles on which diagnosis, treatment and further management are unequivocally based. However, sadly for sure, if the fundamental principles of reliability in good quality research which ultimately percolates as benefits to sick humans are faulty and leaves a lot to be desired, there is no hope at all for progress in medicine.
The terrible consequences of research misconduct can be extremely severe and ever so grave. Such aftermath effects would include causation and propagation of preventable illnesses, the loss of human life due to misinformation in the literature as well as continued citing and usage of retracted work. It can also result in wasted resources, both human and financial when newer research processes or clinical work are based on previous flawed or fraudulent research. Deceitful research is the pits of the world and is fit only for guttersnipes.
Funding agencies often require that cases of research misconduct be reported to them which can be damaging to the careers of those who commit transgressions and there is a financial cost to the institution in investigating allegations as well. The retraction of papers and reputational risks of misconduct can be damaging to the research careers of those who commit misconduct as well as their academic institutions.
There are well-organised systematic initiatives such as “Paper Mills” that undertake certain nefarious academic activities for filthy lucre(3). These are money-making unethical commercial ventures which specialise in producing fake or fraudulent research papers. Very often the main parent organisations are in one country, the customers who pay a lot of money for these dubious services are in another country and the ‘ghostwriters’ who produce the papers for pretty high payments but are totally behind the scenes, are perhaps even in yet another country. It is extremely difficult to track down these miserable goings-on and bring the perpetrators to book.
There is also the distasteful spectre of Predatory Journals, also known as fraudulent, deceptive, or pseudo-journals(4) looming on the horizon. They are a mushrooming plethora of journals with questionable and scientifically unsatisfactory review, assessment and publication practices. They tend to play on the personal susceptibilities of authors such as securing publications to satisfy academic requirements of scholastic institutions where they work for considerable sums of money.
From a different perspective, one has to acknowledge that the current vogue of Artificial Intelligence (AI) has revolutionized various sectors, including biomedical research, bringing about promising breakthroughs in disease diagnosis, drug discovery, and treatment optimization. It is an undeniable truth that AI is here to stay. However, beneath the veil of optimism lies a darker reality; AI’s negative and even ugly effects on biomedical research. To all these things that are taking place now in the publication portals of biomedical research, if we add the potentially deleterious effects of AI, say even to enterprises such as Paper Mills, one would shudder at the likely consequences. The possibilities and the deleterious potential of the harmful usages of AI are suspected and somewhat known at present and are established to be quite disastrous.
The way things have panned out, while AI offers tremendous potential, its integration into this field has raised ethical, social, and practical concerns that cannot be overlooked. One of the foremost concerns is the perpetuation of biases. AI systems learn from data, and if this data is biased, the AI models will reflect and perpetuate these biases. In biomedical research, biased data could lead to skewed results, misdiagnoses, and unequal treatment. Moreover, the opaque nature of AI algorithms poses a challenge to transparency and reproducibility in research. Unlike traditional research methods where processes are transparent and results can be scrutinized, AI models often operate as ‘black boxes’, making it difficult to understand how decisions are made. This lack of transparency undermines the scientific method and hampers the ability of researchers to validate findings or identify errors, potentially leading to misguided conclusions and wasted resources.
Furthermore, overreliance on AI may diminish the role of human expertise and intuition in biomedical research. While AI algorithms can analyse vast amounts of data and identify patterns, they lack the contextual understanding and creativity that human researchers possess. This could lead to the neglect of valuable insights that cannot be quantified or captured by algorithms alone, thereby stifling innovation and limiting the potential for groundbreaking discoveries.
All the foregoing details and statements have a direct bearing on the work of editors of medical journals in the publishing industry. The author of this communique is very conscious of, and, in fact, seriously worried about, these implications concerning his work with editorial duties in two esteemed medical journals of Sri Lanka. Some of these potential consequences strike at the very core of the heart of medical publishing endeavours; namely the authenticity, veracity and unabridged reliability of the research material that is published in medical journals.
It has to be acknowledged that most medical journals have peer review systems in place which assess the different features, scientific quality, and many other components as well as implications of articles of research that are submitted to the journals. The research papers in medical journals are published after a rigorous process of such intense appraisal. However, as evidenced by the alarmingly increasing numbers of retractions, this system has perhaps most unfortunately not been all that successful in maintaining the very best standards of medical publications. It is getting progressively difficult to separate the grain from the chaff, especially for the editors of medical journals. This editor at least is well aware of the likely problems and constraints that would be placed on the venture of publishing well-tested and reliable scientific papers in the not-too-distant future.
References
1. Van Noorden R. More than 10,000 research papers were retracted in 2023 — a new record. Nature 2023;624:479-481.
2. What is research misconduct? Available from https://www.imperial.ac.uk/research-and-innovation/research-office/research-governance-and-integrity/research-integrity/what-is-research-integrity/what-is-research-misconduct/ Accessed on 01-03-2024.
3. Perera BJC. ‘Paper mills’: a detestable blot like no other. Sri Lanka Journal of Child Health 2021;50(2):185-187.
4. Elmore SA, Weston EH. Predatory Journals: What They Are and How to Avoid Them. Toxicologic Pathology 2020;48(4):607-10
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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