Editors: Two weeks ago, the BMJ and Lancet published "expressions of concern" about articles published by Dr Ram Singh of Moradabad, India, after investigations provided reasons to suspect that the data in these articles had been fabricated.(1,2) The articles in question concerned dietary interventions, and fortunately the public health consequences of the deception were minimal. Two years ago, I drew attention to the large increase in the number of articles on bioterrorism published in 5 major medical journals in the period leading up to the Anglo-American invasion of Iraq (March 2003).(3) I was concerned that the number of articles was disproportionate to the public health importance of bioterrorism and that the articles served the political function of causing fear in the general population thus helping to justify the attack. As the table below shows, the number of articles reached a peak just prior to the attack and fell afterwards. In drawing attention to bioterrorism, the articles gave credence to the claim that Iraq possessed weapons of mass destruction. This claim has subsequently been shown to be false and several of the key documents on which the claim was based have been shown to have been fabricated. The public health importance of this deception has been considerable.

Number of articles on bioterrorism published in 5 major medical journals JAMA, NEJM, BMJ, Lancet, Annals of Internal Medicine:

Information published in medical journals is regarded as credible by the general public and is regularly reported on in the lay press. For these reasons, there should now be an investigation into pre-war burgeoning in bioterrorism articles. This investigation should consider the source of the articles, whether they were solicited or unsolicited, and whether the authors of these articles had any conflicts of interests.

References
1. Expression of concern. BMJ. 2005;331:266.
2. Al-Marzouki S, Evans S, Marshall T, Roberts I. Are these data real? statistical methods for the detection of data fabrication in clinical trials. BMJ. 2005;331:267-270.
3. Roberts I. Medical journals may have had a role in justifying war. BMJ. 2003;326:820

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Ian Roberts questioned whether the increase in the number of publications on bioterrorism in 2001 and 2002 might be due to an increase in fraudulent data, presumably encouraged by the US and UK governments. Fraud is always a possibility, but most of us in the biomedical sciences make the assumption that a study is legitimate unless there are clear reasons to question its legitimacy. Regardless of my opinion about the wisdom of the decision to invade Iraq, I do not see why an increase in the number of publications should suggest foul play. The US government invests about 100 billion dollars in research and development each year. It puts its money where it thinks new research is needed. Whether this is prostate cancer or bioterrorism, the government is obviously directing the activity of researchers. One may call this "conflict of interest," but it applies to all fields of research. Unless there is evidence that the outcome of studies on bioterrorism was manipulated to satisfy the wishes of the funding agency, I don't see why the increase in number of publications should be seen as an indication of foul play.

Roberto Refinetti
Editor-in-Chief, Journal of Circadian Rhythms

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As much as I enjoy reading and, occasionally, participating in the WAME listserve, if those who control it can't keep political discussions out of it and focus on the processes and policies surrounding publishing peer-reviewed medical journals, I will be forced to resign from WAME.

Bill Tierney
Co-Editor-in-Chief, Journal of General Internal Medicine

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Bill, I imagine many others—myself included—would also resign from WAME the day that a policy decision is made to declare "political discussions" relevant to the editing task to be out-of-bounds. Political decisions impact on a huge range of issues with which we all need to be concerned. The sponsorship of research by vested interests of different sorts, with the documented history of all that can follow from that, is surely a core policy matter for editors and their boards. If there is evidence that governments are part of such a process, we need to talk about it, not spurn such possibilities as somehow unworthy of discussion.

Ian Roberts makes an interesting observation and his research question implies the possibility of covertly politicized research. There may well be nothing to it, but if the research he proposes suggests something more than simple responsiveness to a massive world event by the international research community, then another front on compromised research scholarship might open up.

WAME must be more than an anodyne forum for discussion of the practical/technical aspects of editing.

Simon Chapman
Editor, Tobacco Control

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There may be more than meets the eye in the note suggesting political motivations to the increase in bioterrorism articles. Was it written as a put-on?

The note did not mention the most significant and horrible event on US soil since the attack on Pearl Harbor in 1941: the destruction of the World Trade Center in 2001 by terrorists. By what warped reasoning would or could anyone interpret the subsequent flurry of articles and concern about bioterrorism as due to fact manipulation by government to justify a conflict 1 1/2 years later?

Had there not been a discussion and mobilization of medical resources for the probability of more attacks—including infectious and nuclear—the US government and private establishments would have been guilty of gross ignorance and neglect.

To attribute the increase in medical articles devoted to potential mass injuries to political motivation suggests to me in itself some sort of political motivation or a parallax view of current events.

I have been a quiet observer of this list but I am concerned—distressed—by such conspiratorial and political reactions of other journal editors and more concerned about editorial staff policies justifying publications according to their peculiar politics. I refer to the BMJ article and to the Lancet article estimating the military to be responsible for 100 000 deaths in Iraq. The methodology of that report was loose to say the least, and its timing was suspiciously political. And the estimate was probably wrong.

I am also concerned that there are such views expressed from within the Cochrane Collaboration—clues to a worrisome systematic bias.

I second Dr Tierney's demand that the messages to the list be screened for appropriateness, and be pertinent to editing. An appropriate communication would be one from an editor asking for direction in publishing papers such as the above.

Wallace Sampson
Editor, The Scientific Review of Alternative Medicine
Editorial Board, MedGenMed

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Projects like RODS-the Real-time Outbreak and Disease Surveillance system: http://rods.health.pitt.edu/NRDM.htm and http://openrods.sourceforge.net/index.php?page=introduction) are undoubtedly among the finest, genuine research projects ever conducted in our discipline (public health informatics/geoinformatics):

1. Tsui FC, Espino JU, Dato VM, Gesteland PH, Hutman J, Wagner MM. Technical description of RODS: a real-time public health surveillance system. J Am Med Inform Assoc. 2003;10:399-408.

2. Wagner MM, Robinson JM, Tsui FC, Espino JU, Hogan WR. Design of a national retail data monitor for public health surveillance. J Am Med Inform Assoc. 2003;10:409-418.

There is definitely good science here, not fraudulent data. See also: http://www.cdc.gov/epo/dphsi/syndromic.htm

Maged N Kamel Boulos
Editor-in-Chief, Int J Health Geogr (http://www.ij-healthgeographics.com)
Editor, NLH/NHS Informatics UK Health GIS SIG (http://www.informatics.nhs.uk/groups/group3/index.htm)

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It seems that most of the readers of this list missed the announcement in early April 2004, which was reported in Science (9 April 2004 304:187) that the US Department of Treasury's Office of Foreign Assets Control sent a letter to the Institute of Electrical and Electronic Engineers (IEEE), which had challenged the government ruling against editing manuscripts from proscribed countries.

The letter ruled that IEEE is "not constrained" from having reviewers propose substantive improvements to the manuscript nor from making editorial changes before publication. Peer review and copy editing are specifically allowed. The Journal of the American College of Nutrition has published 2 manuscripts from Iran in the last year with no repercussions.

David M. Klurfeld
Editor-in-Chief, Journal of the American College of Nutrition

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At the time of the September 11, 2001, attacks and the aftermath of anthrax deaths and scares, I was working at the house that publishes Pulmonary Reviews. Did that publication cover anthrax? Yes. Why? It was newsworthy and applicable to the audience. I would imagine that most articles were published for similar reasons.

Martha Heckel
Senior Editor, Physician's Weekly/Patient Education Center

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