Eric Rubin had been in cost for less than three months. The editor in chief of the New England Journal of Drugs (NEJM) had come into the function with no earlier editorial expertise however a profession in infectious illness drugs. “Little did I anticipate my coaching can be so helpful,” he says.
As quickly because the information of a pneumonia-like outbreak in China reached NEJM’s editors, “we made some calls to determine what was happening, soliciting manuscripts from colleagues in Wuhan and later in Italy and the US when the epidemic unfold,” says Rubin. Unsolicited submissions swelled, spiking at about 200 covid associated papers a day.
Editors felt the strain of workloads, but in addition duty. Richard Horton, editor of the Lancet, informed the New York Occasions, “We really feel very a lot that we’re publishing analysis that’s actually, daily, guiding the nationwide and world response to this virus. If we make a mistake in judgment about what we publish, that might have a harmful impression on the course of the pandemic.”1
This was the primary world pandemic that the scientific publishing business had ever confronted—whereas journals existed, no organised business did when the 1918 flu pandemic occurred—and the primary in a brand new digital age of web communication and publishing. An estimated 1.5 million articles have been added to the worldwide literature in 2020—the most important single yr enhance in historical past, says Vincent Larivière, who research bibliometrics on the College of Montreal, Canada. This peaked in April 2020, when many nations have been deep into lockdown or making use of heavy restrictions.
Some noticed it as a possibility. There have been guarantees of extra open science and publishing: numerous journals and analysis establishments agreed to a knowledge sharing pledge issued by the funder the Wellcome Belief on 31 January 2020 that supposed to “be certain that analysis findings and knowledge related to this outbreak are shared quickly and overtly to tell the general public well being response and assist save lives.”2 However it additionally stoked an already, some say, twisted business—one which thrives on competitiveness—to publish the primary knowledge or to have the best visibility and impression. This modified the ways in which papers have been produced and vetted, for good and dangerous.
An excessive amount of, too quick, too dangerous?
For the 885 well being and drugs journals revealed by Elsevier, submissions elevated by greater than 60%, together with nearly 1 / 4 of one million submissions within the first wave of covid-19.3 At BMJ Journals they rose by nearly 20% in 2020 from the yr earlier than, as almost 4400 submissions have been made to The BMJ and BMJ Open alone inside 5 months in 2020.4
By the tip of 2022 the World Well being Group’s covid-19 database contained 742 202 objects. To fulfill such demand editors have been “all arms on deck” and have been typically redeployed from their traditional roles to quickly appraise coronavirus papers, says Theodora Bloom, govt editor of The BMJ—a transfer fuelled by “the sense that we aren’t on the scientific entrance line however we’re on a important entrance line.”
Medical journals halved their turnaround instances within the first half of 2020.5 Regardless of the unknown nature of the virus and its science, editors took far much less relatively than extra time over choices, a February 2023 evaluation of 339 000 papers has discovered.6
Naomi Lee, senior govt editor for analysis on the Lancet through the pandemic, remembers how the normally uncommon observe of “quick monitoring” choose papers was expanded in order that “virtually everybody and all the things was accelerated with the aim of disseminating important information.” The PubMed database reveals that the 5 most cited articles within the Lancet since 2020—most reporting early coronavirus knowledge—have been accepted inside 14 days and revealed inside 22 days of receipt.
Alarms have been raised early on concerning the mixture of sheer quantity and unprecedented pace. Commentators decried a flood of junk within the literature: observational research, opinion articles, and duplicated efforts as researchers rushed to capitalise on covid associated funding calls.7 Rubin says that NEJM’s editors needed to abandon their traditional full checks and balances within the acute part of covid article triage and have been publishing issues they usually wouldn’t, together with case experiences, small trials, and uncontrolled research. Bolstered by his personal “scary” expertise of treating sufferers with covid in intensive care at Brigham & Ladies’s Hospital in Boston, USA, he says that within the context of a public well being emergency, publishing “some information was higher than none.”
Extra threatening to folks’s belief in journals have been excessive profile retractions, notably these of papers within the Lancet and NEJM from Might 2020 that reported early efficacy of hydroxychloroquine for covid-19, subsequently discovered to be fraudulent.89 But, towards expectations, retractions haven’t risen to a degree to match the large enhance in quantity and publishing pace of covid papers. Retraction Watch, an internet site that tracks the phenomenon, has recorded 301 retracted or withdrawn covid papers to eight February 2023.89 It estimates that simply 0.07% of covid papers have been retracted—in step with an anticipated total fee of retraction.
Not-so-open science
Proponents of open science had breathlessly heralded a revolution.10 medRxiv, a BMJ affiliated preprint server, noticed a 10-fold rise in submissions inside two months of the primary reported covid case. However this enthusiasm receded, and submissions at medRxiv and others stabilised by mid-2020.
Evaluation reveals that simply 5% of all peer reviewed journal articles about covid-19 revealed in 2020 began out as preprints.11 And, whereas some pivotal trials comparable to Restoration and Solidarity have been first reported as open entry preprints, not one of the part 3 covid vaccine trials supported by Oxford-AstraZeneca, Moderna, or Pfizer was, and solely the Oxford-AstraZeneca part 3 trial report was revealed with a gold open entry licence. A 2022 analysis by Wellcome of the info sharing dedication it initiated discovered that fewer than half of signatories’ covid papers contained details about the place and methods to entry accessible knowledge,12 elevating concern a couple of lack of transparency, notably in scientific trials.1314
Progress in direction of extra open analysis has additionally upset. Whereas the main publishers agreed to make their covid content material open and reusable,2 Wellcome’s evaluation discovered that simply 46% of signatories’ covid papers have been genuinely open entry, the place re-use is permitted and authors retain copyright.12
As an alternative, most journals retained industrial rights and easily took down a paywall (“bronze” open entry15), says Larivière. He provides that, whereas main publishers together with Elsevier, Springer Nature, and Wiley proceed to make covid content material freely accessible, solely about half of papers on the local weather disaster are equally accessible. That is regardless of all being signatories (together with The BMJ) to the United Nations sustainability improvement publishers’ compact, which commits publishers to actively promote content material that advocates for themes comparable to sustainability, justice and safeguarding, and strengthening the surroundings.
“Covidisation”
Considerations are being raised that the domination of covid associated papers in medical journals got here at the price of different well being points comparable to non-communicable situations, violence, and psychological well being.
John Ioannidis, professor of drugs at Stanford College, USA, has studied quotation patterns through the covid pandemic and is frightened concerning the impact on variety in science. His evaluation of the peer reviewed scientific literature in 2020-21 (to 1 August) confirmed that, whereas covid papers represented 4% of the scientific literature, they took 20% of citations to all papers revealed.16
The numbers rose when drilling all the way down to common medical literature. Of these, 17% of all articles revealed within the interval have been on covid-19, hoarding 80% of the citations.16 In different phrases, covid papers in a common medical journal obtained about 5 instances extra citations on common than non-covid papers in the identical interval, and the overwhelming majority of citations to such journals have been from the covid papers.
This was an enormous boon to journals and their editors, as journal impression issue scores greater than doubled for 2021 on the premise of pandemic publishing in 2020: the Lancet rose from 79 to 202, NEJM from 91 to 176, the Journal of the American Medical Affiliation from 56 to 157, and The BMJ from 40 to 96. These surges in publications, article views, social media visibility, and citations have led to a brand new quotation elite and well being management that can form future funding and institutional priorities.
Ross Upshur, pandemic governance professional on the College of Toronto, Canada, who additionally teaches analysis integrity, says that every one this opportunism is nothing new. To him, what occurred through the pandemic displays an already perverse system of educational reward that has little motive to vary: the gold rush to publish was merely an extension of the same old “publish or perish” tradition. It’s subsequently unsurprising that “folks needed to turn into a covid professional to outlive, or at the least a self-appointed professional.”
Ivan Oransky, cofounder of Retraction Watch, agrees that the system is mutually reinforcing as a result of the highest medical journals have been aggressively engaged in “an arms race for consideration, eyeballs, and citations.”
Elizabeth Gadd, a UK scholarly publishing professional, says, “The pandemic simply highlighted the issues of publishing. It’s costly, sluggish, and reinforces journal articles being the accounting unit of scholarship. It’s not about contributing to scholarly dialog. It’s scholarly fanfaring of outcomes that doesn’t align with the mission of science. If all authors acquired was suggestions from reviewers and readers there can be no race to publish. As it’s, the scenario is a quest for glory.”
Three years on, Rubin admits to having “covid fatigue” however insists that he has “no regrets” and that NEJM is keen to maneuver on to publish in different areas. Elizabeth Loder, head of analysis at The BMJ, shares the need to “broaden the subjects we’re overlaying now to tell our viewers and likewise to beat the neglect of different issues, which is only one space of fallout from the depth of covid-19 publishing.”
Upshur is pessimistic, nevertheless: he doesn’t see reform of the standard publishing system taking place till publication is much less tied to analysis. Loder accepts that journals have a weight of duty within the pandemic publishing rush, however she agrees that a lot of the dangerous behaviour within the eagerness to publish, particularly in high journals, is all the way down to incentives and an absence of oversight in educational promotion methods.
“There must be extra of a reckoning for educational medical establishments,” she says. “These establishments unduly rewarded folks for pivoting their analysis to covid, not matching high quality to quantity, and in the end contributed to hurt through the pandemic.”
Footnotes
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Competing pursuits: Jocalyn Clark is worldwide editor of The BMJ and was govt editor on the Lancet throughout covid-19. She is a 2023 visiting researcher on the Brocher Basis for a venture on pandemic publishing.
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Commissioning and peer evaluate: Commissioned; not externally peer reviewed.
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