Published 3/1/2003
Jennie McKee

(Don’t) stop the presses!

Researchers must avoid sullying the integrity of orthopaedic literature

James D. Heckman, MD, had a simple message when he addressed attendees of the 2008 annual meeting of the American Orthopaedic Foot and Ankle Society: orthopaedists and other researchers must adhere to ethical guidelines to preserve the integrity of the scientific literature.

Dr. Heckman, a former AAOS president and the current editor-in-chief of the Journal of Bone and Joint SurgeryAmerican (JBJS), outlined some of the ethical issues that JBJS has encountered and provided guidance on how authors can avoid these problems.

Fraud, plagiarism, and redundant publication
According to Dr. Heckman, one of the most egregious ethical issues involved fraudulent research. The problem came to light just days before the September 2005 issue was scheduled to go to press.

“The study reported on the use of an implant between 2000 and 2002—but the implant had not become available until 2004,” he recalled. “We had sufficient evidence to realize that the study was fraudulent, so I told the general manager of JBJS to ‘stop the presses.’”

Plagiarism and redundant publication are more common than fraud, said Dr. Heckman, who cited a study on exertional compartment syndrome of the forearm that appeared in both JBJS and another journal.

“The same magnetic resonance imaging scan was published in both journals,” he said. “At this point, we had two case reports in the literature. It turned out that two separate groups of authors had reported the same case: the internists who had made the diagnosis and the orthopaedists who treated the patient.”

Neither group knew the other was publishing the study.

“It was pure coincidence,” said Dr. Heckman. “As a result, we had double the number of cases of exertional compartment syndrome in the literature than actually existed.”

A similar issue occurred when a study on deep vein thrombosis and osteomyelitis in children appeared in JBJS and another journal, just months apart. Again, lack of communication between two groups of researchers at the same institution caused the problem.

“Because of the redundant publication, the literature was reporting 21 cases,” said Dr. Heckman. “All of a sudden, this looked like a burgeoning disease, when it really wasn’t.”

Investigating allegations of ethical issues
Dr. Heckman noted that after JBJS learns of a possible case of plagiarism or redundant publication, a side-by-side review of the two manuscripts is performed, as is an independent review from a third party. Often an electronic search of the documents is performed to compare them word-for-word.

“If we have a concern, we confront the author, usually in writing,” said Dr. Heckman.

After receiving the author’s response, the journal takes appropriate action. In cases that involve accidental misreporting or coincidental reporting of similar cases, publishing a “Letter to the Editor” in JBJS written by the author(s) is sufficient to correct the problem. Manuscripts may also be retracted prior to publication.

In particularly serious cases, such as those that involve fraud, the JBJS will notify the author’s institution, which may then carry out investigations and further actions. Extreme examples of unethical behavior often result in an individual’s being suspended for publication, often for 2 years.

Protecting the integrity of the literature
According to Dr. Heckman, orthopaedic researchers should follow the Guidelines on Good Publication Practice developed by the Committee on Publication Ethics (
www.publicationethics.org). The guidelines, which were developed in 1999, cover issues such as study design, data analysis, plagiarism, conflicts of interest, and redundant publication.

In addition, Dr. Heckman directed orthopaedists to the AAOS Standards of Professionalism (SOPs) on Research and Academic Responsibilities. These SOPs address issues such as peer review, fraudulent research, and intellectual property.

Dr. Heckman also notes that it’s crucial to read all author agreements from journals carefully. He urged authors to call the JBJS office before signing a document, if necessary.

“Don’t be afraid to ask questions,” said Dr. Heckman. “We’re always happy to provide useful information and guidance to authors.”

Prevention is the most important and effective approach to eliminating ethical issues in the scientific literature, said Dr. Heckman.

“It’s critical to spread the word about this—to raise the awareness,” he said. “Authors must be advised and educated better by journals. It is a good idea to have a departmental review of all proposed manuscripts prior to submission, and we must address offenders through journal sanctions or the AAOS SOPs on Research and Academic Responsibilities. In addition, journals that require submission of meeting podium presentations for consideration for publication should exercise greater caution to avoid the issue of redundant publication.”

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org

AAOS response to duplicative publishing and plagiarism
The AAOS Council on Education recently held a discussion on duplicative publishing and plagiarism, which has become a growing problem for the Academy, and one with potentially serious legal and ethical implications for both the Academy and the authors who, whether intentionally or not, submit plagiarized material. According to Marilyn Fox, PhD, director of the publications department, one recent example involved an article submitted to the Journal of the AAOS with material plagiarized from a scientific article.

Alan M. Levine, MD, council chair, reports that the Council on Education has an educational initiative to increase understanding of authors and presenters about the pertinent areas of intellectual property rights so they can avoid unintentional violations. He has appointed a project team of members and staff to develop a reasonable approach to certifying that material submitted to the Academy is original and to develop an improved communication program regarding these issues so that authors understand the seriousness of copyright violations. The council discussed various means to detect and prevent violations of copyright, including the use of plagiarism-detecting software programs. In addition, an intellectual property quiz is being developed that will be mandatory for every author and editor of Academy publications. The quiz will carry continuing medical education credit and is designed to educate authors about their intellectual property rights and responsibilities.