Gaslighting the Medical Literature

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Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

Is predatory publishing gaslighting the medical literature?

It may not be intentional. It may be an accidental by-product of various forces:

  • The warranted erosion of trust in the traditionally respected best medical literature that we described last year;

  • The recognition of George Orwell's predictive genius in his 1949 novel 1984, with Big Brother, the Thought Police, Newspeak, and the unperson;

  • The recent American political emergence of repetitive charges of "real leaks" with "fake news," and now "very fake news;" and

  • The rapid growth of medical and scientific articles from predatory publishers.

But we seem at a crisis point akin to Ingrid Bergman's mental state on display in the great 1944 film Gaslight.


As in the film, gaslighting is a form of mental manipulation that seeks to sow seeds of doubt in a targeted individual or members of a group, hoping to make targets question their own memory, perception, and sanity. This may not be the intent of predatory publishing, but it certainly can be an effect, inserting doubt about much in medicine that you may read.

According to Wikipedia,[1] predatory publishing is "an exploitative open-access publishing business model that involves charging publication fees to authors without providing the editorial and publishing services associated with legitimate journals (open access or not)." Of course, those fees (money, money, money) are the reason for the practice. Jeffrey Beall, a librarian at the University of Colorado Denver, is by far the best known expert in this field and is credited with coining the term "predatory publishers" in relation to his famous Beall's list, now unfortunately defunct.[2] The key actual difference between legitimate and predatory journals is the quality and consistency of the editorial and peer review process.

How many predatory publishers and journals are there? A lot, although the actual number is unknown. One recent study[3] reported that about 45% of open access journals in emergency medicine were predatory. A 2014 article[4] reported finding 8000 predatory journals that published 420,000 articles in 1 year, and the numbers were rapidly growing.

But get this: The "legitimate journals" (not necessarily vanity presses) also often charge authors publication fees, even hefty fees, in the range of hundreds and thousands of dollars . The predatory publishers appear uninvited in your inbox, like Bourbon Street barkers hawking their publishing prowess and charging lower fees than the "legitimate journals." Thus, a key distinguisher is bargain basement price, presumably related to costs not incurred for quality of publishing services.

Real Journals With Fake Articles, or Fake Journals With Real Articles

Real journals may publish fake articles, but they try not to. Real journals often publish articles with irreproducible results. This is a big problem, but it's not done on purpose. Real journals charge a lot of money in author fees, paid subscriptions for readers, and big fees for libraries, plus advertisers. Medical publishing is a big business.

Fake journals may publish real or fake articles from real or fake authors. They prefer to publish real articles of a quality as high as they can get from real authors at real institutions. That is how they may improve their standing and could even aspire to join legitimacy.

The 'best' simple solution is to personally know the competence, morality, and ease of availability of the journal's top editor.

To be fair, the professional publishing community is trying to prevent this mess. Retraction Watch most recently summarized some of the efforts of ICMJE (the International Committee of Medical Journal Editors) and COPE (the Committee on Publication Ethics) to deal with this burgeoning problem monster.[5] In addition, INANE (International Academy of Nursing Editors) has published its own recommendations.[6] The WAME (World Association of Medical Editors) is working on definitive recommendations about what poor authors and editors may do to protect themselves. The "best" simple solution is to personally know the competence, morality, and ease of availability of the journal's top editor.

The Internet did change everything. Well, not exactly everything—100% of the energy entering earth's atmosphere still comes from the sun; Avogadro's number is still 6.022140857 × 10 23; and Steely Dan still sings Deacon Blues. And they got a name for the winners in the world: Alabama, the Crimson Tide.

So the Internet changed almost everything, including the now positive ubiquity of open access publishing. The emergence of Internet-based predatory publishing is an out-of-control, very disconcerting byproduct of open access publishing.

Did I hear you say, " This whole subject is outrageous"? Yes, it is. Now you understand.

In some ways, the revolutionary new publishing platform and medical journal called Cureus may offer the best solution to the whole mess caused by publishers in pursuit of money from authors. Cureus is the anti-predatory publisher. (Disclosure: I am an unpaid executive advisor, but I do own stock options.) We call Cureus "medical publishing beyond open access": free to the author; free to the reader; rapid publication; exclusively electronic; funded by grants and licenses; listed in PubMed Central; and relying for quality control on professional in-house editing, a community of scholars on editorial boards, and both pre- and post-publication peer review.

Get that? Post-publication peer review is always the most important kind, but rarely organized as such. It is potentially widely applicable as the solution to exposing sloppy, irreproducible research in "legitimate" journals, recognizing potentially valid work published in "predatory" journals, and everything in between. Check it out. That could be the future.

That is my opinion. I am Dr George Lundberg, At Large at Medscape.


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