Speech is silver, but silence is golden

Rinckside 2020; 31,6: 11-12.

myriad of medical papers have been and still are written and published that are inessential and truly pointless. I have written about it quite often, the last time with a long list of references in 2015 [1]. However, virtually no one seemed inter­ested or talked about it.

Worse still, there seem to be far more articles in the pipeline because some writers want to use other people’s data for papers of their own. In an editorial published in 2016, the editor-in-chief Dr. Jeffrey Drazen and deputy editor Dr. Dan Longo of The New England Journal of Medicine were worried about this kind of misappropriation of data by rival researchers.

They talked about "research parasites" — “a new class of research person[s] … people who had nothing to do with the design and execution of the study but use another group’s data for their own ends, possibly stealing from the research productivity planned by the data gatherers … [2]"

Within a few days, an outcry went through parts of the scientific community, and the two authors of the editorial clarified their remarks by promoting “symbiotical” work but they didn’t retract their earlier statement. Unfortunately their own journal was hit by “parasitic” data use. What they had predicted happened to themselves. The critics remained silent.

spaceholder red600   Even publications in commonly respected peer-reviewed journals were joining in the mad rush of the Covid-19 rat race to become the first with “important” scien­tific or research results — without them being properly reviewed. The Lancet and The New England Journal of Medicine had to retract two papers about chloroquine for the treatment of Covid-19 and cardiovascular disease, drug ther­apy, and mortality in that disease. For The Lancet and The New England Journal of Medicine this turned to a disaster because “the veracity of the data underlying this observational study could not be assured by the study authors [3,4]."

The main authors had used data that they hadn’t collected themselves. They had been provided by one of the co-authors who runs a data collecting company. The inconsistencies in the data sets were not discovered by the peer reviewers of the two journals (if any), but apparently by Australian journalists. They detected the flaws in the papers immediately — but they might have escaped a cursory reader. I could imagine that the two papers were put on the fast-track to be published through favoritism, passing by other papers that were put on hold. Raw data and statistical analyses of studies are often at the center of fraud. Only in rare cases they are checked and verified by the peer reviewers.


More so, novel electronic means, articles for which it’s difficult to get peer-reviewers, and the emergence of preprints put pressure on the ascendancy of well-established journals like The Lancet and The New England Journal of Medicine.

The media got upset about the amount and minor quality of “scientific” papers turned out like junk mail by researchers.

When Covid-19 struck, daily newspapers, weekly magazines and other media got upset about the amount and minor quality of “scientific” papers turned out like junk mail by researchers and medical doctors all over the world. Suddenly there were preprints, press releases and scientific papers all over. Already at the beginning of June, 14,300 preprints were counted; meanwhile tens of thousands of preprints have been published. They are collected in an amazing repository [5]. In addition, there are more than 3,000 papers on Covid-19 and radiology, counting preprints and articles on MedLine.

Preprints are, by and large, un­fi­nish­ed pre­li­mi­na­ry pub­li­ca­tions of scien­ti­fic pa­­pers before they are submitted to scientific journals — uploaded to on-line plat­forms. Since preprints are not independently peer-reviewed, their quality and validity is not controlled by any impartial decision of somebody of competence and experience in the field and, thus, cannot be relied on. Yet, it is now common practice to cite preprints, and not just reviewed final publica­tions.

Preliminary publications are not the way to go, neither in research nor in science. Some readers lack the ability to discern if the information given is trustworthy or not. They need “filtered”, i.e. reviewed, information they can depend on. Trust plays a major role for such journals in the way as, for instance, for Radiology and European Radiology. If one cannot rely any more upon the accuracy and credibility of papers published in these journals, they face an additional stumbling block in their battle for survival, and the readers have trouble finding the right directions for making professional medical decisions.

Writing papers has no moral value in itself, but is the default choice of many to succeed in their careers. Scientific misconduct is usually driven by two factors: money and the ego, and often leads to maneuvering in the borderland between pseudoscience and scientific scams, between ambition and integrity.

Simulating science

Sometimes one gets the impression that not only virologists and epidemiologists are the real experts of the Corona crisis, but also vampirologist and epididymologists — often academics who pretend to be knowledgeable in the field. Fortunately one country is blessed and has a former neuroradiologist as an advisor to the government’s Coronavirus Task Force, leading the country through the pandemic.

Preprints and publications in junk journals flourishing by the thousands in the recent decade mean research published with minimal effort, thereby padding academic CVs. Many of the Covid-19 preprints found coverage in popular media — mainly noise, very few real findings.

However, soon a critical mass of un­trust­wor­thy re­sults and con­clu­sions was reached, so that leading newspapers such as Neue Zürcher Zeitung and Le Monde complained about sloppy science while, on the other hand, journalists, politicians, and the general public were, sometimes inadvertently, relying on fraudulent and flawed research to guide major health-political decisions, and even veteran researchers had a hard time to ascertain which publications were indisputable. Unfortunately, some of this material sticks to one’s mind and becomes etched in people’s memories — right or wrong.

What do we read concerning radiology: Chest MRI is a viable alternative to chest CT in Covid-19 pneumonia follow-up, although a number of other publications claim that chest CT is the best method. Yet, perhaps ultrasound is the best modality. But then again, regular chest x-rays are sufficiently good …

spaceholder red600   In a diplomatic way, the problem was also described in a recent survey article by Ivana Blažić, Boris Brkljačić, and Guy Frija about guide­lines of how to use ra­dio­logi­cal tech­ni­ques faci­li­tat­ing the dia­gnosis of Covid-19:

"Guide­lines and re­com­men­da­tions of na­tio­nal and re­gio­nal pro­fess­io­nal so­ci­e­ties differ to a certain degree ... As a con­clu­s­ion, it is ob­vious that the prac­tice of imag­ing in Covid-19 dif­fers through­out the world, espe­cial­ly re­gard­ing the uti­li­za­tion of con­ven­tio­nal chest x-ray and com­puted tomo­graphy [6]."

Five years from now we will know better.


1. Rinck PA. The calamity of medical and radiological publications. Rinckside 2015; 26,8: 21-22.
2. Longo DL, Drazen JM. Data Sharing. N Engl J Med 2016; 374: 276-277.
3. Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of Covid-19: a multina­tional registry analysis. Lancet; 2020. | Mehra MR, Ruschitzka F, Patel AN. Retraction—Hydroxychloroquine or chloro­quine with or without a macrolide for treatment of Covid-19: a multinational registry analysis. Comment. Lancet. 2020. Volume 395, issue 10240, P1820, June 13, 2020.
4. Mehra MR, Desai SS, Kuy SR, Henry TD, Patel AN. Cardiovascular Dis­ease, Drug Therapy, and Mortality in Covid-19. N Engl J Med 2020; 382: e102. | Mehra MR, Desai SS, Kuy SR, Henry TD, Patel AN. Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med 2020; 382: 2582
5. Fraser N, Kramer B. Covid-19 Preprints. Re­posi­tory.
6. Blažić I, Brkljačić B, Frija G. The use of imaging in Covid-19 — results of a global survey by the International Society of Radio­logy. Eu­ro­pean Ra­dio­logy; 2020: 17 September 2020.

Citation: Rinck PA. Speech is silver, but silence is golden. Rinckside 2020; 31,6: 11-12.

A digest version of this column was published as:
COVID-19 papers: Publish fast, even if it’s trash.
Aunt Minnie Europe. Maverinck. 29 September 2020.

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