Wednesday, 23 May 2018

Indian Journal of Medical Ethics Troubles Deepen as Editorial Team Responds to Criticism

Only the other day, I posted about "highly problematic" publication ethical decisions of the Indian Journal of Medical Ethics, and even more problematic positions taken when challenged. After having raised the issue in some closed facebook groups in my field, the initial concerns I had about the direction taken by the journal, have now deepened considerably.

First, the entire managing editorial team – excluding the main editor of the journal, Amar Jesani – has now responded for a second time to the criticism of the Karolinska Institutet president Ole-Petter Ottersen, in a facebook post. I'm quoting it verbatim here, and adding screenshot below as proof of authenticity:

IJME Working Editors Respond to Prof Ole Petter Ottersen, President, Karolinska Institute, Sweden.
Response to the blog post of Prof Ole Petter Ottersen, President of the Karolinska Institutet, Sweden:…/comments-from-indian-journal-of-medica…/
Prof Ottersen has raised important issues on the role of journals and of research institutions in ensuring ethical research and informing medical practice. However, his attack on The Indian Journal of Medical Ethics in the name of publication ethics is flawed, and indicates a reluctance to engage in discussion on the scientific issues. He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.
Good editorial practice:
While journals should make every effort to confirm the author’s identity and affiliation, this is not routine editorial practice even among well-established journals. The Journal of Internal Medicine (published by Wiley) and Vaccine (published by Elsevier) have carried material by “Lars Andersson”, without checking his institutional affiliation and despite his use of a non-institutional id.
Editors’ accountability:
The comment by “Lars Andersson” (…/increased-incidence-of-cervical-cancer-in…/ ) was reviewed by an external, international subject expert, an external statistician, a working editor with expertise in research methodology (Mala Ramanathan) and the manuscript editor (Sandhya Srinivasan) before being accepted for publication. When we were notified of the deception regarding the author’s identity and affiliation, we immediately removed the KI affiliation from the journal. We have explained our justification (… ) for retaining the article on our website, and maintaining the author’s anonymity.
The need to enable scientific debate:
Prof Ottersen does not explain how anonymity prevents scientific debate on an analysis of publicly available data. And he does not explain how “false affiliation” is relevant in the context of the IJME article which no longer carries any affiliation. He says that “leading researchers with intimate knowledge of the vaccination field have identified serious flaws in the published report and its conclusion, thus questioning the quality of the review process”. However, neither he nor these unnamed researchers have stated what those flaws are. The attack on IJME for maintaining the author’s anonymity ​appears to be to avoid scientific debate. We invite critical commentaries on the paper by “Lars Andersson” towards advancing the scientific debate on the issue at hand.
The suggestion that false affiliation and anonymity are preventing scientific debate is a red herring. Does Prof Ottersen’s indignation comes from his inability to personally target the person questioning the HPV vaccine?
The need for institutional accountability:
We suspect that, in addition to using the author’s anonymity as a red herring to prevent scientific debate on the article, KI has reasons to whip up sentiments against IJME to hide glaring failures of governance in the institute in relation to "Lars Andersson".
Between 2014 and 2017, two internationally reputed journals, JoIM and Vaccine, published correspondence from "Lars Andersson" who reported affiliation to KI. The letters in JoIM were in response to a paper in the same journal. A perusal of the JoIM articles shows that "Lars Andersson" had filed a complaint of research misconduct in 2016 against six authors of this paper, five of them affiliated to KI. The complaint was with KI for about a year, after which it investigated these allegations without confirming the identity of the complainant. Let alone a journal published from India, KI did not verify, on its own, the existence of a person on whose complaint it was acting. It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation. In this background, and with KI providing legitimacy to "Lars Andersson", how could JoIM and Vaccine have suspected that "Lars Andersson" did not exist in KI? And how could this question have ever occurred to IJME?
The prevention of deception by an author on the name or affiliation requires the joint efforts of many stakeholders, including journals. While IJME has taken full responsibility for what has happened, the attacks on it in the name of publication ethics cannot wish away the ongoing governance failure in the KI, and cannot be used to prevent scientific debate on an article which nobody has proved to be unscientific, except by innuendo.

Sunita V S Bandewar, PhD, MHSc (Bioethics), Independent Senior Research Professional; Working Editor, IJME. Email:
Rakhi Ghoshal, PhD, Assistant Professor, United World School of Law, Gandhinagar INDIA, Consultant Researcher, King’s College, London, UK; Working Editor, IJME. Email:
Vijayaprasad Gopichandran, MD, PhD, Primary Care Physician, Reproductive Health Cliic, Rural Women's Social Education Centre, Kancheepuram District, Tamil Nadu; Assistant Professor, Department of Community Medicine, ESIC Medical College and PGIMSR, Chennai, INDIA; Working Editor, IJME. Email:
Sanjay A Pai, MD, Working Editor, IJME. Email:
Mala Ramanathan, MSc, PhD, MA; Working Editor, IJME.
Sandhya Srinivasan, MA, MPH, Independent Journalist, Mumbai; Consulting Editor, IJME. Email:
Screenshots (click to enlarge):

This response demonstrates the obvious fact that the editorial team of IJME is apparently unaware of the most elementary principles of academic publication ethical principles. They are unaware of the importance of why proven research fraudsters should have their publications retracted, and they believe that the importance of being able to correctly identify authors and their academic affiliations of research articles is "a red herring" (see my former post for some of the most obvious reasons for why it is not). This leads me to conclude that the editorial team lacks the necessary competence to manage a well regarded bioethics journal. Which helps to explain why IJME has gone so sadly astray.

However, it does not end there. In the closed Facebook group Bioethics International - a forum for explicit professionals and dedicated researchers in bioethics, or advanced students on track to become any of those, a number of additional points were importantly raised, in addition to the ones in my original post. First, the fact that IJME decides to publish an epidemiological article in a politically highly contested field, where research fraud from "antivaxxers" have been numerous, in an ethics journal. The whole point of having journals organised by fields is that this can guarantee appropriate scientific competence among the journal editorial management, e.g., to select suitable reviewers for manuscripts, and to appropriately evaluate reviewer comments. This is very obviously not the case regarding the fake author paper in the IJME: One of the working editors that is named as having handled the paper, Sandhya Srinivasan, does not hold a PhD, while the other, Mala Ramanathan, is a reproductive health specialist with nil research competence in the topical area of the paper (albeit she does hold an Msc in statistics according to informal reports). The only quality screening of the paper was made by one unnamed external expert on statistics, andMala Ramanathan. That is, no research expertise on vaccination, on HPV and cervical cancer, or on epidemiology ever assessed the paper, despite the fact that this was the topic of the article, and the fact that there is plenty of expertise available in those fields. This is, I would say, serious and willful editorial mismanagement of the publication process of a bioethics journal.

In the further discussion in the same Facebook group, several members of the editorial team engaged themselves, and demonstrated some further causes for concern, besides what has already been mentioned. First, there were repeated assurances about Amar Jesani, the IJME editor who was responsible for the decision not to retract the fraudulent article, and who also made the initial, ill-conceived response to Ole-Petter Ottersen, having the highest of ethical competence and integrity. When people reacted to that with the appropriate "so what, that does not justify what he's done", the working editors started to rave about a lot of other journals being conned too, basically trying to say that, because of that, the IJME would be right not to retract a proven fraudulent article. All of this, of course, just adds to the already amassing reasons to view the IJME as an unserious academic journal, that has sadly departed from its formerly very promising track for becoming a well regarded publication forum in bioethics. I sincerely hope that the journal's editorial board can swiftly step in and set this sad development right, and if it so does, I will be happy to revise my judgement.

But before I end, there is a final twist to the ongoing scandal. As is made clear by the editor, Amar Jesani's first response to Ole-Petter Ottersen, he now is aware of the real identity of the fraudulent author calling him-/herself "Lars Andersson" and claiming affiliation to Karolinska Institutet in order to peddle an antivaxx junk article to what has now proven to be a substandard journal. However, instead of disclosing this identity – what expertise this author supposedly possesses and what research affiliation he or she holds – the editor Amar Jesani continues to keep this a secret. As I said in my former post, the bogus after-the-fact excuse that the author must be shielded from criticism isn't worth the paper it was written on. In addition, as this is a proven research fraudster, it is in the publiuc interest and the interest of the entire research community, to be informed about who this person is. What is worth noting, however, is this: Amar Jesani very obviously finds the combination of the following three actions very important to sustain: (1) let a fraudulent antivaxx article stay in an ethics journal, (2) shield the proven fraudulent author of this article from public exposure, (3) have is editorial team do its best to deflect further critical inquiry into this matter, especially critical assessment of Jesani's own actions. I just let that stay there as food for thought until this matter develops further.


Monday, 21 May 2018

Highly Problematic Stance on Fake "Antivaxx" Authorship By the Indian Journal of Medical Ethics

It is a recognised challenge of my research field, bioethics, to include and empower researchers and institutions from low- and midlle-resource settings. Since a few years, the leading journal of Bioethics, runs the side journal Developing World Bioethics to address this issue, and over the past few years a number of journals have appeared, based at institutions outside of the most affluent parts of the world with a natural focus on bioethical issue of relevance to such settings, as well as global health related issues. One of these is the Indian Journal of Medical Ethics, that has quickly been rising in the ranks and attracting respect for its consistent work.

However, very recently the IJME has been dragged into potential scandal. First, the editor, Amar Jesani, decided to publish an article by a fake author, claiming fake credentials and affiliations, of an obvious antivaxx junk article of the sort that antivaxxers – just like tobacco-industry sponsored scientists used to do regarding the dangers of smoking – are constantly trying to peddle to various journals to create an image of "scientific controversy" around the use of vaccines to fight infectious disease and build public health. The fakes were all very easy to detect, and already the fact that the "author" was not using the email-domain of, and has no profile at the webpages of, the institution (Karolinska Institutet) to which he claimed affiliation should have rung immediate alarm-bells. But then, when this is pointed out, and the journal is alerted to this research fraud, the editor Amar Jesani decides not to retract the article! Instead, the editor appears to have decided to trust the author's obviously bogus explanations for his (?) fraud, and to attempt to counter a, to my mind, quite sound statement on the matter from the Karolinska Institutet president, Ole-Petter Ottersen.

The bogus explanations and Jesani's expression of sympathy with them, and Ottersen's stringent response, is to be found here. This very surprising and ill-conceived action of Jesani is potentially extremely damaging for the IJME, and in effect risks to soil the reputation of the entire field of bioethics. The fake author's attempt at justifying the fraud is that he/she has to be anonymous to protect him-/herself from persecution for unpopular views. This, of course, is not even worth the scrap of paper it was scribbled on. The real role of the fraud is to block any investigation into conflicts of interests (the antivaxx movement is nowadays a flourishing industry of quackery), other activities of the author that would undermine confidence in the article's content, and the fact the author lied to the editor, and offered the explanation only in retrospect when the scam had been uncovered should, of course, mean that the editor should have no trust in what the author is claiming. This is a proven fraudster, and should be treated as such. Just as authors lying about ethics approval should have their papers taken out, authors who lie about other things of relevance to the evaluation and assessment of the research have their papers removed. As Ottersen says in his second blog post: an editor of an ethics journal should know this. The editorial board of the journal should immediately and strongly recommend its editor, who has obviously let his personal prestige lead him astray in this matter, to revise his position and act according to the high publication ethical standards expected of a bioethics journal that aspires to be well regarded.

Let me, lastly, comment on the possible need for author anonymity for research articles. The afterconstructed reason brough forward by the fake author and that Jesani surprisingly buys, is the idea that is often practices within news reporting. Where, eg., a newspaper may protect sources by keeping them confidential. However, that also means that whatever story is built on this, needs to present suffient additional public evidence, that is open for scrutiny, in order to compensate for the loss of control following source anonymity. This has not taken place in the case of the fraudulent article. Also, the whole spinn about author/source confidentiality is obviously a lie in the present case: Had the author had any such plan, he/she would have honestly and openly contacted the IJME editor about it, and Jesani could have pondered - bringing in the editorial board - the issue. Had they decided to approve such a request, this would have brought with it extraordinarily strong obligations to check the author credibility, CoI, etc. This is not what occurred, however. What occurred is that a con-man defrauded the journal, and the journal editor then decides, against any common sense, to trust said con-man. Unbelievable!


Saturday, 16 December 2017

On the "One State Solution" to the Israel-Palestine Conflict

Since the Oslo Accords of 1993 and 1995 initiated what has become known as the "Oslo Process", the recognised vision of how to resolve the longstanding violent conflict between the state of Israel and Palestinian representatives, organisations and people have been the so-called  Two State Solution, where the state of Israel is to mostly withdraw to its original 1947 borders, and a state of Palestine reign over the remaining territory of what used to be the British colonial "protectorate" of Palestine. This resulted in the creation of the Palestinian Authority reign over the Westbank and Gaza territories, pending final negotiations about nation state borders, which have never so far taken place. In the meantime Israeli seizure of Palestinian property and land, and colonial settlements in occupied territory have continued, as have violent rhetoric and activities both within the Palestinian territories (since the militant islamist Hamas movement seized power over Gaza and effectively put a stop to democracy there), and between the Israeli army and various militias and activists from the Palestinian side. Of course, mostly with the result of massive domination and show of force from the Israeli side, to the repeated disbenefit of people living in the areas, especially the blockaded Gaza strip. Very recently, some initiatives from Hamas has signaled attempts to overcome the infighting with the Palestinian Authority, but so far with no notable political result. Even more recently, US president Donald Trump stumbled into the conflict in the rogue elephant manner he has made himself known for and designated Jerusalem from now on to be the recognised capital of Israel, albeit the US (or the UN) does not recognise the territory where Jerusalem is located as part of Israeli territory, but as occupied land. Not surprisingly, this gave rise to a new wave of violence from military, militants and activists on both sides. The idea of the two state solution seems less politically realistic than it has ever done.

Against this background, a number of debaters have suggested an alternative idea, The One State Solution, which to a lot of people makes a lot more sense than the fiasco and resulting mayhem that has been going on since the creation of the state of Israel in 1947. This idea, simply put, is that all of the territory currently contested is made into one single state, that this state is made ethnically unaligned (abolishing ideas about a Jewish or Palestinian homeland), democratic, and secular, and that a deal is struck on the question of how people in various forms of exile may return (or not return) to the area to settle. One idea would here be to allow Palestinians housed in refugee camps, e.g., in Syria and Lebanon, since generations a "law of return", just as the present state of Israel allows a "law of return" for Jews who can prove appropriate lineage. Another notion is to stop the current Israeli practice, and to instate normal migration laws based on ethnically and religiously neutral criteria. All who discuss this idea recognise that no such deal will be satisfying chauvinists and extremists on either side, as it means abolishing the notions of a "Jewish", a "Muslim" or "Islamic", a "Palestinian", an "Arab", etc. state. Nevertheless, having one state, with one administration, one judicial apparatus, one police force and one military, will be in a better position to control such elements than in the current state of a nasty mix of virtual anarchy and martial law, where extremist on both sides continue to perpetuate a state of chaos and violence to no benefit for most people on either side. Some examples of proponents and critics of this idea can be found here, here, here, here.

However, the practical way towards a one state solution is making a lot of people uneasy, as it necessitates breaking with some cherished ideas and longstanding practical solutions. The most obvious way to instigate the one state solution is for the current state of Israel to simply annex the territory it presently illegally occupies; the West Bank, Gaza and Jerusalem. Thereby, these areas are declared to be parts of the state of Israel, its settlers are recognised as Israeli citizens, with the same rights and obligations as any other current Israeli citizen. Those who want to hold on to ethnic or religious chauvinist political ideas don't like this, of course. Besides the obvious dissatisfaction from islamist camps (such as Hamas), there is also a lot of Israeli orthodox chauvinists and rightwing politicians, who quite like the present situation of occupation, as it allows the military to rule with martial law style arbitrary discretion. The whole Jewish settlement and land grabbing operation pretty much rests on this situation of (lack of) law enforcement. That, by itself, should be excellent reason for reasonable people to like the one state solution. But also many people of this sort I have talked to hesitate to support the one state road ahead, and I have heard two reasons for this: First, the fear of enlarged interstate military conflict though having surrounding countries interpret the move as hostile and react accordingly. This is an important point, but this risk is present also – if not more – with the current two state debacle. Whatever solution for the Israel-Palestine conflict is reached needs to contain agreements with neighbouring countries in the region that guarantee sustainable, stable and peaceful conditions for all.

The second reason for hesitation is a distrust of the current state of Israel's ability to maintain itself as the kind of democratic, ethnically neutral and secular state, committed to rule of law and equal treatment, that is necessary for the one state solution to function. This reason, in contrast to the first one, is a game changer issue. This since it will force the state of Israel – and its present government – to finally put down its foot with regard to its political identity. With the one state solution, either Israel takes the consequences, and abolishes all notions of ethnic or religious identity as its basis, or it will have to abolish its often held out liberal democratic aura and turn itself into a bona fide apartheid state within its own lawful borders (in contrast to the virtual apartheid currently practiced via the partition into "real" Israel and occupied territories). Likewise, should citizens of Palestinian origin reach political power in the new one state of Israel/Palestine, they will face a similar choice between maintaining the ethnically neutral and secular democratic solution of a one state Israel/Palestine, or pursuing the islamist/Palestinianchauvinist agenda lurking within the notion of this territory "belonging to" a certain "people", thereby promoting their own apartheid solution. That is, the very same basic notion that drives the Jewish chauvinist notion of present day Israel, only with another "people" as the supposedly chosen one. Both, of course, can only lead to genocide, should they prevail.

This, I suggest, is what makes the one state solution both very scary for many people, and at the same time immensely attractive. It is the best solution under ideal conditions, but given the still apparently strong commitment of dominant parties involved to ethnic/religious chauvinism, and the infantile notion of a possibility to "win" over the opposing side, it may seem politically infeasible. At the same time, the alternatives of continued anarchy and war or one or the other version of genocide are hardly more appealing. I'm torn.