By David Tuller, DrPH
On Friday, STAT posted my opinion piece about BMJ and the Lightning Process paper–in particular, about BMJ’s decision not to retract the paper despite the multiple documented violations of core ethical and methodological principles of medical research. That anti-scientific decision is potentially harmful not only to children suffering from a stigmatizing illness but ultimately to the reputations of BMJ and Dr Godlee as well.
STAT is an excellent, Boston-based, online reporting operation that examines the nuts-and-bolts of research and policy in health care and medicine. ItÂ is widely read and widely respected. STAT has published previous pieces on the illness in question, including this on the downfall of PACE (by Julie Rehmeyer), this on the CDC’s decision to drop its CBT/GET recommendations (by Julie Rehmeyer and me), and this on an insurance decision in a patients’ favor (by Steven Lubet and me).
Three years ago, STAT published a laudatory profile of Dr Fiona Godlee, editor-in-chief of The BMJ and editorial director of BMJ, which publishes dozens of journals under its umbrella. That profile–called “No time for stodgy: Crusading editor aims to shake things up in science”–provided a useful starting point for my own article on BMJ’s and Godlee’s troubling actions in this instance.
The headline for my opinion piece was direct:
“BMJ should retract flawed research paper on chronic fatigue syndrome”
Here are the opening paragraphs:
Few journals have been more admirable than The BMJ (formerly the British Medical Journal) and some of its sister publications under the BMJ brand in highlighting issues of direct significance to health care consumers. So it is baffling â€” and troubling â€” when BMJ editors fail to take appropriate action to address unacceptable lapses in high-profile research they have published.
For years, the reading list for my journalism class on public health and medicine at the University of California, Berkeley, included groundbreaking articles in The BMJÂ on â€œdisease-mongeringâ€ â€” how pharmaceutical companies have manipulated and misrepresented research data to expand existing diagnostic categories and create new ones. I have also appreciated BMJâ€™s campaign for open access to trial data and its forays into investigative journalism.
Much of this hard-hitting approach can be attributed to Dr. Fiona Godlee, the Cambridge University-educated physician who has led the organization since 2005. Godlee is both editorial director of BMJ, which publishes dozens of titles, and editor-in-chief of The BMJ, one of the worldâ€™s leading medical journals. A 2016 profile of Godlee in STAT called her a â€œcrusading editorâ€ who â€œaims to shake things up in science.â€ The BMJ, she told STAT, is â€œa campaigning journal.â€
Thatâ€™s why I am disappointed at how BMJ and Godlee have handled a seriously problematic paper in a field I know well â€” behavioral and psychological interventions for the illness (or cluster of illnesses) often called chronic fatigue syndrome (CFS) but also known as myalgic encephalomyelitis (ME), CFS/ME, and ME/CFS, among other names.
Here are the final two paragraphs:
A complicating factor could be that the Lightning Process trialâ€™s lead investigator, Dr. Esther Crawley of Bristol University, has a close relationship with BMJ. Crawley, a pediatrician, has published many papers about this illness in BMJ journals and is an associate editor at BMJ Paediatrics Open. Unfortunately for BMJ, in addition to the mess over the Lightning Process study, Crawley was also directed earlier this year to correct the ethics statements in eleven other published papers â€” five of them in BMJ journals. (Disclosures from my ongoing Virology Blog investigation triggered this development as well.)
BMJâ€™s inability to detect problems in these cases, despite supposedly rigorous oversight systems, suggests that its peer-review and editorial processes might need a significant overhaul. Beyond that, the failure to take appropriate steps in the face of disqualifying flaws, like those in the Lightning Process study, suggests that BMJ is prioritizing concerns about reputational damage or other interests over the health and well-being of children, at least in this arena of science.
For the full piece, go here: