Egypt is just one of the places in the Arab world where scientific misconduct is tolerated. But the onus is global. What are research institutions waiting for to enforce policies? And what is the international community waiting for to stop the use of populations as guinea pigs?
I was recently approached by a scholar from the American University of Sharjah (UAE) who asked me to edit a draft of a research paper of his which needed “rephrasing and unifying”, a common request by non-native English speakers prior to submission in a peer-reviewed journal.
Having agreed on fee and timeline, I edited and returned the paper. The scholar's response was astounding: “when I checked your rephrased document on a plagiarism detection site, it indicated that 87% is copied...the aim is to reach 10% at most”. His expectation, as it turns out, was for me to rewrite the paper, concealing plagiarised chunks of text. Though I had noticed entire paragraphs in irreproachable English, I had assumed co-authorship, not academic theft. Replying that I did not expect to devote my time to forging research papers, I was not surprised when payment was withheld.
This all took place while news made the headlines of a miracle cure developed by the Egyptian army for HIV and hepatitis C – today remaining in the anthology as 'KoftaGate' – someone needed to address this culture of unethical scientific behaviour.
Forgery, plagiarism and other plagues
Plagiarism is one of the most widespread manifestations of scientific misconduct: it happens everywhere. When misconduct is identified, the publication is generally retracted. An independent watchdog launched in August 2010, Retraction Watch, has become the go-to institution for remarkable work in this field.
In 2012, a close examination of more than 2,000 retracted biomedical and life-science research articles showed that two-thirds were removed because of proven or suspected misconduct. Plagiarism accounted for nearly 10% of retractions. Fraud or suspected fraud, e.g. photoshopping images and “arranging data” to support one's claims are other types of forgery. Last but not least, there are also scientists so fond of their own work that they practice duplicate publishing.
Follow-up studies make it clear that misconduct can happen at any stage of a career, from the trainee to the senior researcher. Some blame the “publish or perish” rules that govern research. Others explain it by limited resources: if a lab does not have enough money to sustain its projects, then it might as well resort to crafting what is deemed necessary to publish the study in the hopes of getting better funding. Whatever the reason, however, lies and copy-paste habits are unethical and harm science as they influence research trends, waste public funds and can have a direct impact on people's lives.
Misconduct also spans across all scientific domains. Some experts even believe that as much as 90% “of all [archeological] artefacts and coins sold on internet auctions as genuine are nothing but fakes.” Among antiquities forgery cases fall the largely overlooked traffic of real but stolen artefacts, a long-lived practice found to occur in many countries across the Middle East including embattled Syria.
Scientific misconduct in the Arab world
Gallons of digital ink have been spilt discussing depressing laundry lists of misconduct cases in the west (and more recently, in China). There is, however, very little on unethical behaviour in the Arab world, despite the wide number of Mid-Eastern students from local and foreign universities who work and publish, both at home and abroad, prior to entering academia.
Fixing misconduct is also a topic of concern for editors and practitioners from the MENA region. The Regional Office for the Eastern Mediterranean (WHO's regional branch) for instance supports a professional association – the Eastern Mediterranean Association of Medical Editors, – which organises its eponymous conference. Its sixth edition was initially scheduled for 1-4 September 2013, but has been postponed. The sixth edition's conference-desired outcomes included a draft declaration endorsing “uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication”, including, reads the website, “a clear statement on adherence to ethical conduct in research and publishing.”
Plagiarism and duplicate publications have also been addressed during an earlier edition, resulting in a wrap-up and call for the inclusion of research ethics in the university curriculum. Published in 2009, the text showcases that editors are mainly held accountable for misconduct identified in publications. In a bid to curtail unethical behaviour, “many medical journals [from MENA] have taken it upon themselves to carry out a sentence in case of proven guilt,” citing journals which bar guilty authors from publishing for years.
Editors cannot and must not, however, be solely held to account for frauds, forgery and plagiarism. Yet nothing suggests that research institutions and universities in the Arab world have engaged in actual policy-making to prevent misconduct. A quick search on Retraction Watch lists 16 retractions for Egypt, one for Kuwait, three for Lebanon, two for Morocco, ten for Saudi Arabia, nine for Tunisia and five for the United Arab Emirates. If you scroll through the explanations, you will notice a lot of plagiarism (including self-plagiarism), author's lack of consent to publish the paper, duplicate and even triplicate publishing. Among these quite traditional cases of misconduct a particularly dreadful one is the retraction of three studies “by a group of Lebanese researchers who appear to have been engaging in illicit trafficking of human kidneys.”
The latter case brings to the table an overlooked yet essential question: clinical trials regulation. Those encompassing prospective biomedical or behavioural research on human subjects are conducted only after comprehensive information is collected that justifies an ethical authority's green light. Each country has its own legislation; so that an authorisation to proceed issued in one country is only valid within its borders. The US, the EU and the WHO, among others, have their dedicated clinical trials registries. In 2010, the estimated cost of bringing a new drug to the market was of approximately 1.8 billion USD (and is rising rapidly). A major part of it is dedicated to human clinical trials. As one of the biggest players in the field of outsourced clinical trials phrases it, “outstanding access to patients in the Middle East region with a population of over 200 million means that the Middle East is an important emerging region for the biopharmaceutical industry.” From an easily-accessible patient base to developing “niche blockbuster” drugs, the region is a gold mine for large pharmaceutical companies.
And what would dissaude them from fraudulent activity? No universal and internationally valid legislation exists, so every company does as it pleases. The Indian government finally came up with a law and companies increasingly turn their eyes to the vast Mediterranean. There is neither a clinical trials registry in MENA as a whole, nor on the national level. Only Jordan, the UAE and Syria have developed relevant legislation. Thus, clinical trials can be and are conducted without any accountability mechanism whatsoever, without ethical supervision and on entirely naïve patients. Is it then surprising that Lebanese researchers can publish (at least) three studies based on human trafficking material?
One cannot speak of policy-making and public oversight without mentioning one very worrisome trend in the MENA: the politicisation of science. The latter is not new: former Soviet Union agronomist Lysenko is a textbook example of the manipulation of science for political gain. And a long history of politically-motivated cures for AIDS in Africa already exists.
The most recent example that springs to mind is of course the Egyptian army's miraculous cure for hepatitis C and AIDS. The diagnostic story made a relatively brief appearance in international media in 2013, nothing comparable with the 2014 great fanfare. A surprising scientific breakthrough, Egyptian physician Mostafa Hussein pointed out, as “the Egyptian military isn't exactly on the map of worldwide biomedical research. It is an institution, when it comes to medicine, that has a reputation for virginity checks, operating on protesters without anesthesia and targeting field hospital doctors.” The military also announced its firm intention to allow only Egyptian nationals to be cured and to maintain the miracle in a classified file.
On 26 February 2014, the man behind the breakthrough, General Abdel Atti gave an even more surreal turn to the whole story by saying that he would turn AIDS into kebab, then feed it to a patient as nourishment. And #KoftaGate was born. While citizens were furiously discussing the value of such statements, the newly appointed Minister of Health announced his involvement in the team that developed the miracle. The Egyptian interim president's scientific advisor said that the whole invention had no scientific merit whatsoever and described their discovery as, “illusionary solutions to real problems”. The media, overwhelmingly supportive to the army, reprimanded him for such lèse-majesté. When famous satirist Bassem Youssef (a trained physician) voiced concern over the alleged cure, he was promised a military trial by no less than General Abdel Atti himself.
A research paper of abysmal quality showcasing the results also surfaced. The journal turned out not to be peer reviewed, but blacklisted for predatory open-access publishing. The alleged breakthrough became the media's focal point in no time, operating an even clearer divide within Egypt's already polarised society, with some asking for all critics to be denied the cure.
This story is polysemous. It crystallises the lack of functional science communication: science journalists and researchers blogging about science are non-existent in the region. 'KoftaGate' is also a manifestation of political abuse of public health issues. With El Sisi revered as president even before elections were held, instrumentalising the health of 12 million Egyptians with hepatitis C to serve fleeting political interests is obvious. But more absurd than everything that has come before, this story actually constitutes the most far-reaching public debate around AIDS to have happened in Egypt.
Egypt is just one of the places in the Arab world where scientific misconduct is tolerated. But the onus is global. What are research institutions waiting for to enforce policies and mount adequate responses? And what is the international community waiting for to curtail the use and misuse of populations as guinea pigs?