In this study, we analyzed the retractions from hospitals in mainland China from 2017 to 2019, and paid attention to features of retractions and retracted publications like whether there were PubPeer comments issued before the retraction, whether the author used ORCID, whether there are authors came from grade A, third-class hospitals (not just third-class hospital), and whether there are response or requirements from authors, which were rarely reported before. As a small number of retractions were not correctly labeled in the database, we acknowledge that we may not have collected all retractions that should be included.
Many hospitals in China have a complex form as academic institutions, and this is important in two ways. One is that doctors receive different administration in scientific research and clinical work, and the other is that the scientific research platforms available to different doctors sometimes lack comparability. In addition, there may be research departments are run by full-time researchers, which is more common to major hospitals. Large hospitals, especially the grade A, third-class hospitals, need doctors to contribute their research results, which is one of the contents of evaluating the performance of hospital management(11). However, at the same time, hospitals may not be able to provide adequate support for doctors in scientific research, especially for hospitals that are not teaching hospitals in medical schools. Doctors need to do scientific research activities in laboratories in other institutions or commission others to perform experiments. A considerable number of Chinese doctors want to learn and publish Meta-analysis, which has formed a tendency, but hospitals possibly does not provide sufficient database accesses. These may cause difficulties in maintaining original records, difficulties in monitoring the research process by the corresponding author, and motivating doctors to find other solutions. Hospitals have a positive attitude towards acknowledging their articles, but have a negative attitude towards accountability for research misconduct(12). Doctors in China need to publish papers in academic journals for promotion and economic benefits. Young doctors face fierce competitions, especially in Third-class hospitals, and their pressures to publish in internationally indexed journals were described as “Perish or Publish”(13). Chinese doctors are under tremendous clinical work pressure, most of them work more than forty hours a week(14). Finally, some factors cause these busy doctors to choose research misconduct, since we found that provinces with larger average hospital visits have more retractions. But this is not to say that they cannot conduct scientific research. Some doctors and graduate students can get involved in research for a period of time without participating in clinical work. In addition, some doctors conduct scientific research at night and on rest days. Nonetheless, our results suggest that the more busy doctors are, the more retractions happened is not true. Although in the research process, there may be unfair access to academic resources, in recent years academic journals have been fairly fair to recognize academically valuable articles from Chinese doctors. Impact factors, journal divisions, these quantitative indicators provide a predictable channel for doctors to get rid of their disadvantaged position. The reasonable standards of international journals on alternative medicine also limit the impact of non-medical causes. Chinese doctors, especially those in large hospitals, have conflicting attitudes towards publishing papers. Different doctors have different ideas, and they have different ideas in different periods, depending on whether they can win in this competition. But even those at a disadvantage in this race may not be willing to accept another set of qualitative and vague rules. As a result, doctors invest a lot of effort in writing articles, even if they will occasionally like the post that calls for cancellation of quantitative evaluation.
A common view is that academic journals should explain the reasons for retractions in more detail and in a more standardized way(15, 16). In this study, sometimes we need some help from PubPeer comments to figure out the reason for retractions, because the retraction notice is not clear. However, journals need the cooperation of authors to obtain sufficient evidence. In the case of insufficient evidence, journals often choose vaguely word retractions. In an intriguing example, the journal has announced that the experimental methods described by the authors were not able to get the results they reported, but they have not made up their minds to retract that article, and just advised readers to “interpret these results with caution”(17). Some retractions indicate that the author refused to respond to publisher inquiries, nevertheless, we observed that in 37 cases the editors still accused and retracted the articles. We suggest that hospitals should list refusals to respond to editor’s inquiries and failure to find original experimental results as reasons for punishment, not just retractions.
Although the reasons for many retractions are not clearly given, we can still speculate on some reasons based on our research. Some authors seem unfamiliar with academic norms and do not have any sense of academic integrity. For example, a group of authors published four Meta-analyses that were highly similar except for the substance in 2014, and two of them were identified as self-plagiarized(18-20). The details mentioned in another retraction may explain this phenomenon. The authors clarified that they referred to templates to write their article, which from a training course on how to write Meta-analyses(21). Some retractions from hospitals in mainland China due to self-plagiarism, plagiarism, fake peer review, forged authorship and data manipulation/fabrication/fraud is confirmed to involve third parties, which has been mentioned by several retractions(22-24). In other words, we guess that many Chinese doctors are not able to complete some fraud independently. These third parties usually charge high fees, and may use aggressive violations to help clients publish articles. In a case of forged authors and plagiarism, a third party got an unpublished manuscript from an agency for language editing, and used that to write an article for their clients, which brought tricky trouble for the real authors(25). In another case, it may be due to a lack of communication that a third party published the manuscript in another journal after the author had already published it(26). In other cases, the results were purchased by the author from a third party, and they can not ensure the reliability of their articles(27). For example, the editor stated in a retraction that the authors’ contributions to the work were “unclear” in their perspective(28). A third party provided the same results to two research teams, and the articles of both teams solved the same research questions and reported the same data, results, and conclusions(29). Recent investigations have suggested the presence of paper mills(30). They use manuscript templates to produce a lot of similar articles, regular and similar results pictures, and submit these articles to various journals for his client. Some Chinese doctors may be involved, but this is a new discovery that received the attention of the public only in 2020(31), and it is not yet reflected in the results we have collected in these three years. It is worth noting that there are tens of retractions due to ethical issues occurred, which mentioned similar reasons, and similarly worrying matters behind(32).
We counted several external features of retracted articles and retractions, and found that the retractions were concentrated in grade A, third-class hospitals, a limited regions, and medium and high-impact journals. Explanations of these phenomena require qualitative interviews to be published. There are not many low impact factor articles, probably because the benefits are too small compared to the risk of research misconduct. The post-publish peer review website PubPeer provides an effective platform for senior scientists to point out that they have found research misconduct. However, it is difficult to evaluate the role of PubPeer in these retractions from 2017 to 2019, as most articles(92.7%) do not have any comments posted before they were retracted. Only a small number of comments were answered by the author, and the author's response was generally decent. We found ORCID information in a few articles(6.5%), but most did not show any public information. Although we did not see the current role of ORCID in holding researchers responsible for their retractions, we can still be optimistic. We suggest ORCID to consider that the retraction records are showed and visible to the trusted parties or everyone by default on ORCID homepage, which can accurately increase the adverse consequences of research misconduct. As more and more researchers use ORCIDs, publishers can force authors to submit their ORCIDs and associated retraction records. Even if the hospital subscribes to a small academic database, it can review applicants' ORCID accounts to check if they have retracted manuscripts when hiring and promoting doctors. Hospitals should record the e-mail addresses and ORCIDs of senior doctors, as using one-time e-mail addresses or ORCID submissions is suspect.
The phenomenon that a large number of retractions from Chinese hospitals in recent years is really worrying. Hospitals and medical libraries should take some measures to reduce the occurrences of research misconduct. In addition to the measure that seems to solve the problem fundamentally, but it is actually impossible to be promoted by individual hospitals: reform the doctor evaluation system, there are some short-term and mild measures that can be taken. In a prospective study on perceptions of Chinese Biomedical researchers towards research misconduct among Chinese biomedical researchers, more than 60% of participants thought that the punishment for research misconduct from authority and institutions was not severe enough(12). In fact, few hospitals in China have detailed rules and enforce them transparently, putting researchers with retracted publications at a disadvantage to their long-term interests, such as relegation, be limited to access to academic resources, and no promotion for several years(33). In 2019, the National Press and Publication Administration released the first industry standard against misconduct entitled Academic Publishing Specification-Definition of Academic Misconduct for Journals (CY/T174-2019)(34). This document provides a reference for hospital to design rules. In addition, it can be asserted that most of the retractions did not actually have widespread social impact in mainland China, regardless of whether the reasons were sufficiently interesting. Medical library should educate doctors, particularly in the early stages of their career, which will help them cultivate an ethical research system(35). The training includes introduction to academic publishing, peer review, and unique identifiers for researchers, as well as instruction on the rational use of software, because if doctors can use the tool software themselves, they may not buy third-party services. Libraries should also consider inviting journal editors, which can be Chinese journals or English journals, to introduce doctors to effective methods of communication with editors. The hospital's library should consider collecting the raw data and experimental records submitted by the doctor, so that when the doctor refuses to answer the editor's inquiry, or jumps to another hospital and cannot be contacted, the hospital can have a way to reduce the research misconduct discovered to the institution's reputation loss. In our position, we do not want researchers from hospitals in mainland China to face any discrimination, but we hope that the improvement of the status quo begins with valuing academic integrity, improving the quality of research, and stopping the unreasonable pushing of doctors to publish papers.